Oral Candidiasis Is Primarily Caused by Candida

Oral candidiasis is primarily caused by Candida albicans, in which yeast adheres to the buccal epithelial cellular surface during the earliest phase of infection. This process is predominantly implicated by the hydrophobicity of fungus on the cell surface. The infection process is enabled by penetration of Candida albicans into the oral tissue, which is facilitated by secretion of exoenzymes and the development of hyphae (Calamari et al., 2011).

Following limited exposure to antifungal agents, growth recovery capacity can be measured through the post antifungal effect, which indicates virulence levels of yeast. Increasingly, there has been a demonstrated resistance to antifungals, which is a cause for concern since there are fewer antifungals available in comparison to antibiotics. Therefore, research has been directed toward investigations of alternatives to antifungals for the treatment of Candida albicans. A few of these alternatives include chlorhexidine-based oral rinses, fluconazole, and chitosan. The researchers in the study by Calamari et al. (2011) sought to investigate the antifungal and post anti-fungal effects of chlorhexidine, fluconazole, and chitosan individually and in combination, with regard to their effects on the virulence of Candida albicans.

In regards to the methods employed in this study, the first stage was the isolation and identification of ten isolated wild strains of Candida albicans (Calamari et al., 2011), which were isolated from the saliva of ten patients presenting with oral candidiasis, who were not under treatment with any sort of antifungal drug. The process used to identify the strains of Candida albicans involved germinative tube development test, assimilation of sugar and fermentation, and finally yeast growth within a chromogenic medium.

In order to assess antifungal effects, chlorhexidine solutions, fluconazole, and chitosan and their combinations were used in phosphate saline buffer, and minimum inhibitory concentration was determined. This minimum inhibitory concentration was essentially the lowest concentration of antifungal agent that results in considerable colony size decrease in comparison to growth of controls. Also, germinative tube development was induced, and both cell surface hydrophobicity and post antifungal effect were determined. Moreover, all experiments in the study were done three times, and the data involved were analyzed through the use of Spearman's correlation coefficient, Student's t-test for independent samples with a significance level of p

Results of the study indicated a decrease in germinative tube development among patients that received treatment with any of the agents under investigation, either alone or in combination. Cell surface hydrophobicity was observed to increase among patients that were treated with chitosan alone or in combination with chlorhexidine or fluconazole. However, this was not observed when treatment was only done with chlorhexidine or fluconazole alone. In regard to post antifungal effect, a significant decrease in growth recovery was observed among those treated with chlorhexidine or fluconazole. However, increase in growth recovery was observed among those treated with chitosan alone or in combination with fluconazole. Therefore, it is demonstrated by these results that the presence of chitosan counteracts any ability chlorohexidine or fluconazole has to decrease growth recovery. Also, chlorhexidine treatment was shown to significantly decrease phospholipase activity. Furthermore, it was determined that there was a significant positive correlation among the virulence factors under analysis in the Candida albicans strains.

Overall, the results of the study indicated to the researchers that low concentrations of antifungals have the ability to drastically reduce the infection capability of Candida albicans as observed in virulence factors. This points to the viable possibility that the drugs under investigation could effectively fight off microorganisms within the oral cavity. The value of this research lies in its implications for practical application, as the agents investigated could be used to successfully treat Candidiasis in patients that demonstrate resistance to most antifungals. One limitation of the study is the small sample size that was used, as it was only ten people, and this may decrease the reliability of the study or may reduce likelihood for replication of the results found. Further research into the effectiveness of these antifungal agents could utilize clinical trials, in which effectiveness of the drugs are assessed based on the extent to which they decrease infection rates among patients.