Oral candidiasis in patients hospitalised in the intensive care unit: Diagnosis through clinical and cytopathological examinations

• Published in: Cytopathology (Oxford) 2023-07, Vol.34 (4), p.353-360
• Main Authors: Santos Freire, Fabiane Marques, Marques, Letícia Côgo, Silva, Natasha Camargo, Cunha, Karin Soares, Conde, Danielle Castex, Milagres, Adrianna, Gonçalves, Lúcio Souza, Junior, Arley Silva
• Format: Article
• Language: English
• Subjects: Candida; Candidiasis; Candidiasis - diagnosis; Candidiasis - epidemiology; Candidiasis, Oral - diagnosis; Candidiasis, Oral - epidemiology; Clinical aspects; Creatinine; Diagnosis; Hematocrit; Hemoglobin; Humans; Intensive care; intensive care unit; Intensive Care Units; Length of stay; Medical records; microbiology; oral manifestations; Patients; Prospective Studies; Statistical analysis
• ISSN: 0956-5507; 1365-2303
• DOI: 10.1111/cyt.13243

Objective To evaluate the prevalence and clinical aspects of oral candidiasis in patients hospitalised in the intensive care unit. Methods This is a longitudinal and prospective study that included 48 participants hospitalised in the intensive care unit. Sociodemographic data, presence of systemic disorders, use of medications, laboratory tests, cause of hospital admission, type of breathing, and length of hospital stay were obtained from medical records. Oral clinical inspection and cytopathological examinations were performed on all participants. The diagnosis of clinical candidiasis was based on the presence of clinical alterations together with positive cytopathological examination results. The diagnosis of subclinical candidiasis was based on the absence of clinical lesions and a positive cytopathological examination. The absence of oral candidiasis was considered when the participant did not present oral lesions and had a negative cytopathological examination. Results Clinical candidiasis was present in 18.8% of the 48 participants, and 45.8% of them had the subclinical form. Levels of urea (P = 0.005), creatinine (P = 0.009), haemoglobin (P = 0.009), haematocrit (P = 0.011), bands (P = 0.024), international normalised ratio (INR; P = 0.034), types of breathing (P = 0.017), length of hospital stay (P = 0.037), and outcome (P = 0.014) demonstrated statistically significant differences between the groups with and without oral candidiasis. Conclusions Clinical and subclinical forms of oral candidiasis are frequent in intensive care unit patients. Levels of urea, creatinine, haemoglobin, haematocrit, bands, INR, type of breathing, length of hospital stay, and outcome can be associated with the presence of candidiasis. In this study, clinical candidiasis was present in 18.8% and subclinical candidiasis in 45.8% of patients hospitalized in the intensive care unit. This data is very important, considering the possibility that these patients may have a longer hospitalization time, worsening of their general condition caused by candidemia, and even die. The authors suggest cytological examination as an important tool for the diagnosis of candidiasis in patients in the intensive care unit, considering that it is easy to perform, non‐invasive, and can diagnose both clinical and subclinical candidiasis.