Oral colonisation and infection by Candida sp. in diabetic and non-diabetic patients with chronic kidney disease on dialysis

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Several authors have reported that diabetes is the most common cause of CKD in adults, its incidence is increasing and it is a public health problem.9-11 Chronic kidney disease patients on dialysis have a high frequency of anaemia, malnutrition and multifactorial immunological deterioration, and as such, they are considered to be immunosuppressed.12,13In the oral context, it has been reported that these patients have decreased salivary flow (SF), xerostomia and mucosal atrophy,14,15 conditions that are conducive to OC development both in diabetic (DM) patients without complications and in DM patients16 with CKD on dialysis.14,15,17 Although prevalence of colonisation and OC has been reported in different groups of immunocompromised patients, few studies have been conducted on dialysis patients. The purpose of this study was to determine the prevalence of different Candida species that colonise or infect the OM of DM patients with CKD on dialysis and compare them with non-diabetic (non-DM) patients with CKD on dialysis and analyse some potential risk factors. MATERIAL AND METHOD Study population A cross-sectional study in which we examined DM and non-DM CKD patients of the Haemodialysis Unit at the Hospital General de Zona No. 50 from the Instituto Mexicano del Seguro Social in San Luis Potosí, Mexico. The study had previously been approved by the hospital’s research and ethics committees. We collected demographic data, kidney disease data, the progression time of diabetes mellitus (where applicable) and clinical laboratory data from the patients’ clinical records. All patients were requested their informed consent for us to take oral samples. We excluded patients with unstable clinical conditions who were not suitable for oral examination and/or SF measurement. We excluded cases when the culture became contaminated and we were unable to contact the patient in order to obtain a new sample. The oral examination was carried out by a specialist in Oral Pathologies and Medicine. The culture sample was taken in the morning and at least two hours after eating food or intaking liquids and the patients were asked about their use of dental prostheses (DP). Before taking samples for the microbiological culture, we measured SF using Schirmer’s test, which consists of measuring accumulated saliva in the floor of the mouth for five minutes using Whatman strips (millimetrically graded filter paper). We considered the SF to have decreased whenever the reading was ≤2.0cm.18 The clinical criteria for the diagnosis of OC were those of Holmstrup and Axéll (erythematous or pseudomembranous candidiasis or prosthesis-associated candidiasis).19 When a lesion suggestive of OC was identified in the oral examination, we performed an exfoliative cytology, which was stained with Periodic acid–Schiff to confirm the infection. The patient was considered to have an infection whenever there was a clinical lesion and the exfoliative cytology was positive. Microbiological methods and species identification For fungal identification, we took samples of the whole OM of each patient with sterile swabs, which were coded for their subsequent inoculation on Sabouraud dextrose agar plates with chloramphenicol and on Biggy agar plates. Candida was characterised by various phenotypic methods, including cultures, germ tube formation in human serum and biochemical profiles with API® galleries. We considered as colonised (healthy carrier) asymptomatic patients without oral lesions and with mucosa swab culture positive for Candida sp. The plates were incubated at 36.5±0.5°C, with growth readings being performed after 24, 48 and 72 hours. With the Biggy agar culture, we carried out a presumptive identification of the Candida species, in accordance with the colorimetric characteristics; furthermore, the use of this means allowed us to identify the presence of two or more Candida species in the same sample. Positive cultures in one or more species were re-inoculated and purified in Sabouraud glucose agar plates and were incubated at 36°C (±1ºC) for two days. The Candida species were identified by the carbohydrate assimilation system API 20 C AUX (BioMerieux, Lyon, France). Statistical analysis We performed a descriptive analysis of the demographic and clinical variables, age, sex, body mass index, causes of chronic renal failure (CRF) and clinical laboratory data. Comparisons were made with the Student’s t-test and χ2. The presence or absence of Candida in the OM was graded on an ordinal scale of three levels: 1) absent, 2) carrier and 3) present with candidiasis. Potential risk factors were investigated using multiple logistic regression analysis, with candidiasis as the dependent variable and the independent variables being sex, genus, CKD data, laboratory data and the use of DP. We used the Epi Info version 3.4.3 software and considered a P-value of <.05 to be statistically significant. RESULTS We studied a total of 136 patients (56 DM and 80 non-DM), 80 males and 56 females, with an average age of 45.3±17.6 (14-86) years old. One hundred and twenty-six were on chronic haemodialysis (HD) and 10 on peritoneal dialysis, with a median treatment time of 24 (2 to 168) months. Table 1 shows a comparative analysis of demographic and clinical characteristics and laboratory results for both groups. Twenty-four patients (17.6%) reported a history of smoking, with there being no difference between groups. Oral conditions Table 2 shows that DM patients more commonly used DP (P=.004), had higher xerostomia (P=.018) and lower SF (p=.008). Eighteen patients (13.2%) used DP.The prevalence of Candida in OM was 43.4% (59/136): 53.6% (30/56) in DM and 36.2% (29/80) in non-DM (P=.045). As regards Candida species, we did not observe a difference between DM and non-DM. Table 3 displays the frequency by species of the total isolated Candida and cases with two or more species in the same patient. The frequencies per species of the total positive isolated Candida (71) were: C. albicans 44 (74.6%), C. glabrata 13 (22.0%), C.tropicalis 9 (15.2%), C. parapsilosis 2 (3.4%), C. kefyr 2 (3.4%) and C. famata 1 (1.7%). Eleven patients (8.1%) had more than one Candida species; one patient had C. albicans/C. glabrata/C. tropicalis, 5 patients had C. albicans/C. glabrata, 3 patients had C. albicans/C. tropicalis, one had C. glabrata/C. tropicalis and one had C. glabrata/C. parapsilosis. We observed OC in 16.9% (23/136) of the total group, 23.2% (13/56) in DM-CRF patients and 12.5% (10/80) in non-DM patients (P=.101). Of the 18 DP users, 55.6% (10/18) had prosthesis-associated OC, 61.5% (8/13) were DM patients and 40% (2/5) were non-DM patients (P=.608, Fisher’s ET). In relation to the clinical type, 19 patients (82.6%) displayed the erythematous type on the dorsum of the tongue and one patient had erythematous and pseudomembranous candidiasis and DP-associated candidiasis. The Candida species identified in cases with candidiasis were C. albicans 17 (73.9%), C. tropicalis 7 (30.4%), C. glabrata 4 (17.4%) and C. kefyr 1 (4.3%). In the 36 cases without candidiasis, we identified: C. albicans 27 (75.0%), C. glabrata 9 (25.0%), C. parapsilosis 2 (5.6%), C. tropicalis 2 (5.6%), C. kefyr 1 (2.8%) and C. famata 1 (2.8%). We did not observe a difference between groups (those with and without candidiasis) in the prevalence of C. albicans.Table 4 shows the final multiple logistic regression analysis, after discarding the variables that showed P values>.50 in previous analyses. We observed an increased relative risk of the presence of Candida in OM (with or without candidiasis) in patients who used DP (p=.006), with xerostomia (p=.001) and with low serum albumin values (p=.044) (the latter was 3.6±0.6g/dl in patients with candidiasis, 3.8±0.8g/dl in carrier patients and 4.1±0.6g/dl in patients not colonised). DISCUSSION Our results demonstrated that the presence of Candida in OM, colonising or infecting, was related to the use of DP, xerostomia and low serum albumin.Colonisation by Candida sp. in the mucosa is a risk factor for superficial infections such as OC, and others of greater significance, i.e. invasive infections, especially in immunocompromised patients.5,17,20 The coexistence of different Candida species in an infection makes it more persistent and difficult to treat.8,21Colonisation by Candida sp. occurred in 43.4%, a prevalence similar to that reported (39%) in a similar study on patients with CKD.22 Other authors have reported frequencies of 46%23  in DP users with HD, or 51.2% in which the oral microbiota of HD patients was what was measured.24 The frequency observed in this study was lower than that reported in other immunocompromised groups of patients with head and neck neoplasms 56.8%,25 with solid organ transplants 57%,8 with the human immunodeficiency virus (HIV/AIDS) 66.7%,26 at the end of radiotherapy for oral cancer 69%27 and with type 2 diabetes mellitus 77%.21 The foregoing may be explained by the fact that in each group studied, there are major local factors, such as a severe decrease in SF due to radiotherapy, systemic factors such as the use of immunosuppressant drugs or antineoplastic medication that causes xerostomia or immunosuppression due to the underlying disease. CKD patients, despite the known decrease in monocyte functions, systemic deterioration and hyposalivation, are not on average as immunosuppressed as the other patients.12,27-29Candida albicans was the predominant species (74.6%), without there being a difference between