Dahiya Marta C, Redding Spencer W, Dahiya Rajiv S, Eng Tony Y, Kirkpatrick William R, Coco Brent J, Sadkowski Lee C, Fothergill A W, Waite Annette, Rinaldi Michael G, Patterson Thomas F, Thomas Charles R
Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):79-83. doi: 10.1016/s0360-3016(03)00415-2.
To characterize non-albicans Candida oral infections in patients with head-and-neck cancer receiving external beam radiotherapy (EBRT) with or without concurrent chemotherapy.
Thirty-seven patients with head-and-neck cancer received EBRT in 2.0-Gy daily fractions to a median dose of 60.4 Gy (range 38-82.8, mean 64.6). They were followed for oropharyngeal candidiasis (OPC) confirmed by positive examination, positive KOH smear, and/or positive swab or swish culture. Samples were identified and plated on chromogenic media to identify non-albicans yeasts. Colonies were plated on Sabouraud dextrose slants for microdilution antifungal susceptibility testing to fluconazole. DNA typing, including karyotyping, restriction fragment length polymorphism analysis, and Southern blot hybridization with the moderately repetitive Ca3 probe, was performed on selected isolates to confirm individual species.
Of the 37 patients, 10 (27%) developed OPC, and 26 (70.3%) displayed Candida carriage state. The median EBRT dose at time of positive culture was 22.5 Gy and at time of OPC was 28.6 Gy. Of the 6 patients receiving chemotherapy and EBRT, 4 (66%) developed OPC at median dose of 27.6 Gy. Three (8%) of 37 patients were infected with non-albicans Candida, and 3 (30%) of all 10 infections were caused by these organisms.
Non-albicans Candida is emerging as a relatively common cause of OPC in head-and-neck cancer patients. Chromogenic media are helpful to screen these infections. Our data also suggest a greater likelihood of developing OPC in patients receiving concomitant chemotherapy and EBRT.
对接受或不接受同步化疗的头颈部癌患者进行外照射放疗（EBRT）时非白色念珠菌口腔感染的特征进行描述。
37名头颈部癌患者接受EBRT，每日分次剂量为2.0 Gy，中位剂量为60.4 Gy（范围38 - 82.8，平均64.6）。对患者进行随访，通过检查阳性、氢氧化钾涂片阳性和/或拭子或漱口水培养阳性来确诊口咽念珠菌病（OPC）。对样本进行鉴定并接种于显色培养基上以鉴定非白色念珠菌酵母菌。将菌落接种于沙氏葡萄糖斜面用于氟康唑的微量稀释抗真菌药敏试验。对选定的分离株进行DNA分型，包括核型分析、限制性片段长度多态性分析以及用中度重复的Ca3探针进行Southern印迹杂交，以确认各个菌种。
37名患者中，10名（27%）发生OPC，26名（70.3%）呈现念珠菌携带状态。培养阳性时的EBRT中位剂量为22.5 Gy，OPC发生时为28.6 Gy。在6名接受化疗和EBRT的患者中，4名（66%）在中位剂量27.6 Gy时发生OPC。37名患者中有3名（8%）感染非白色念珠菌，10例感染中有3例（30%）由这些微生物引起。
非白色念珠菌正逐渐成为头颈部癌患者OPC的相对常见病因。显色培养基有助于筛查这些感染。我们的数据还表明，接受同步化疗和EBRT的患者发生OPC的可能性更大。
