ORAL CANDIDIASIS AND CURRENT TRENDS IN ITS RATIONAL PHARMACOTHERAPY

Devіatkina N. M., Skrypnykov P. M., Skrypnikova T. P., Khmil T. A.

LITERATURE REVIEWS

Scentific article

Oral candidiasis is one of the most common opportunistic infections caused by C. albicans and other species of the genus Candida. Clinical recognition of oral lesions is the basis for the diagnosis of oral candidiasis, and the isolation of Candida in pure culture and susceptibility testing for antifungal drugs help if the infection is recurrent or caused by species other than C. albicans. The aim of the work is to analyze the literature data on modern approaches to the etiotropic therapy of oral candidiasis depending on the form and severity of the process.Treatment of oral candidiasis is based on the diagnosis of the type of oral candidiasis, correction of risk factors or diseases, as well as the use of the most appropriate antifungal drugs. The three major families include the most commonly used antifungal drugs: polyenes (amphotericin B and nystatin), echinocandins (anidulafungin, caspofungin, and micafungin), and azoles (fluconazole, itraconazole, etc). Antifungal treatment of oral candidiasis can be performed locally or systemically. Topical therapy with nystatin and miconazole remains the recommended treatment for oral candidiasis due to its high efficacy, low cost and minimal number of side effects. Oral fluconazole is recommended for the treatment of moderate and severe oral candidiasis. At a disease refractory to fluconazole, itraconazole, posaconazole, and voriconazole can be appointed. Among the advantages of echinocandins for the treatment of severe and resistant forms of oral candidiasis is their antibiofilm activity and a long-term post-antifungal effect. Other therapeutic alternatives include the use of terpenes, probiotics, peptides, antibodies, cytokines or substances that prevent the transition of C. albicans from commensal to pathogen. Therefore, topical treatment with nystatin or miconazole and systemic treatment with oral fluconazole has shown similar efficacy. In case of treatment failures or recurrent infections, new antifungal agents with old and new mechanisms of action should be expected.

oral candidiasis, treatment, antifungal drugs.