groups (p=.148). This species is the most prevalent both in healthy individuals2 and in those with systemic involvement.7,8,22-25 Its frequencies vary in accordance with the group studied: dialysis patients from 51.7% to 63%,22,23 kidney transplant patients 44%,8,30 patients with cancer in the head and neck 74%,25 patients with infection due to HIV/AIDS from 60.7% to 83.5%,7,26 and in DM patients from 68.9% to 86.5%.21,31C. glabrata was the second most common Candida species, similar to that observed in another study on chronic dialysis patients.22 In our study, 8 patients simultaneously presented C. glabrata and another species, 4 of them without OC. This mixed colonisation may be a risk factor for developing more severe infections. C. glabrata has been shown to be the second most isolated species after C. albicans in patients with CKD and a renal transplant,8,22 cancer of the head and neck and haematological malignancies.25C. glabrata has been identified as an opportunistic species that in conditions of severe immunosuppression is associated with nosocomial infections, a long dwell time of intravenous catheters, the prophylactic use of antifungal medication (especially fluconazole) and the chronic use of DP.32 This species may cause severe oropharyngeal candidiasis, which is difficult to treat because it is innately less sensitive to fluconazole and itraconazole and results in higher mortality rates when candidaemia occurs.33 -35OC is the most commonly reported opportunistic fungal infection in CKD patients, with frequencies ranging from 5.7% to 32%.15,17 In this study, OC was present in 17% of patients. The erythematous type was the most common (83%), and xerostomia was a major risk factor. It occurred on the dorsum of the tongue in all cases, with there being no difference between DM and non-DM. This prevalence is similar to that previously reported by us in CKD patients on HD,15 which suggests that the characteristics of our study population are similar in terms of systemic condition. Another factor associated with OC is a lower SF, which results in a loss of the defensive function of saliva.14,15 In this study, DM patients displayed lower SF and a higher frequency of xerostomia, but only xerostomia was associated with OC.This study confirmed that the use of DP is a risk factor for colonisation and infection by Candida, as shown by the high odds ratio of 25.6 that we observed, since in 83% of patients who used a prostheses, the Candida was isolated. The use of DP is a risk factor for colonisation and/or infection by Candida in the OM and is due to a lack of hygienic care and its use over many years.5,23,24,32 DM patients on HD have a higher frequency of tooth loss, and as such, the use of this dental apparatus is common.36 Furthermore, it was confirmed that the adhesion capacity of the fungus to inert polymers such as acrylic resins, converts the latter into reservoirs, which favours colonisation and/or infection.3,5,32 Other authors found an association between the density of colonisation by the fungus and the progression time of kidney disease, but not of dialysis treatment,23,37 possibly due to the progressive deterioration caused by this disease.CKD patients on dialysis have a high frequency of nutritional, immunological, and psychological disorders as well disorders from invasive procedures and antimicrobial treatments, which are known to contribute to the presence of a higher number of yeast colonies.12,13,29 Their peritoneal dialysis or HD treatment requires the introduction of central venous or peritoneal catheters, which, as has already been mentioned, are risk factors for invasive infections.38-40 In this regard, the colonisation and/or infection by Candida at different anatomical sites, including the oropharyngeal mucosa, increases the risk of candidaemia, through various mecanisms.17,28,41 The implication of this risk factor for CKD patients on dialysis has been poorly documented.Furthermore, diabetes mellitus has been described as a risk factor for OM colonisation by Candida.21,31 However, in the multiple logistic regression analysis of this study, it was ruled out as an independent risk factor for both colonisation and OC. One possible explanation is that ckd patients on dialysis may have deteriorated and have other systemic and local risk factors that are relatively more important. Female sex was observed to be only marginally more associated with the presence of Candida in the OM in contrast to that reported by other authors.31,42 Notably, an independent association was found between the presence of Candida colonising and/or infecting the OM and low serum albumin, which supports the notion that hypoalbuminaemia is a reflection of systemic deterioration, with there being a lower capacity to defend against microorganisms. While there have previously been reports on the association between low albumin and the female sex and diabetes in CKD patients on chronic dialysis, particularly peritoneal dialysis13 (where it is interpreted as a negative acute phase reactant),43 our study does not confirm this association, possibly due to the role of albumin as a marker, particularly of nutritional status in HD patients. CONCLUSIONS This study was important for identifying the frequency of colonisation and infection by Candida in CKD patients on dialysis, since few studies have been carried out on this group of patients, which in Mexico represents high rates of morbidity and mortality. DM patients had lower SF (hyposalivation), higher xerostomia and low serum albumin, with the latter being a risk factor not previously described for the presence of Candida in the OM in these patients. We should be aware of the diversity found in Candida species, including some highly pathogenic species, such as C. glabrata and C. tropicalis, in the treatment of these patients, since some of them have been reported in severe infections related to dialysis catheters. Conflicts of interest The authors declare that they have no conflicts of interest related to the contents of this article.<a href="grande/11790_16025_52163_en_t1.11790.jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52163_en_t1.11790.jpg" alt="Demographic and clinical data of diabetic and non-diabetic patients with chronic kidney disease and chronic dialysis"></img></a>Table 1. Demographic and clinical data of diabetic and non-diabetic patients with chronic kidney disease and chronic dialysis<a href="grande/11790_16025_52164_en_t2.11790.jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52164_en_t2.11790.jpg" alt="Oral characteristics and candidiasis in 136 patients with chronic kidney disease on dialysis"></img></a>Table 2. Oral characteristics and candidiasis in 136 patients with chronic kidney disease on dialysis<a href="grande/11790_16025_52165_en_t3.11790.jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52165_en_t3.11790.jpg" alt="Distribution of Candida species in the oral mucosa of diabetic and non-diabetic patients on chronic dialysis"></img></a>Table 3. Distribution of Candida species in the oral mucosa of diabetic and non-diabetic patients on chronic dialysis<a href="grande/11790_16025_52166_en_t4.11790.jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52166_en_t4.11790.jpg" alt="Risk factors for the presence of Candida (with or without candidiasis), in diabetic and non-diabetic patients on chronic dialysis"></img></a>Table 4. Risk factors for the presence of Candida (with or without candidiasis), in diabetic and non-diabetic patients on chronic dialysis" "pdfFichero" => "P1-E562-S4403-A11790-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439411" "palabras" => array:1 [ 0 => "Hemodiálisis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439413" "palabras" => array:1 [ 0 => "Enfermedad renal crónica" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439415" "palabras" => array:1 [ 0 => "Albúmina sérica" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439417" "palabras" => array:1 [ 0 => "Diabetes mellitus" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439419" "palabras" => array:1 [ 0 => "Candida glabrata" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439421" "palabras" => array:1 [ 0 => "Candida albicans" ] ] ] "en" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439412" "palabras" => array:1 [ 0 => "Haemodialysis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439414" "palabras" => array:1 [ 0 => "Chronic kidney disease" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439416" "palabras" => array:1 [ 0 => "Serum albumin" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439418" "palabras" => array:1 [ 0 => "Diabetes mellitus" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439420" "palabras" => array:1 [ 0 => "Candida glabrata" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439422" "palabras" => array:1 [ 0 => "Candida albicans" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Introducción: La candidosis bucal (CB) es una infección oportunista frecuente en el paciente inmunocomprometido y algunas veces es importante conocer la especie para el tratamiento. Objetivo: Determinar la prevalencia de distintas especies de Candida colonizando o infectando la mucosa bucal (MB) de pacientes diabéticos (DM) y no diabéticos (no DM) con enfermedad renal crónica, comparando ambos grupos y explorando algunos posibles factores de riesgo. Metodología: Se examinó a 56 pacientes DM y 80 no DM con diálisis crónica. Se tomaron muestras de la MB y se sembraron en agar placas dextrosa Sabouraud. La especie se identificó con galerías API®. La CB se confirmó con citología exfoliativa. Las asociaciones se investigaron con χ2, Prueva exacta (PE) de