Type 2 diabetes mellitus and oral Candida colonization: Analysis of risk factors in a Sri Lankan cohort

Abstract

Aims: Oral candidiasis is a major oral manifestation of uncontrolled diabetes mellitus, and a number of cofactors are associated with the pathogenesis of this infection. Here, we describe the prevalence of oral Candida in a Sri Lankan cohort of type 2 diabetes mellitus and risk factors that predispose them to this common fungal infection.

Methods: A case–control study was conducted in 250 diabetics with type 2 diabetes and 81 nondiabetic controls. Clinical and demographic data were collected using an interviewer administered questionnaire, and patient records. Oral rinse samples were collected to determine the candidal carriage, and the resultant yeast growth was quantified and speciated using multiplex-PCR and phenotypic analyses. Chi-square test (χ² test) and Fisher exact test were used for the determination of the significant relationships between risk factors and oral candidiasis.

Results: The oral prevalence of Candida species among both groups was similar (81%) although a significantly higher proportion of diabetics (32.8%) yielded >2000 CFU/mL of yeasts compared with only 12.3% of the healthy controls (p < .05). Significant associations were noted between oral candidal carriage amongst diabetics, and (i) denture wearing, (ii) female gender and (iii) cigarette smoking (all, p < .05). Amongst both groups, C.albicans was the most common Candida species isolated followed by C. parapsilosis, C. tropicalis and C. glabrata.

Conclusions: The oral infestation of Candida in our Sri Lankan cohort of diabetics is significantly higher than their healthy counterparts, and co-carriage of multiple yeast species is a common finding in the study population. As there are no previous such reports of the latter phenomenon particularly from the Asian region it is noteworthy, mainly in view of the recent data on the emergence of drug-resistant yeast species the world over.

Keywords:

• Oral Candida
• Diabetes
• Sri Lanka
• multiplex PCR

Acknowledgements

We thank all diabetics, staff of endocrinology clinic at Colombo South Teaching Hospital, Sri Lanka and the members of the Department of Microbiology, Faculty of Medical Sciences and University of Sri Jayewardenepura, Sri Lanka for their assistance in the specimen collection.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported in part by grants from University of Sri Jayewardenepura, Sri Lanka [Grant No. ASP/06/RE/MED/2014/08] and by Medical Research Institute Sri Lanka. [Grant No: 2013/33] Ethical approval for this study was obtained from the Ethical Review Committee of University of Sri Jayewardenepura, Sri Lanka [Ref. No: 764/13].