1. Vila T, Sultan AS, Montelongo-Jauregui D, Jabra-Rizk MA. Oral candidiasis: A disease of opportunity. J Fungi (Basel). 2020 Mar;6(1):15. DOI: 10.3390/jof6010015.
2. Miranda-Cadena K, Marcos-Arias C, Mateo E, Aguirre JM, Quindós G, Eraso E. Prevalence and antifungal susceptibility profiles of Candida glabrata, Candida parapsilosis and their close-related species in oral candidiasis. Arch Oral Biol. 2018 Nov;95:100-7. DOI: 10.1016/j. archoralbio.2018.07.017.
3. Millsop JW, Faze LN. Oral candidiasis. Clin. Dermatol. 2016;34:487-494. DOI: 10.1016/j.clindermatol.2016.02.022.
4. Hellstein JW, Marek CL. Candidiasis: Red and white manifestations in the oral cavity. Head Neck Pathol. 2019;13:25-32. DOI: 10.1007/ s12105-019-01004-6.
5. Lewis MAO, Williams DW. Diagnosis and management of oral candidosis. Br. Dent. J. 2017;223:675-681. DOI: 10.1038/sj.bdj.2017.886.
6. Jabra-Rizk MA, Kong E, Tsui C, Nguyen M, Clancy C, Fidel P, et al. Candida albicans pathogenesis: Fitting within the host-microbe damage response framework. Infect. Immun. 2016;84:2724-2739. DOI: 10.1128/IAI. 00469-16..
7. Sultan AS, Rizk AM, Vila T, Ji Y, Masri R, Jabra-Rizk MA. Digital design of a universal rat intraoral device for therapeutic evaluation of topical formulation against Candida-associated denture stomatitis. Infect. Immun. 2019 Nov 18;87(12):e00617-19. DOI: 10.1128/IAI.00617-19.
8. Neville B, Damm DD, Allen C, Chi AC. Oral and maxillofacial pathology. 4th ed. Amsterdam: Elsevier; 2016. Chapter 6, Fungal and protozoal diseases; pp. 191-217.
9. Tilakaratne W, editor. Oral medicine and pathology. A guide to diagnosis and management. New Delhi: Jaypee; 2014. Chapter 16, Infections of the oral mucosa; pp. 361-382.
10. Khan SA, Jr PLF, Al Thunayyan A, Varlota S, Meiller TF, Jabra-Rizk MA. Impaired histatin-5 level and salivary antimicrobial activity against C. albicans in HIV-infected individuals. J. AIDS Clin. Res. 2013 Mar;4(193):1000193. DOI: 10.4172/2155-6113.1000193.
11. Vila T, Rizk AM, Sultan AS, Jabra-Rizk MA. The power of saliva: Antimicrobial and beyond. PLoS Pathog. 2019 Nov;15(11):e1008058. DOI: 10.1371/journal.ppat.1008058.
12. Sroussi HY, Epstein JB, Bensadoun RJ, Saunders DP, Lalla RV, Migliorati CA, Heaivilin N, Zumsteg ZS. Common oral complications of head and neck cancer radiation therapy: Mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer Med. 2017 Dec;6(12):2918-31. DOI: 10.1002/cam4.1221.
13. Perić M, Živković R, Milić Lemić A, Radunović M, Miličić B, Arsić Arsenijević V. The severity of denture stomatitis as related to risk factors and different Candida spp. Oral Surg; Oral Med, Oral Pathol, Oral Radiol. 2018;126(1): 41-47. DOI: 10.1016/j.oooo.2018.03.003.
14. Gasparoto TH, de Oliveira CE, Vieira NA, Porto VC, Gasparoto CT, Campanelli AP, et al. The pattern recognition receptors expressed on neutrophils and the associated cytokine profile from different aged patients with Candida-related denture stomatitis. Exp. Gerontol. 2012;47:741-748. DOI: 10.1016/j.exger.2012.07.003.
15. Vidya KM, Rao UK, Nittayananta W, Liu H, Owotade FJ. Oral mycoses and other opportunistic infections in HIV: Therapy and emerging problems – A workshop report. Oral Dis. 2016;22:158-165. DOI: 10.1111/odi.12437.
16. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L. Clinical practice guideline for the management of candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. DOI: 10.1093/ cid/civ933.
17. Coronado-Castellote L, Jiménez-Soriano Y. Clinical and microbiological diagnosis of oral candidiasis. J Clin Exp Dent002E 2013 Dec;5(5):e279-86. DOI: 10.4317/jced.51242.
18. Garcia-Cuesta C, Sarrion-Pérez MG, Bagán JV. Current treatment of oral candidiasis: A literature review. J Clin Exp Dent. 2014 Dec ;6(5):e576-82. DOI: 10.4317/jced.51798.
19. Nikolishyna EV, Marchenko AV, Ilenko NM, Lytovchenko IYU. Mistseve likuvannya khronichnoho kandydoznoho stomatytu. Ukrayinsʹkyy zhurnal medytsyny, biolohiyi ta sportu. 2020;5.2(24):121-124. [in Ukrainian].
20. Zhang LW, Fu JY, Hua H, Yan ZM. Efficacy and safety of miconazole for oral candidiasis: a systematic review and meta-analysis. Oral Dis. 2016 Apr;22(3):185-95. DOI: 10.1111/odi.12380.
21. Mukherjee PK, Chen H, Patton LL, Evans S, Lee A, Kumwenda J, et al. Topical gentian violet compared with nystatin oral suspension for the treatment of oropharyngeal candidiasis in HIV-1-infected participants. AIDS. 2017 Jan;31(1):81-8. DOI: 10.1097/QAD.0000000000001286.