Fisher y regresión logística múltiple. Resultados: La prevalencia de Candida fue del 43,4 %: 53,6 % DM y 36,2 % no DM (p = 0,045). Las especies fueron C. albicans 74,6 %, C. glabrata 22,0 %, C. tropicalis 15,2 %, C. parapsilosis 3,4 %, C. kefyr 3,4 % y C. famata 1,7 % sin diferencia entre grupos. Los DM tuvieron mayor frecuencia de xerostomía (p = 0,002), flujo salival bajo (p = 0,008) y albúmina sérica más baja (p = 0,018). Tuvieron CB 16,9 %, 23,2 % DM frente a 12,5 % no DM (p = 0,101). Se asociaron a presencia de Candida en la MB: uso de prótesis (odds ratio [OR] 25,6, límite de confianza [LC] 95 % 2,5 a 253, p = 0,001), xerostomía (OR 9,6, LC 95 % 2,4 a 38,1, p = 0,001) y bajos valores de albúmina sérica (OR 0,41, LC 95 % 0,22 a 0,98, p = 0,044). Conclusiones: La presencia de Candida sp. en la MB se asoció a prótesis dental, xerostomía y albúmina sérica baja. " ] "en" => array:1 [ "resumen" => "Introduction: Oral candidiasis (OC) is a common opportunistic infection in immunocompromised patients. Species identification is sometimes important for treatment. Objective: to determine the prevalence of different Candida species colonising or infecting the oral mucosa (OM) of diabetic (DM) and non-diabetic (non-DM) chronic kidney disease patients, comparing both groups and exploring potential risk factors. Methods: 56 DM and 80 non-DM patients on chronic dialysis were examined. OM swabs were cultured on Sabouraud dextrose agar plates. Candida species were identified with API® galleries. OC was confirmed by exfoliative cytology. Statistical associations were analysed using χ2, Fisher’s exact test (ET), and multiple logistic regression. Results: Candida prevalence was 43.4%: 53.6% DM and 36.3% non-DM, (p=.045). The species identified were C. albicans 74.6%, C. glabrata 22.0%, C. tropicalis 15.2%, C. parapsilosis 3.4 %, C. kefyr 3.4% and C. famata 1.7% without difference between groups. DM patients had a higher xerostomia prevalence (p=.002) and lower salivary flow (p=.008) and lower serum albumin (p=.018). 16.9% of patients had OC, 23.2% DM compared with 12.5% non-DM, (p=.101). The following were associated with the presence of Candida in the OM: the use of dental prostheses (odds ratio [OR] 25.6, 95% confidence interval [CI] 2.5 to 253, P=.001), xerostomia (OR 9.6, 95% CI 2.4 to 38.1, P=.001) and low serum albumin values (OR 0.41, 95% CI 0.22 to 0.98, P=.044). Conclusions: The presence of Candida sp. in the OM was associated with dental prostheses, xerostomia and low serum albumin." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11790_16025_52163_en_t1.11790.jpg" "Alto" => 1278 "Ancho" => 2168 "Tamanyo" => 553643 ] ] "descripcion" => array:1 [ "en" => "Demographic and clinical data of diabetic and non-diabetic patients with chronic kidney disease and chronic dialysis" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11790_16025_52164_en_t2.11790.jpg" "Alto" => 798 "Ancho" => 2180 "Tamanyo" => 231192 ] ] "descripcion" => array:1 [ "en" => "Oral characteristics and candidiasis in 136 patients with chronic kidney disease on dialysis" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11790_16025_52165_en_t3.11790.jpg" "Alto" => 621 "Ancho" => 2166 "Tamanyo" => 135130 ] ] "descripcion" => array:1 [ "en" => "Distribution of Candida species in the oral mucosa of diabetic and non-diabetic patients on chronic dialysis" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11790_16025_52166_en_t4.11790.jpg" "Alto" => 499 "Ancho" => 2183 "Tamanyo" => 139975 ] ] "descripcion" => array:1 [ "en" => "Risk factors for the presence of Candida (with or without candidiasis), in diabetic and non-diabetic patients on chronic dialysis" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cannon RD, Chaffin WL. Oral colonization by Candida albicans. Crit Rev Oral Biol Med 1999;10:359-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10759414" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yang YL, Leaw SN, Wang AH, Chen HT, Cheng WT, Lo HJ. Characterization of yeasts colonizing in healthy individuals. Med Mycol 2011;49:103-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20491531" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gow NA, van de Veerdonk FL, Brown AJ, Netea MG. Candida albicans morphogenesis and host defence: discriminating invasion from colonization. Nat Rev Microbiol 2011;10:112-22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22158429" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cannon RD, Holmes AB, Monk BC. Oral Candida: Clearance, colonization, or candidiasis? J Dent Res 1995;74:1152-61." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cannon RD, Chaffin L. Colonization is a crucial factor in oral candidiasis. J Dent Educ 2001;65:785-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11518251" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Reichart PA, Samaranayake LP, Phillipsen HP. Pathology and clinical correlates in oral candidiasis and its variants: a review. Oral Dis 2000;6:85-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10702784" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Luque AG, Biasoli MS, Tosello ME, Binolfi A, Lupo S, Magaró HM. Oral yeast carriage in HIV-infected and non-infected populations in Rosario, Argentina. Mycoses 2009;52:53-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dongari-Bagtzoglou A, Dwivedi P, Ioannidou E, Shaqman M, Hull D, Burleson J. Oral Candida infection and colonization in solid organ transplant recipients. Oral Microbiol Immunol 2009;24:249-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19416456" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Paniagua R, Ramos A, Fabian R, Lagunas J, Amato D. Chronic kidney disease and dialysis in Mexico. Perit Dial Int 2007;27(4):405-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17602147" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Amato D, Alvarez-Aguilar C, Castañeda-Limones R, Rodriguez E, Avila-Diaz M, Arreola F, et al. Prevalence of chronic kidney disease in an urban Mexican population. Kidney Int Suppl 2005;(97):S11-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cueto-Manzano AM, Rojas-Campos E. Status of renal replacement therapy and peritoneal dialysis in Mexico. Perit Dial Int 2007;27:142-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17299147" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Haag-Weber M, Dumann H, Hörl WH. Effect of malnutrition and uremia on impaired cellular host defence. Miner Electrolyte Metab 1992;18:174-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1465054" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pupim LB, Caglar K, Hakim RM, Shyr Y, Ikizler TA. Uremic malnutrition is a predictor of death independent of inflammatory status. Kidney Int 2004;66:2054-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15496179" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kho HS, Lee SW, Chung SC, Kim YK. Oral manifestations and salivary flow rate, pH, and buffer capacity in patients with end-stage renal disease undergoing hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:316-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10503861" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "de la Rosa GE, Mondragón PA, Aranda S, Bustamante M. Oral mucosa symptoms, signs, and lesions, in end-stage renal disease and non-end stage renal disease diabetic patients. Med Oral Patol Oral Cir Bucal 2006;11:E467-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "de la Rosa GE, Cruz Mérida S, Mondragón Padilla A. Frecuencia de manifestaciones bucales en pacientes diabéticos tipo2 de una unidad de medicina familiar del IMSS. Rev Ciencias Clínicas 2006;7:81-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Thorman R, Neovius M, Hylander B. Prevalence and early detection of oral fungal infection: a cross-sectional controlled study in a group of Swedish end-stage renal disease patients. Scand J Urol Nephrol 2009;43:325-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19363743" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "López-JP, Camacho AF, Bermejo FA. A simple test for salivary gland hypofunction using oral Schirmer's test. J Oral Pathol Med 2006;35:244-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16519773" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Holmstrup P, Axéll T. Classification and clinical manifestations of oral yeast infections. Acta Odontol Scand 1990;48:57-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2181811" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Picazo JJ, González-Romo F, Candel FJ. Candidemia in the critically ill patient. Int J Antimicrob Agents 2008;32 Suppl 2:S83-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19013345" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Willis AM, Coultert WA, Fultont CR, Hayes JR, Bell PM, Lamey PJ. Oral candidal carriage and infection in insulin-treated diabetic patients. Diabet Med 1999;16:675-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10477213" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Godoy JS, de Souza Bonfim-Mendonca P, Nakamura SS, Yamada SS, Shinobu-Mesquita C, Pieralisi N, et al. Colonization of the oral cavity by yeasts in patients with chronic renal failure undergoing hemodialysis. J Oral Pathol Med 2012;42:229-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22978344" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pires-Gonçalves RH, Toscano-Miranda E, Cristiane-Baeza L, Teruyuki-Matsumoto M, Zaia JE, Mendes-Giannini MJS. Genetic relatedness of commensal strains of Candida albicans carried in the oral cavity of patients dental prosthesis users in Brazil. Mycopathologia 2007;164:255-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17906942" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Takeuchi Y, Ishikawa H, Inada M, Shinozuka O, Umeda M, Yamazaki T, et al. Study of the oral microbial flora in patients with renal disease. Nephrology (Carlton) 2007;12:182-90." