Show simple item record

dc.contributor.advisorMacFadyen, Eithne
dc.contributor.advisorRich, Alison
dc.contributor.advisorCannon, Richard
dc.contributor.authorMohamed Thani, Wan Syasliza
dc.date.available2015-11-18T20:34:15Z
dc.date.copyright2015
dc.identifier.citationMohamed Thani, W. S. (2015). Oral Candida Carriage and Antifungal Susceptibility in Patients Receiving Antipsychotic Medication (Thesis, Doctor of Clinical Dentistry). University of Otago. Retrieved from http://hdl.handle.net/10523/6086en
dc.identifier.urihttp://hdl.handle.net/10523/6086
dc.description.abstractObjective: The overall objective of this project was to investigate oral Candida carriage and antifungal susceptibility of Candida albicans isolates in patients receiving antipsychotic medications. Specific objectives were: to determine the level of colonisation with Candida of the oral mucosa in individuals taking antipsychotic medications relative to healthy controls and to xerostomic individuals not prescribed with antipsychotics; to determine the Candida species present; to measure the azole resistance of these isolates; and to determine whether the antipsychotic medication fluphenazine affected azole resistance of C. albicans isolates. Methods: Nine participants aged between 20 and 70, who were currently on antipsychotic medications were recruited into this study with informed consent. Xerostomia symptoms were determined from the Xerostomia Inventory (XI) and clinical examinations. Saliva rinses were collected by asking each participant to rinse their mouth with 10 mL water for 30 s and then expectorated into specimen bottles. Smears were taken from the buccal mucosa (both sides), tongue, and any other mucosal site with signs of infection. Smears were sent to Medlab for Candida hyphae and yeast identification. Saliva samples were diluted and cultured on CHROMagar Candida™ plates. The colony-forming units (CFU) and species (presumptively assigned from the colony colour) were recorded. The susceptibility of the C. albicans isolates to fluconazole was measured using the E-test and liquid microdilution assay. The interaction between fluconazole and fluphenazine was investigated using a disc diffusion assay and checkerboard liquid microdilution assay. Results: The majority of the participants (78%) presented with dry mouth. However, the degree of dry mouth symptoms they experienced was not severe based on their XI scores. Four of nine participants (44%) were diagnosed with oral candidosis. The infection coincided with antipsychotic medication intake, although may not have been caused by the antipsychotic because three of the four participants were on other medications as well. Higher numbers of participants were colonised with Candida spp. (7 of 9) compared to an age-matched group of healthy individuals (2 of 9). The numbers of yeast detected per participant was also significantly higher than for the control group. The Candida species most frequently presumptively identified by colony colour on CHROMagar Candida™ was C. albicans. Fluphenazine showed low antifungal activity. However, fluphenazine was found to produce antagonistic effects towards fluconazole, both in disc diffusion assays and the more quantitative checkerboard MIC assays. Conclusion: Many antipsychotic medications are known to cause xerostomia and predispose to Candida infections. Investigating C. albicans infections and their resistance to fluconazole will potentially lead to more appropriate treatment. The discovery that antagonism between the antipsychotic fluphenazine and fluconazole occurs with C. albicans clinical isolates indicates that careful consideration is necessary when prescribing fluconazole to patients currently taking fluphenazine or medications of a similar class. Other antifungal agents such as nystatin lozenges (not readily available in New Zealand) and amphotericin B lozenges might be better for individuals on such antipsychotic medications.
dc.format.mimetypeapplication/pdf
dc.language.isoen
dc.publisherUniversity of Otago
dc.rightsAll items in OUR Archive are provided for private study and research purposes and are protected by copyright with all rights reserved unless otherwise indicated.
dc.subjectoral
dc.subjectcandida
dc.subjectantipsychotic
dc.subjectfluconazole
dc.subjectresistance
dc.titleOral Candida Carriage and Antifungal Susceptibility in Patients Receiving Antipsychotic Medication
dc.typeThesis
dc.date.updated2015-11-18T04:54:09Z
dc.language.rfc3066en
thesis.degree.disciplineSir John Walsh Research Institute
thesis.degree.nameDoctor of Clinical Dentistry
thesis.degree.grantorUniversity of Otago
thesis.degree.levelDoctoral
otago.openaccessOpen
 Find in your library

Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record