Prevalence and association of oral candidiasis with dysphagia in individuals with acquired brain injury

ABSTRACT

Objective: To describe the prevalence of oral candidiasis (OC) in individuals with acquired brain injury (ABI) and to evaluate the association of OC with improvement in dysphagia.

Design: Longitudinal observational study.

Methods: Individuals with ABI admitted to rehabilitation were recruited over a one-year period (n = 206 (59% with dysphagia)). OC-data were collected by clinical examinations and verified by cultivation/microscopy in every 3 weeks during first 10 weeks of admission. Dysphagia improvement was defined by: 1) first positive change in food consistency, 2) initiation of at least soft food consistency. Individuals with/without OC were compared using multivariable Cox proportional hazards regression.

Results: The overall OC prevalence in all individuals, in individuals with dysphagia and in individuals not treated with antifungal agents were 32.5%, 43.4% and 29.7%, respectively. The OC prevalence was 24.8% at one week after admission and reduced to 10.1% ten weeks after admission. Adjusted hazard ratios for improvement in dysphagia were 0.64–0.77 in OC compared to without OC, though not statistically significant.

Conclusion: Prevalence of OC was high at admission but reduced during rehabilitation. Though non-significant, the negative trend between OC and improvement in dysphagia suggest that OC may delay rehabilitation of dysphagia.

KEYWORDS:

• Oral thrush
• stroke
• traumatic brain injury
• oral health
• oral hygiene

Acknowledgments

The authors would like to acknowledge all the study participants who gave of their time generously, Hanne Møller Nielsen, neurorehabilitation specialised nurse at Hammel Neurorehabilitation Centre and University Research Clinic for coming up with the idea for the project and Jesper Reinholdt, dentist at Aarhus University for kind advices during data collection regarding Candida albicans.

Declaration of Interest

The author reports no conflicts of interest in this work.