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Schelenz S, Abdallah S, Gray G, Stubbings H, Gow I, Baker P, et al. Epidemiology of oral yeast colonization and infection in patients with hematological malignancies, head neck and solid tumors. J Oral Pathol Med 2011;40:83-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20923440" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sánchez-Vargas LO, Ortiz-López NG, Villar M, Moragues MD, Aguirre JM, Cashat-Cruz M, et al. Oral Candida isolates colonizing or infecting human immunodeficiency virus-infected and healthy persons in Mexico. J Clin Microbiol 2005;43:4159-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16081965" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mañas A, Cerezo L, de la Torre A, García M, Alburquerque H, Ludeña B, et al. Epidemiology and prevalence of oropharyngeal candidiasis in Spanish patients with head and neck tumors undergoing radiotherapy treatment alone or in combination with chemotherapy. Clin Transl Oncol 2012;14:740-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22960994" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mitchell KG, Bradley JA, Ledingham IM, Hamilton DN. Candida colonization of the oral cavity. Surg Gynecol Obstet 1982;154:870-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7079931" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lim WH, Kireta S, Leedham E, Russ GR, Coates PT. Uremia impairs monocyte and monocyte-derived dendritic cell function in hemodialysis patients. Kidney Int 2007;72:1138-48. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17728708" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ahmadieh A, Baharvand M, Fallah F, Djaladat H, Eslani M. Oral microflora in patients on hemodialysis and kidney transplant recipients. Iran J Kidney Dis 2010;4:227-31. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20622312" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Al-Attas SA, Amro SO. Candidal colonization, strain diversity, and antifungal susceptibility among adult diabetic patients. Ann Saudi Med 2010;30:101-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20220258" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Salerno C, Pascale M, Contaldo M, Esposito V, Busciolano M, Milillo L, et al. Candida-associated denture stomatitis. Med Oral Patol Oral Cir Bucal 2011;16:e139-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20711156" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Li L, Redding S, Dongari-Bagtzoglou A. Candida glabrata: an emerging oral opportunistic pathogen. J Dent Res 2007;86:204-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17314251" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Redding SW. The role of yeasts other than Candida albicans in oropharyngeal candidiasis. Curr Opin Infect Dis 2001;14:673-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11964883" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Merenstein D, Hu H, Wang C, Hamilton P, Blackmon M, Chen H, et al. Colonization by Candida species of the oral and vaginal mucosa in HIV-infected and noninfected women. AIDS Res Hum Retroviruses 2013;29:30-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23098053" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "de la Rosa E, Cruz S, Mondragón A. Tooth loss in diabetic patients with and without chronic kidney disease and dialysis. Nefrologia 2008;28:645-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19016639" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yazdani M, Jahanshahi GR, Mahdavi KN, Asadian F. Study of the relationship between oral Candida colony counts and time on hemodialysis at Khorshid Hospital, Isfahan, Iran. Transplant Proc 2003;35:2580-1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14612025" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Khan FY, Elsayed M, Anand D, Abu Khattab M, Sanjay D. Fungal peritonitis in patients undergoing continuous ambulatory peritoneal dialysis in Qatar. J Infect Dev Ctries 2011;5:646-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21918305" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Picazo JJ, González-Romo F, Candel FJ. Candidemia in the critically ill patient. Int J Antimicrob Agents 2008;32 Suppl 2:S83-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19013345" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García-Martos P, Gil de Sola F, Marín P, García-Agudo L, García-Agudo R, Tejuca F, et al. Fungal peritonitis in ambulatory continuous peritoneal dialysis: description of 10 cases. Nefrologia 2009;29:534-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19935997" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Giri S, Kindo AJ. A review of Candida species causing blood stream infection. Indian J Med Microbiol 2012;30:270-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22885191" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Martínez RF, Jaimes-Aveldañez A, Hernández-Pérez F, Arenas R, Miguel GF. Oral Candida spp carriers: its prevalence in patients with type 2 diabetes mellitus. An Bras Dermatol 2013;88:222-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23739717" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Blake PG. Adequacy of peritoneal dialysis and chronic peritoneal dialysis prescription. In: Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. Fourth ed. Lippincott Williams & Wilkins 2007. pp. 387-409." 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Colonización e infección bucal por Candida sp. en pacientes diabéticos y no diabéticos con enfermedad renal crónica en diálisis

Estela de la Rosa Garcíaa, Estela de la Rosa-Garcíaa, Mónica Miramontes Zapatab, Mónica Miramontes-Zapatac, Luis-Octavio Sanchez-Vargasd, Luis O. Sánchez-Vargase, Arnoldo Mondragón Padillaf, Arnoldo Mondragón-Padillag

a Especialización y Maestría en Patología y Medicina Bucal, Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Ciudad de México, Distrito Federal, México,

b Servicio de Laboratorio Clínico, Hospital General de Zona No 50 del Instituto Mexicano del Seguro Social de la Ciudad de San Luis Potosí., San Luis Potosí, San Luis Potosí, México,

c Servicio de Laboratorio Clínico, Hospital General de Zona No 50 del Instituto Mexicano del Seguro Social de la Ciudad de San Luis Potosí, México,

d Laboratorio de Bioquímica, Microbiología y Patología Bucal., Facultad de Estomatología de la Universidad Autónoma de San Luis Potosí., San Luis Potosí, San Luis Potosí, México,

e Laboratorio de Bioquímica, Microbiología y Patología Bucal, Facultad de Estomatología de la Universidad Autónoma de San Luis Potosí, México,

f Servicio de Nefrología, Hospital General de Zona No 50 del Instituto Mexicano del Seguro Social de la Ciudad de San Luis Potosí., San Luis Potosí, San Luis Potosí, México,

g Servicio de Nefrología, Hospital General de Zona No 50 del Instituto Mexicano del Seguro Social de la Ciudad de San Luis Potosí, México,

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<span class="elsevierStyleItalic">C&#46; parapsilosis&#44; C&#46; tropicalis&#44; C&#46; glabrata&#44; C&#46; krusei&#44; C&#46; guilliermondii </span>and<span class="elsevierStyleItalic"> C&#46; dubliniensis </span><span class="elsevierStyleItalic">have also been reported</span><span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">1&#44;2&#44;4 </span>Colonisation of the OM by <span class="elsevierStyleItalic">Candida </span>sp<span class="elsevierStyleItalic">&#46;</span> is a risk factor for progression to oral candidiasis &#40;OC&#41;&#44; both in immunocompetent and immunocompromised individuals&#46;<span class="elsevierStyleSup">1&#44;5</span> OC is due to the proliferation of fungi on the mucosa surface and it may come from the microbiota of the same patient in a carrier state&#46;<span class="elsevierStyleSup">4</span> Its growth is explained by fungal mechanisms and the host&#8217;s defences&#46;<span class="elsevierStyleSup">3&#44;6</span> The coexistence of different Candida species in an infection makes it more persistent and difficult to treat&#46;<span class="elsevierStyleSup">7&#44;8</span></p><p class="elsevierStylePara">In Mexico there is no chronic kidney disease &#40;CKD&#41; patient registry&#46; Several authors have reported that diabetes is the most common cause of CKD in adults&#44; its incidence is increasing and it is a public health problem&#46;<span class="elsevierStyleSup">9-11</span> Chronic kidney disease patients on dialysis have a high frequency of anaemia&#44; malnutrition and multifactorial immunological deterioration&#44; and as such&#44; they are considered to be immunosuppressed&#46;<span class="elsevierStyleSup">12&#44;13</span></p><p class="elsevierStylePara">In the oral context&#44; it has been reported that these patients have decreased salivary flow &#40;SF&#41;&#44; xerostomia and mucosal atrophy&#44;<span class="elsevierStyleSup">14&#44;15</span> conditions that are conducive to OC development both in diabetic &#40;DM&#41; patients without complications and in DM patients<span class="elsevierStyleSup">16</span> with CKD on dialysis&#46;<span class="elsevierStyleSup">14&#44;15&#44;17 </span>Although prevalence of colonisation and OC has been reported in different groups of immunocompromised patients&#44; few studies have been conducted on dialysis patients&#46; The purpose of this study was to determine the