Risk of oral candidiasis: profile analysis of patients admitted to the dermatology clinic of a tertiary hospital in southeast of Brazil

Abstract

The Candida genus colonizes the oral mucosa of immunocompetent individuals and healthy people, which is maintained by the innate immune system. However, any disturbance in this relationship, such as immunodepression, can turn this normally harmless yeast into a dangerous pathogen. This study evaluates the prevalence and risk factors for oral candidiasis (OC) among patients hospitalized in the dermatology department of a tertiary public hospital and identifies the Candida species involved. This cross-sectional study involves 240 patients. Oral candidiasis was diagnosed via clinical evaluation and mycological examination, with species confirmed using MALDI-TOF mass spectrometry. The prevalence of Candida species was 32.1%, in which C. albicans was the most common (92.1% of OC cases), followed by Nakaseomyces glabrata, Pichia kudriavzevii, C. tropicalis, and C. parapsilosis. Univariate analysis indicated that aging, use of oral prostheses, need for dental intervention, immunosuppression, and autoimmune diseases increase the risk of candidiasis. Multivariate analysis confirmed that aging, necessity for dental treatment, and immunosuppression were in 80% of OC cases. Given the great prevalence of oral candidiasis in hospitalized patients, dentists need to assess them for oral candidiasis and provide information on oral hygiene and healthy practices. Although C. albicans is the main microorganism responsible for these infections, other species have also been identified, highlighting the need for immediate identification and awareness of risk factors.

Figure 1. Frequency of species isolated by culture according to sex and diagnosis.

Figure 2. Clinical features and microbiological findings of fungal characterization methods: (A) Clinical presentation of pseudomembranous candidiasis, showing as widespread nonadherent white plaques on the dorsal tongue; (B) Direct examination, revealing yeast hyphae; (C) Identification of fungal species by CHROMagar, with Candida albicans in green; (D) Microculture of chlamydoconidia (arrow) and blastoconidia (asterisk) within fungal clusters.