22. Scheibler E, Garcia MCR, Medina da Silva R, Figueiredo MA, Salum FG, Cherubini K. Use of nystatin and chlorhexidine in oral medicine: Properties, indications and pitfalls with focus on geriatric patients. Gerodontology. 2017 Sep;34(3):291-8. DOI: 10.1111/ger.12278.
23. Roque L, Alopaeus J, Reis C, Rijo P, Molpeceres J, Hagesaether E. Mucoadhesive assessment of different antifungal nanoformulations. Bioinspir Biomim. 2018 Aug;13(5):055001. DOI: 10.1088/1748-3190/aad 488.
24. Lyu X, Zhao C, Yan ZM, Hua H. Efficacy of nystatin for the treatment of oral candidiasis: a systematic review and meta-analysis. Drug Des Devel Ther. 2016 Mar;10:1161-71. DOI: 10.2147/DDDT.S100795.
25. Gotzsche PC, Johansen HK. Nystatin prophylaxis and treatment in severely immunodepressed patients. Cochrane Database Syst Rev. 2014;9:CD002033. DOI: 10.1002/14651858.CD002033.
26. Hamill RJ. Amphotericin B formulations: a comparative review of efficacy and toxicity. Drugs. 2013 Jun;73(9):919-34. DOI: 10.1007/ s40265-013-0069-4.
27. Vazquez JA, Sobel JD. Miconazole mucoadhesive tablets: a novel delivery system. Clin Infect Dis. 2012 May;54(10):1480-4. DOI: 10.1093/ cid/cis205.
28. Hellfritzsch M, Pottegård A, Pedersen AJ, Burghle A, Mouaanaki F, Hallas J. Topical antimycotics for oral candidiasis in warfarin users. Basic Clin Pharmacol Toxicol. 2017 Apr;120(4):368-72. DOI: 10.1111/bcpt.12722.
29. De-la-Torre J, Ortiz-Samperio ME, Marcos-Arias C, Marichalar-Mendia X, Eraso E, Echebarria-Goicouria MÁ. In vitro antifungal susceptibility of oral Candida isolates from patients suffering from caries and chronic periodontitis. Mycopathologia. 2017 Jun;182(5- 6):471-85. DOI: 10.1007/s 11046-017-0112-1.
30. Wiederhold NP. The antifungal arsenal: alternative drugs and future targets. Int J Antimicrob Agents. 2018 Mar;51(3):333-9. DOI: 10.1016/j. ijantimicag. 2017.09.002.
31. Azanza Perea JR, Sádaba Díaz de Rada B. Pharmacological profile of isavuconazole. Rev Iberoam Micol. 2018 Oct-Dec;35(4):186-91. DOI: 10.1016/j.riam.2018.04.003.
32. Gil-Alonso S, Jauregizar N, Eraso E, Quindós G. Postantifungal effect of caspofungin against the Candida albicans and Candida parapsilosis clades. Diagn Microbiol Infect Dis. 2016 Oct;86(2):172-7. DOI: 10.1016/j. diagmicrobio.2016.07.011
33. Pristov KE, Ghannoum MA. Resistance of Candida to azoles and echinocandins worldwide. Clin. Microbiol. Infect. 2019 Jul;25(7):792-8. DOOI: 10.1016/j.cmi.2019.03.028.
34. Malakhov A, Wen J, Zhang BX, Wang H, Geng H, Chen XD. Rechargeable anticandidal denture material with sustained release in saliva. Oral Diseases. 2016 Jul;22(5):391-8. DOI: 10.1111/odi.12456.
35. Sardi JC, Gullo FP, Freires IA, Pitangui NS, Segalla MP, Fusco-Almeida AM. Synthesis, antifungal activity of caffeic acid0020derivative esters, and their synergism with fluconazole and nystatin against Candida spp. Diagn Microbiol Infect Dis. 2016 Dec;86(4):387-91. DOI: 10.1016/j.diagmicrobio. 2016.08.002.
36. Ai R, Wei J, Ma D, Jiang L, Dan H, Zhou Y. A meta-analysis of randomized trials assessing the effects of probiotic preparations on oral candidiasis in the elderly. Arch Oral Biol. 2017 Nov;83:187-92. DOI: 10.1016/j.archoralbio. 2017.04.030.
37. Pedraza-Sánchez S, Méndez-León JI, Gonzalez Y, Ventura-Ayala ML, Herrera MT, Lezana-Fernández JL. Oral administration of human polyvalent IgG by mouthwash as an adjunctive treatment of chronic oral candidiasis. Front Immunol. 2018 Dec 21;9:2956. DOI: 10.3389/ fimmu.2018.02956.
38. Vila T, Romo JA, Pierce CG, McHardy SF, Saville SP, Lopez-Ribot JL. Targeting Candida albicans filamentation for antifungal drug development. Virulence. 2017 Feb;8(2):150-8. DOI: 10.1080/21505594.2016.1197444.
39. Pierce CG, Lopez-Ribot JL. Candidiasis drug discovery and development: New approaches targeting virulence for discovering and identifying new drugs. Expert Opin. Drug Discov. 2013;8:1117-1126. DOI: 10.1517/ 17460441.2013.807245.
40. Pierce CG, Chaturvedi AK, Lazzell AL, Powell AT, Saville SP, McHardy SF, et al. A novel small molecule inhibitor of Candida albicans biofilm formation, filamentation and virulence with low potential for the development of resistance. NPJ Biofilms Microbiomes. 2015;1:15012. DOI: 10.1038/npjbiofilms.2015.12.
41. Romo JA, Pierce CG, Chaturvedi AK, Lazzell AL, McHardy SF, Saville SP, et al. Development of anti-virulence approaches for candidiasis via a novel series of small-molecule inhibitors of Candida albicans filamentation. mBio. 2017;8:e01991-17. DOI: 10.1128/mBio.01991-17.

«Bulletin of problems biology and medicine» Issue 1 (163), 2022 year, 22-28 pages, index UDK 616.311-002.828:582.282.23:[615.282.23+615]

10.29254/2077-4214-2022-1-163-22-28