prevalence of different <span class="elsevierStyleItalic">Candida</span> species that colonise or infect the OM of DM patients with CKD on dialysis and compare them with non-diabetic &#40;non-DM&#41; patients with CKD on dialysis and analyse some potential risk factors&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study population</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A cross-sectional study in which we examined DM and non-DM CKD patients of the Haemodialysis Unit at the Hospital General de Zona No&#46; 50 from the Instituto Mexicano del Seguro Social in San Luis Potos&#237;&#44; Mexico&#46; The study had previously been approved by the hospital&#8217;s research and ethics committees&#46; We collected demographic data&#44; kidney disease data&#44; the progression time of diabetes mellitus &#40;where applicable&#41; and clinical laboratory data from the patients&#8217; clinical records&#46; All patients were requested their informed consent for us to take oral samples&#46; We excluded patients with unstable clinical conditions who were not suitable for oral examination and&#47;or SF measurement&#46; We excluded cases when the culture became contaminated and we were unable to contact the patient in order to obtain a new sample&#46; The oral examination was carried out by a specialist in Oral Pathologies and Medicine&#46; The culture sample was taken in the morning and at least two hours after eating food or intaking liquids and the patients were asked about their use of dental prostheses &#40;DP&#41;&#46; Before taking samples for the microbiological culture&#44; we measured SF using Schirmer&#8217;s test&#44; which consists of measuring accumulated saliva in the floor of the mouth for five minutes using Whatman strips &#40;millimetrically graded filter paper&#41;&#46; We considered the SF to have decreased whenever the reading was &#8804;2&#46;0cm&#46;<span class="elsevierStyleSup">18</span> The clinical criteria for the diagnosis of OC were those of Holmstrup and Ax&#233;ll &#40;erythematous or pseudomembranous candidiasis or prosthesis-associated candidiasis&#41;&#46;<span class="elsevierStyleSup">19 </span>When a lesion suggestive of OC was identified in the oral examination&#44; we performed an exfoliative cytology&#44; which was stained with Periodic acid&#8211;Schiff to confirm the infection&#46; The patient was considered to have an infection whenever there was a clinical lesion and the exfoliative cytology was positive&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Microbiological methods and species identification</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">For fungal identification&#44; we took samples of the whole OM of each patient with sterile swabs&#44; which were coded for their subsequent inoculation on Sabouraud dextrose agar plates with chloramphenicol and on Biggy agar plates&#46; <span class="elsevierStyleItalic">Candida</span><span class="elsevierStyleItalic"> was characterised by various </span>phenotypic methods&#44; including cultures&#44; germ tube formation in human serum and biochemical profiles with API<span class="elsevierStyleSup">&#174;</span> galleries&#46; We considered as colonised &#40;healthy carrier&#41; asymptomatic patients without oral lesions and with mucosa swab culture positive for <span class="elsevierStyleItalic">Candida </span>sp&#46; The plates were incubated at 36&#46;5&#177;0&#46;5&#176;C&#44; with growth readings being performed after 24&#44; 48 and 72 hours&#46; With the Biggy agar culture&#44; we carried out a presumptive identification of the <span class="elsevierStyleItalic">Candida</span> species&#44; in accordance with the colorimetric characteristics&#59; furthermore&#44; the use of this means allowed us to identify the presence of two or more <span class="elsevierStyleItalic">Candida</span> species in the same sample&#46; Positive cultures in one or more species were re-inoculated and purified in Sabouraud glucose agar plates and were incubated at 36&#176;C &#40;&#177;1&#186;C&#41; for two days&#46; The <span class="elsevierStyleItalic">Candida</span> species were identified by the carbohydrate assimilation system API 20 C AUX &#40;BioMerieux&#44; Lyon&#44; France&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We performed a descriptive analysis of the demographic and clinical variables&#44; age&#44; sex&#44; body mass index&#44; causes of chronic renal failure &#40;CRF&#41; and clinical laboratory data&#46; Comparisons were made with the Student&#8217;s t-test and &#967;<span class="elsevierStyleSup">2</span>&#46; The presence or absence of <span class="elsevierStyleItalic">Candida</span> in the OM was graded on an ordinal scale of three levels&#58; 1&#41; absent&#44; 2&#41; carrier and 3&#41; present with candidiasis&#46; Potential risk factors were investigated using multiple logistic regression analysis&#44; with candidiasis as the dependent variable and the independent variables being sex&#44; genus&#44; CKD data&#44; laboratory data and the use of DP&#46; We used the Epi Info version 3&#46;4&#46;3 software and considered a <span class="elsevierStyleItalic">P</span>-value of &#60;&#46;05 to be statistically significant&#46;&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We studied a total of 136 patients &#40;56 DM and 80 non-DM&#41;&#44; 80 males and 56 females&#44; with an average age of 45&#46;3&#177;17&#46;6 &#40;14-86&#41; years old&#46; One hundred and twenty-six were on chronic haemodialysis &#40;HD&#41; and 10 on peritoneal dialysis&#44; with a median treatment time of 24 &#40;2 to 168&#41; months&#46; Table 1 shows a comparative analysis of demographic and clinical characteristics and laboratory results for both groups&#46; Twenty-four patients &#40;17&#46;6&#37;&#41; reported a history of smoking&#44; with there being no difference between groups&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Oral conditions</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Table 2 shows that DM patients more commonly used DP &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;004&#41;&#44; had higher xerostomia &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;018&#41; and lower SF &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;008&#41;&#46; Eighteen patients &#40;13&#46;2&#37;&#41; used DP&#46;</p><p class="elsevierStylePara">The prevalence of <span class="elsevierStyleItalic">Candida</span> in OM was 43&#46;4&#37; &#40;59&#47;136&#41;&#58; 53&#46;6&#37; &#40;30&#47;56&#41; in DM and 36&#46;2&#37; &#40;29&#47;80&#41; in non-DM &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;045&#41;&#46; As regards <span class="elsevierStyleItalic">Candida </span><span class="elsevierStyleItalic">species</span>&#44;<span class="elsevierStyleItalic"> </span>we did not observe a difference between DM and non-DM&#46; Table 3 displays the frequency by<span class="elsevierStyleItalic"> </span>species of the total isolated <span class="elsevierStyleItalic">Candida</span> and cases with two or more species in the same patient&#46; The frequencies per species of the total positive isolated <span class="elsevierStyleItalic">Candida</span> &#40;71&#41; were&#58; <span class="elsevierStyleItalic">C&#46; albicans</span> 44 &#40;74&#46;6&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; glabrata</span> 13 &#40;22&#46;0&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46;</span><span class="elsevierStyleItalic">tropicalis</span> 9 &#40;15&#46;2&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; parapsilosis</span> 2 &#40;3&#46;4&#37;<span class="elsevierStyleItalic">&#41;</span>&#44;<span class="elsevierStyleItalic"> C&#46; kefyr</span> 2 &#40;3&#46;4&#37;&#41; and <span class="elsevierStyleItalic">C&#46; famata</span> 1 &#40;1&#46;7&#37;&#41;&#46; Eleven patients &#40;8&#46;1&#37;&#41; had more than one <span class="elsevierStyleItalic">Candida </span><span class="elsevierStyleItalic">species</span>&#59; one patient had <span class="elsevierStyleItalic">C&#46; albicans&#47;C&#46; glabrata&#47;C&#46; tropicalis</span>&#44; 5<span class="elsevierStyleItalic"> </span>patients had <span class="elsevierStyleItalic">C&#46; albicans&#47;C&#46; glabrata&#44;</span> 3 patients had<span class="elsevierStyleItalic"> C&#46; albicans&#47;C&#46; tropicalis&#44; </span>one had<span class="elsevierStyleItalic"> C&#46; glabrata&#47;C&#46; tropicalis </span>and one had <span class="elsevierStyleItalic">C&#46; glabrata&#47;C&#46; parapsilosis</span>&#46;&#160;</p><p class="elsevierStylePara">We observed OC in 16&#46;9&#37; &#40;23&#47;136&#41; of the total group&#44; 23&#46;2&#37; &#40;13&#47;56&#41; in DM-CRF patients and 12&#46;5&#37; &#40;10&#47;80&#41; in non-DM patients &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;101&#41;&#46; Of the 18 DP users&#44; 55&#46;6&#37; &#40;10&#47;18&#41; had prosthesis-associated OC&#44; 61&#46;5&#37; &#40;8&#47;13&#41; were DM patients and 40&#37; &#40;2&#47;5&#41; were non-DM patients &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;608&#44; Fisher&#8217;s ET&#41;&#46; In relation to the clinical type&#44; 19 patients &#40;82&#46;6&#37;&#41; displayed the erythematous type on the dorsum of the tongue and one patient had erythematous and pseudomembranous candidiasis and DP-associated candidiasis&#46; The <span class="elsevierStyleItalic">Candida </span>species identified in cases with candidiasis were <span class="elsevierStyleItalic">C&#46; albicans</span> 17 &#40;73&#46;9&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; tropicalis </span>7 &#40;30&#46;4&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; glabrata </span>4 &#40;17&#46;4&#37;&#41; and <span class="elsevierStyleItalic">C&#46; kefy</span>r 