Prevalence Of Oral Candidiasis (Oral Thrush) Among Diabetic Patients Attending Imo State University Teaching Hospital Orlu

CHAPTER ONE

 1.0   INTRODUCTION

Oral candidiasis is an opportunistic infection of the oral cavity caused by an overgrowth of Candida species especially Candida albicans. it affects various sectors of the world population irrespective of age or health status. Close to 90% of AIDS patients suffer from oropharyngeal or esophageal candidiasis at some stage of the disease. In the general population, carriage rates have been reported to range from 20-75% without any symptoms. The incidence of Candida albicans isolated from the oral cavity has been reported to be 50-65% of people who wear removable dentures, 90-95% of patients with acute leukemia undergoing chemotherapy and patients receiving radiation therapy for head and neck cancer.(khaled et al., 2006)

It is well established of yeast carriage among patients with diabetes mellitus could reach up to 54% and that Candida albicans could account for 25-69% of the isolates. (khaled et al., 2006)

Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycemic condition resulting from defects in insulin secretion, insulin action or both. (ozougwu et al., 2013). Diabetes mellitus has also been termed as a common and global epidemic in the new millennium, which is strongly related to life style and economic change, caused chronic hyperglycemia with impairment of carbohydrate, lipid and protein metabolism resulting from defects in insulin secretion and action. (Abbas et al 2013). Diabetes is considered a leading cause of death due to its microvascular and macrovascular complications. (Shelesh and Swarnlata, 2010).

The most common types of diabetes are type 1 also known as insulin dependent diabetes mellitus (IDDM) and type 2 also known as Non insulin dependent diabetes mellitus (NIDDM). Type 2 is the most prevalent type. (Saadi et al., 2007). The world health organization (WHO) has expected an increasing development of diabetes to more than 300 million by the year 2025; particularly with type 2 diabetes. (Lancet, 2009).

Candida infections in particular oral candidiasis has also been frequently recognized in diabetic patients which can be due to the increased glucose tolerance in their oral fluids and their immune dysfunction. (Sahin et al., 2005). The predisposing factors for Candida colonization is thought to include the environmental alteration of diabetic oral cavity which favors Candida colonization and cause a change from the harmless commensally existence of the organism to a pathogenic state (Willis et al, 2000). Of particular importance is the observation that in the presence of 20 mM glucose, the expression of the iC3b receptor on C. albicans was doubled (Hostetter, 1999. Willis et al., 2000). Diseases that weaken the immune system such as HIV and AIDS, Diabetes and Cancer have been reported as predisposing factors that cause oral thrush. Treatments for cancer such as chemotherapy or radiation therapy also can weaken the immune system and lead to oral thrush. Some genetic syndrome/disorders predispose a child to oral thrush (Mudra et al., 2015).

Oral candidiasis was stated by Akpan and Morgan (2002); “to also be a mark of systemic disease such as diabetes mellitus”. Therefore it becomes important to access the oral Candida carriage of diabetes mellitus patients who are already attaining treatment to identify cases of co-infection with Candida species and take measures of control in such cases and preventive measures in cases of no proven co-existence with Candida species.

This study therefore attempts to investigate the prevalence of oral Candida carriage particularly Candida albicans in type 2 diabetes mellitus patients who are currently attending Imo state university teaching hospital (IMSUTH), Orlu, and is compared to the prevalence of oral Candida carriage in non-diabetic subjects and possibly to advice future patients on practices on how to avoid and/or reduce the prevalence of the infection.

 

Well certified literature reports the co-existence of oral candidiasis (oral thrush) with diabetes mellitus. It is also well established as proposed by Khaled et al., (2006) that “diabetes mellitus is a predisposing factor to fungal infections especially those caused by Candida species”. The susceptibility of diabetic patients to cutanous, vaginal and oral Candidiasis has been linked to the abilty of Candida albicans to adhere to mucous membranes(Willis et al., 2000). Of particular importance is the observation that in the presence of 20mM glucose, the expression of iC3b receptor on Candida albicans was doubled (Hostetter, 1999. Willis et al., 2000) The Therefore this study was conducted to further evaluate the potential factors that influence the prevalence of oral carriage of Candida albicans in diabetes type 2 patients thereby considering Diabetes mellitus type 2 as a predisposing factor to oral Candidiasis ( oral thrush).

 

• To estimate the prevalence of Candida albicans in the oral cavity of diabetic and non diabetic subjects.

 

1.4     Objectives of the study;

1. To determine the prevalence of Candida albicans in the oral cavity of diabetic patients.
2. To determine the prevalence of Candida albicans in the oral cavity of non diabetic patients.
3. To access the possible risk factors in oral Candida carriers.

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