1 &#40;4&#46;3&#37;&#41;&#46; In the 36 cases without candidiasis&#44; we identified&#58; <span class="elsevierStyleItalic">C&#46; albicans</span> 27 &#40;75&#46;0&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; glabrata</span> 9 &#40;25&#46;0&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; parapsilosis</span> 2 &#40;5&#46;6&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; tropicalis</span> 2 &#40;5&#46;6&#37;&#41;&#44; <span class="elsevierStyleItalic">C&#46; kefyr</span> 1 &#40;2&#46;8&#37;&#41; and <span class="elsevierStyleItalic">C&#46; famata</span> 1 &#40;2&#46;8&#37;&#41;&#46; We did not observe a difference between groups &#40;those with and without candidiasis&#41; in the prevalence of <span class="elsevierStyleItalic">C&#46; albicans</span>&#46;</p><p class="elsevierStylePara">Table 4 shows the final multiple logistic regression analysis&#44; after discarding the variables that showed <span class="elsevierStyleItalic">P</span> values&#62;&#46;50 in previous analyses&#46; We observed an increased relative risk of the presence of <span class="elsevierStyleItalic">Candida</span> in OM &#40;with or without candidiasis&#41; in patients who used DP &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;006&#41;&#44; with xerostomia &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;001&#41; and with low serum albumin values &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;044&#41; &#40;the latter was 3&#46;6&#177;0&#46;6g&#47;dl in patients with candidiasis&#44; 3&#46;8&#177;0&#46;8g&#47;dl in carrier patients and 4&#46;1&#177;0&#46;6g&#47;dl in patients not colonised&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our results demonstrated that the presence of <span class="elsevierStyleItalic">Candida </span><span class="elsevierStyleItalic">in OM&#44; colonising or infecting&#44; was related to the use of DP&#44; </span>xerostomia and low serum albumin&#46;</p><p class="elsevierStylePara">Colonisation by <span class="elsevierStyleItalic">Candida sp&#46;</span> in the mucosa is a risk factor for superficial infections such as OC&#44; and others of greater significance&#44; i&#46;e&#46; invasive infections&#44; especially in immunocompromised patients&#46;<span class="elsevierStyleSup">5&#44;17&#44;20</span> The coexistence of different <span class="elsevierStyleItalic">Candida</span> species in an infection makes it more persistent and difficult to treat&#46;<span class="elsevierStyleSup">8&#44;21</span></p><p class="elsevierStylePara">Colonisation by <span class="elsevierStyleItalic">Candida sp&#46;</span> occurred in 43&#46;4&#37;&#44; a prevalence similar to that reported &#40;39&#37;&#41; in a similar study on patients with CKD&#46;<span class="elsevierStyleSup">22</span> Other authors have reported frequencies of 46&#37;<span class="elsevierStyleSup">23 </span>&#160;in DP users with HD&#44; or 51&#46;2&#37; in which the oral microbiota of HD patients was what was measured&#46;<span class="elsevierStyleSup">24</span> The frequency observed in this study was lower than that reported in other immunocompromised groups of patients with head and neck neoplasms 56&#46;8&#37;&#44;<span class="elsevierStyleSup">25</span> with solid organ transplants 57&#37;&#44;<span class="elsevierStyleSup">8 </span>with the human immunodeficiency virus &#40;HIV&#47;AIDS&#41; 66&#46;7&#37;&#44;<span class="elsevierStyleSup">26 </span>at the end of radiotherapy for oral cancer 69&#37;<span class="elsevierStyleSup">27</span> and with type 2 diabetes mellitus 77&#37;&#46;<span class="elsevierStyleSup">21</span> The foregoing may be explained by the fact that in each group studied&#44; there are major local factors&#44; such as a severe decrease in SF due to radiotherapy&#44; systemic factors such as the use of immunosuppressant drugs or antineoplastic medication that causes xerostomia or immunosuppression due to the underlying disease&#46; CKD patients&#44; despite the known decrease in monocyte functions&#44; systemic deterioration and hyposalivation&#44; are not on average as immunosuppressed as the other patients&#46;<span class="elsevierStyleSup">12&#44;27-29</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Candida albicans </span>was the predominant species &#40;74&#46;6&#37;&#41;&#44; without there being a difference between groups &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;148&#41;&#46; This species is the most prevalent both in healthy individuals<span class="elsevierStyleSup">2</span> and in those with systemic involvement&#46;<span class="elsevierStyleSup">7&#44;8&#44;22-25</span> Its frequencies vary in accordance with the group studied&#58; dialysis patients from 51&#46;7&#37; to 63&#37;&#44;<span class="elsevierStyleSup">22&#44;23</span> kidney transplant patients 44&#37;&#44;<span class="elsevierStyleSup">8&#44;30</span> patients with cancer in the head and neck 74&#37;&#44;<span class="elsevierStyleSup">25</span> patients with infection due to HIV&#47;AIDS from 60&#46;7&#37; to 83&#46;5&#37;&#44;<span class="elsevierStyleSup">7&#44;26</span> and in DM patients from 68&#46;9&#37; to 86&#46;5&#37;&#46;<span class="elsevierStyleSup">21&#44;31</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">C&#46; glabrata</span> was the second most common <span class="elsevierStyleItalic">Candida</span> species&#44; similar to that observed in another study on chronic dialysis patients&#46;<span class="elsevierStyleSup">22</span> In our study&#44; 8 patients simultaneously presented <span class="elsevierStyleItalic">C&#46; glabrata</span> and another species&#44; 4 of them without OC&#46; This mixed colonisation may be a risk factor for developing more severe infections&#46; <span class="elsevierStyleItalic">C&#46; glabrata</span> has been shown to be the second most isolated species after <span class="elsevierStyleItalic">C&#46; albicans</span> in patients with CKD and a renal transplant&#44;<span class="elsevierStyleSup">8&#44;22</span> cancer of the head and neck and haematological malignancies&#46;<span class="elsevierStyleSup">25</span><span class="elsevierStyleItalic">C&#46; glabrata</span> has been identified as an opportunistic species that in conditions of severe immunosuppression is associated with nosocomial infections&#44; a long dwell time of intravenous catheters&#44; the prophylactic use of antifungal medication &#40;especially fluconazole&#41; and the chronic use of DP&#46;<span class="elsevierStyleSup">32</span> This species may cause severe oropharyngeal candidiasis&#44; which is difficult to treat because it is innately less sensitive to fluconazole and itraconazole and results in higher mortality rates when candidaemia occurs&#46;<span class="elsevierStyleSup">33 -35</span></p><p class="elsevierStylePara">OC is the most commonly reported opportunistic fungal infection in CKD patients&#44; with frequencies ranging from 5&#46;7&#37; to 32&#37;&#46;<span class="elsevierStyleSup">15&#44;17</span> In this study&#44; OC was present in 17&#37; of patients&#46; The erythematous type was the most common &#40;83&#37;&#41;&#44; and xerostomia was a major risk factor&#46; It occurred on the dorsum of the tongue in all cases&#44; with there being no difference between DM and non-DM&#46; This prevalence is similar to that previously reported by us in CKD patients on HD&#44;<span class="elsevierStyleSup">15</span> which suggests that the characteristics of our study population are similar in terms of systemic condition&#46; Another factor associated with OC is a lower SF&#44; which results in a loss of the defensive function of saliva&#46;<span class="elsevierStyleSup">14&#44;15</span> In this study&#44; DM patients displayed lower SF and a higher frequency of xerostomia&#44; but only xerostomia was associated with OC&#46;</p><p class="elsevierStylePara">This study confirmed that the use of DP is a risk factor for colonisation and infection by <span class="elsevierStyleItalic">Candida</span>&#44; as shown by the high odds ratio of 25&#46;6 that we observed&#44; since in 83&#37; of patients who used a prostheses&#44; the <span class="elsevierStyleItalic">Candida</span> was isolated&#46; The use of DP is a risk factor for colonisation and&#47;or infection by <span class="elsevierStyleItalic">Candida</span> in the OM and is due to a lack of hygienic care and its use over many years&#46;<span class="elsevierStyleSup">5&#44;23&#44;24&#44;32</span> DM patients on HD have a higher frequency of tooth loss&#44; and as such&#44; the use of this dental apparatus is common&#46;<span class="elsevierStyleSup">36</span> Furthermore&#44; it was confirmed that the adhesion capacity of the fungus to inert polymers such as acrylic resins&#44; converts the latter into reservoirs&#44; which favours colonisation and&#47;or infection&#46;<span class="elsevierStyleSup">3&#44;5&#44;32</span> Other authors found an association between the density of colonisation by the fungus and the progression time of kidney disease&#44; but not of dialysis treatment&#44;<span class="elsevierStyleSup">23&#44;37</span> possibly due to the progressive deterioration caused by this disease&#46;</p><p class="elsevierStylePara">CKD patients on dialysis have a high frequency of nutritional&#44; immunological&#44; and psychological disorders as well disorders from invasive procedures and antimicrobial treatments&#44; which are known to contribute to the presence of a higher number of yeast colonies&#46;<span class="elsevierStyleSup">12&#44;13&#44;29</span> Their peritoneal dialysis or HD treatment requires the introduction of central venous or peritoneal catheters&#44; which&#44; as has already been mentioned&#44; are risk factors for invasive infections&#46;<span class="elsevierStyleSup">38-40</span><span class="elsevierStyleSup"> </span>In this regard&#44; the colonisation and&#47;or infection by <span class="elsevierStyleItalic">Candida</span> at different anatomical sites&#44; including the oropharyngeal<span class="elsevierStyleSup"> mucosa&#44; increases the risk of candidaemia&#44; through various mecanisms&#46;</span><span class="elsevierStyleSup">17&#44;28&#44;41</span> The implication of this risk factor for CKD patients on dialysis has been poorly documented&#46;</p><p class="elsevierStylePara">Furthermore&#44; diabetes mellitus has been described as a risk factor for OM colonisation by <span class="elsevierStyleItalic">Candida&#46;</span><span class="elsevierStyleSup">21&#44;31</span> However&#44; in the multiple logistic regression analysis of this study&#44; it was ruled out as an independent risk factor for both colonisation and OC&#46; One possible explanation is that ckd patients on dialysis may have deteriorated and have other systemic and local risk factors that are relatively more important&#46; Female sex was observed to be only marginally more associated with the presence of <span class="elsevierStyleItalic">Candida</span> in the OM in contrast to that reported by other authors&#46;<span class="elsevierStyleSup">31&#44;42</span> Notably&#44; an independent association was found between the presence of <span class="elsevierStyleItalic">Candida</span> colonising and&#47;or infecting the OM and low serum albumin&#44; which supports the notion that hypoalbuminaemia is a reflection of systemic deterioration&#44; with there being a lower capacity to defend against microorganisms&#46; While there have previously been reports on the association between low albumin and the female sex and diabetes in CKD patients on chronic dialysis&#44; particularly peritoneal dialysis<span class="elsevierStyleSup">13</span> &#40;where it is interpreted as a negative acute phase reactant&#41;&#44;<span class="elsevierStyleSup">43</span> our study does not confirm this association&#44; possibly due to the role of albumin as a marker&#44; particularly of nutritional status in HD patients&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara"><br></br> This study was important for identifying the frequency of colonisation and infection by <span class="elsevierStyleItalic">Candida</span> in CKD patients on dialysis&#44; since few studies have been carried out on this group of patients&#44; which in Mexico represents high rates of morbidity and mortality&#46; DM patients had lower SF &#40;hyposalivation&#41;&#44; higher xerostomia and low serum albumin&#44; with the latter being a risk factor not previously described for the presence of <span class="elsevierStyleItalic">Candida</span> in the OM in these patients&#46; We should be aware of the diversity found in <span class="elsevierStyleItalic">Candida</span> species&#44; including some highly pathogenic species&#44; such as <span class="elsevierStyleItalic">C&#46; glabrata </span>and<span class="elsevierStyleItalic"> C&#46; tropicalis</span>&#44; in the treatment of these patients&#44; since some of them have been reported in severe infections related to dialysis catheters&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11790&#95;16025&#95;52163&#95;en&#95;t1&#46;11790&#46;jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52163_en_t1.11790.jpg" alt="Demographic and clinical data of diabetic and non-diabetic patients with chronic kidney disease and chronic dialysis"></img></a></p><p class="elsevierStylePara">Table 1&#46; Demographic and clinical data of diabetic and non-diabetic patients with chronic kidney disease and chronic dialysis</p><p class="elsevierStylePara"><a href="grande&#47;11790&#95;16025&#95;52164&#95;en&#95;t2&#46;11790&#46;jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52164_en_t2.11790.jpg" alt="Oral characteristics and candidiasis in 136 patients with chronic kidney disease on dialysis"></img></a></p><p class="elsevierStylePara">Table 2&#46; Oral characteristics and candidiasis in 136 patients with chronic kidney disease on dialysis</p><p class="elsevierStylePara"><a href="grande&#47;11790&#95;16025&#95;52165&#95;en&#95;t3&#46;11790&#46;jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52165_en_t3.11790.jpg" alt="Distribution of Candida species in the oral mucosa of diabetic and non-diabetic patients on chronic dialysis"></img></a></p><p class="elsevierStylePara">Table 3&#46; Distribution of Candida species in the oral mucosa of diabetic and non-diabetic patients on chronic dialysis</p><p class="elsevierStylePara"><a href="grande&#47;11790&#95;16025&#95;52166&#95;en&#95;t4&#46;11790&#46;jpg" class="elsevierStyleCrossRefs"><img src="11790_16025_52166_en_t4.11790.jpg" alt="Risk factors for the presence of Candida &#40;with or without candidiasis&#41;&#44; in diabetic and non-diabetic patients on chronic dialysis"></img></a></p><p class="elsevierStylePara">Table 4&#46; Risk factors for the presence of Candida &#40;with or without candidiasis&#41;&#44; in diabetic and non-diabetic patients on chronic dialysis</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> La candidosis bucal &#40;CB&#41; es una infecci&#243;n oportunista frecuente en el paciente inmunocomprometido y algunas veces es importante conocer la especie para el tratamiento&#46; <span class="elsevierStyleBold">Objetivo&#58; </span>Determinar la prevalencia de distintas especies de <span class="elsevierStyleItalic">Candida</span> colonizando o infectando la mucosa bucal &#40;MB&#41; de pacientes diab&#233;ticos &#40;DM&#41; y no diab&#233;ticos &#40;no DM&#41; con enfermedad renal cr&#243;nica&#44; comparando ambos grupos y explorando algunos posibles factores de riesgo&#46; <span class="elsevierStyleBold">Metodolog&#237;a&#58;</span> Se examin&#243; a 56 pacientes DM y 80 no DM con di&#225;lisis cr&#243;nica&#46; Se tomaron muestras de la MB y se sembraron en agar placas dextrosa Sabouraud&#46; La especie se identific&#243; con galer&#237;as API<span class="elsevierStyleSup">&#174;</span>&#46; La CB se confirm&#243; con citolog&#237;a exfoliativa&#46; Las asociaciones se investigaron con &#967;<span class="elsevierStyleSup">2</span>&#44; Prueva exacta &#40;PE&#41; de Fisher y regresi&#243;n log&#237;stica m&#250;ltiple&#46; <span class="elsevierStyleBold">Resultados</span><span class="elsevierStyleBold">&#58; </span>La prevalencia de <span class="elsevierStyleItalic">Candida</span> fue del 43&#44;4&#160;&#37;&#58; 53&#44;6&#160;&#37; DM y 36&#44;2&#160;&#37; no DM &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#44;045&#41;&#46; Las especies fueron <span class="elsevierStyleItalic">C&#46;</span> <span class="elsevierStyleItalic">albicans </span>74&#44;6&#160;&#37;&#44;<span class="elsevierStyleItalic"> C&#46; glabrata</span> 22&#44;0&#160;&#37;&#44; <span class="elsevierStyleItalic">C</span>&#46; <span class="elsevierStyleItalic">tropicalis</span> 15&#44;2&#160;&#37;&#44; <span class="elsevierStyleItalic">C&#46;</span> <span class="elsevierStyleItalic">parapsilosis</span> 3&#44;4&#160;&#37;&#44;<span class="elsevierStyleItalic"> C&#46; kefyr</span> 3&#44;4&#160;&#37; y <span class="elsevierStyleItalic">C&#46;</span> <span class="elsevierStyleItalic">famata</span> 1&#44;7&#160;&#37; sin diferencia entre grupos&#46; Los DM tuvieron mayor frecuencia de xerostom&#237;a &#40;<span class="elsevierStyleItalic">p </span>&#61; 0&#44;002&#41;&#44; flujo salival bajo &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#44;008&#41; y alb&#250;mina s&#233;rica m&#225;s baja &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#44;018&#41;&#46; Tuvieron CB 16&#44;9&#160;&#37;&#44; 23&#44;2&#160;&#37; DM frente a 12&#44;5&#160;&#37; no DM &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#44;101&#41;&#46; Se asociaron a presencia de <span class="elsevierStyleItalic">Candida</span> en la MB&#58; uso de pr&#243;tesis &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93; 25&#44;6&#44; l&#237;mite de confianza &#91;LC&#93; 95&#160;&#37; 2&#44;5 a 253&#44; <span class="elsevierStyleItalic">p</span> &#61; 0&#44;001&#41;&#44; xerostom&#237;a &#40;OR 9&#44;6&#44; LC 95&#160;&#37; 2&#44;4 a 38&#44;1<span class="elsevierStyleItalic">&#44; p </span>&#61; 0&#44;001&#41; y bajos valores de alb&#250;mina s&#233;rica &#40;OR 0&#44;41&#44; LC 95&#160;&#37; 0&#44;22 a 0&#44;98&#44; <span class="elsevierStyleItalic">p </span>&#61; 0&#44;044&#41;&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span> La presencia de <span class="elsevierStyleItalic">Candida </span><span class="elsevierStyleItalic">sp&#46;</span> en la MB se asoci&#243; a pr&#243;tesis dental&#44; xerostom&#237;a y alb&#250;mina s&#233;rica baja&#46;&#160;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Oral candidiasis &#40;OC&#41; is a common opportunistic infection in immunocompromised patients&#46; Species identification is sometimes important for treatment&#46;<span class="elsevierStyleBold">&#160;Objective&#58;</span> to determine the prevalence of different <span class="elsevierStyleItalic">Candida</span> species colonising or infecting the oral mucosa &#40;OM&#41; of diabetic &#40;DM&#41; and non-diabetic &#40;non-DM&#41; chronic kidney disease patients&#44; comparing both groups and exploring potential risk factors&#46; <span class="elsevierStyleBold">Methods&#58; </span>56 DM and 80 non-DM patients on chronic dialysis were examined&#46; OM swabs were cultured on Sabouraud dextrose agar plates&#46; <span class="elsevierStyleItalic">Candida</span> species were identified with API<span class="elsevierStyleSup">&#174;</span> galleries&#46; OC was confirmed by exfoliative cytology&#46; Statistical associations were analysed using &#967;<span class="elsevierStyleSup">2</span>&#44; Fisher&#8217;s exact test &#40;ET&#41;&#44; and multiple logistic regression&#46; <span class="elsevierStyleBold">Results&#58; </span><span class="elsevierStyleItalic">Candida</span> prevalence was 43&#46;4&#37;&#58; 53&#46;6&#37; DM and 36&#46;3&#37; non-DM&#44; &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;045&#41;&#46; The species identified were C&#46; <span class="elsevierStyleItalic">albicans </span>74&#46;6&#37;&#44;<span class="elsevierStyleItalic"> C&#46; glabrata</span> 22&#46;0&#37;&#44; <span class="elsevierStyleItalic">C</span>&#46; <span class="elsevierStyleItalic">tropicalis</span> 15&#46;2&#37;&#44; <span class="elsevierStyleItalic">C&#46;</span> <span class="elsevierStyleItalic">parapsilosis</span> 3&#46;4 &#37;<span class="elsevierStyleItalic">&#44; C&#46; kefyr</span> 3&#46;4&#37; and <span class="elsevierStyleItalic">C&#46;</span> <span class="elsevierStyleItalic">famata</span> 1&#46;7&#37; without difference between groups&#46; DM patients had a higher xerostomia prevalence &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;002&#41; and lower salivary flow &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;008&#41; and lower serum albumin &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;018&#41;&#46; 16&#46;9&#37; of patients had OC&#44; 23&#46;2&#37; DM compared with 12&#46;5&#37; non-DM&#44; &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;101&#41;&#46; The following were associated with the presence of <span class="elsevierStyleItalic">Candida</span> in the OM&#58; the use of dental prostheses &#40;odds ratio &#91;OR&#93; 25&#46;6&#44; 95&#37; confidence interval &#91;CI&#93; 2&#46;5 to 253&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#44; xerostomia &#40;OR 9&#46;6&#44; 95&#37; CI 2&#46;4 to 38&#46;1&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41; and low serum albumin values &#40;OR 0&#46;41&#44; 95&#37; CI 0&#46;22 to 0&#46;98&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;044&#41;&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> The presence of <span class="elsevierStyleItalic">Candida </span>sp<span class="elsevierStyleItalic">&#46;</span> in the OM was associated with dental prostheses&#44; xerostomia and low serum albumin&#46;</p>"
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            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cannon RD, Chaffin WL. Oral colonization by Candida albicans. Crit Rev Oral Biol Med 1999;10:359-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10759414" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yang YL, Leaw SN, Wang AH, Chen HT, Cheng WT, Lo HJ. Characterization of yeasts colonizing in healthy individuals. Med Mycol 2011;49:103-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20491531" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gow NA, van de Veerdonk FL, Brown AJ, Netea MG. Candida albicans morphogenesis and host defence: discriminating invasion from colonization. Nat Rev Microbiol 2011;10:112-22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22158429" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cannon RD, Holmes AB, Monk BC. Oral Candida: Clearance, colonization, or candidiasis? J Dent Res 1995;74:1152-61."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cannon RD, Chaffin L. Colonization is a crucial factor in oral candidiasis. J Dent Educ 2001;65:785-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11518251" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Reichart PA, Samaranayake LP, Phillipsen HP. Pathology and clinical correlates in oral candidiasis and its variants: a review. Oral Dis 2000;6:85-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10702784" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Luque AG, Biasoli MS, Tosello ME, Binolfi A, Lupo S, Magaró HM. Oral yeast carriage in HIV-infected and non-infected populations in Rosario, Argentina. Mycoses 2009;52:53-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dongari-Bagtzoglou A, Dwivedi P, Ioannidou E, Shaqman M, Hull D, Burleson J. Oral Candida infection and colonization in solid organ transplant recipients. Oral Microbiol Immunol 2009;24:249-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19416456" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Paniagua R, Ramos A, Fabian R, Lagunas J, Amato D. Chronic kidney disease and dialysis in Mexico. Perit Dial Int 2007;27(4):405-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17602147" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Amato D, Alvarez-Aguilar C, Castañeda-Limones R, Rodriguez E, Avila-Diaz M, Arreola F, et al. Prevalence of chronic kidney disease in an urban Mexican population. Kidney Int Suppl 2005;(97):S11-7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cueto-Manzano AM, Rojas-Campos E. Status of renal replacement therapy and peritoneal dialysis in Mexico. Perit Dial Int 2007;27:142-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17299147" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Haag-Weber M, Dumann H, Hörl WH. Effect of malnutrition and uremia on impaired cellular host defence. Miner Electrolyte Metab 1992;18:174-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1465054" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pupim LB, Caglar K, Hakim RM, Shyr Y, Ikizler TA. Uremic malnutrition is a predictor of death independent of inflammatory status. Kidney Int 2004;66:2054-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15496179" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kho HS, Lee SW, Chung SC, Kim YK. Oral manifestations and salivary flow rate, pH, and buffer capacity in patients with end-stage renal disease undergoing hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:316-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10503861" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "de la Rosa GE, Mondragón PA, Aranda S, Bustamante M. Oral mucosa symptoms, signs, and lesions, in end-stage renal disease and non-end stage renal disease diabetic patients. Med Oral Patol Oral Cir Bucal 2006;11:E467-7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "de la Rosa GE, Cruz Mérida S, Mondragón Padilla A. Frecuencia de manifestaciones bucales en pacientes diabéticos tipo2 de una unidad de medicina familiar del IMSS. Rev Ciencias Clínicas 2006;7:81-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Thorman R, Neovius M, Hylander B. Prevalence and early detection of oral fungal infection: a cross-sectional controlled study in a group of Swedish end-stage renal disease patients. Scand J Urol Nephrol 2009;43:325-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19363743" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "López-JP, Camacho AF, Bermejo FA. A simple test for salivary gland hypofunction using oral Schirmer's test. J Oral Pathol Med 2006;35:244-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16519773" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Holmstrup P, Axéll T. Classification and clinical manifestations of oral yeast infections. Acta Odontol Scand 1990;48:57-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2181811" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Picazo JJ, González-Romo F, Candel FJ. Candidemia in the critically ill patient. Int J Antimicrob Agents 2008;32 Suppl 2:S83-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19013345" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Willis AM, Coultert WA, Fultont CR, Hayes JR, Bell PM, Lamey PJ. Oral candidal carriage and infection in insulin-treated diabetic patients. Diabet Med 1999;16:675-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10477213" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Godoy JS, de Souza Bonfim-Mendonca P, Nakamura SS, Yamada SS, Shinobu-Mesquita C, Pieralisi N, et al. Colonization of the oral cavity by yeasts in patients with chronic renal failure undergoing hemodialysis. J Oral Pathol Med 2012;42:229-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22978344" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pires-Gonçalves RH, Toscano-Miranda E, Cristiane-Baeza L, Teruyuki-Matsumoto M, Zaia JE, Mendes-Giannini MJS. Genetic relatedness of commensal strains of Candida albicans carried in the oral cavity of patients dental prosthesis users in Brazil. Mycopathologia 2007;164:255-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17906942" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Takeuchi Y, Ishikawa H, Inada M, Shinozuka O, Umeda M, Yamazaki T, et al. Study of the oral microbial flora in patients with renal disease. Nephrology (Carlton) 2007;12:182-90."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Schelenz S, Abdallah S, Gray G, Stubbings H, Gow I, Baker P, et al. Epidemiology of oral yeast colonization and infection in patients with hematological malignancies, head neck and solid tumors. J Oral Pathol Med 2011;40:83-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20923440" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sánchez-Vargas LO, Ortiz-López NG, Villar M, Moragues MD, Aguirre JM, Cashat-Cruz M, et al. Oral Candida isolates colonizing or infecting human immunodeficiency virus-infected and healthy persons in Mexico. J Clin Microbiol 2005;43:4159-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16081965" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mañas A, Cerezo L, de la Torre A, García M, Alburquerque H, Ludeña B, et al. Epidemiology and prevalence of oropharyngeal candidiasis in Spanish patients with head and neck tumors undergoing radiotherapy treatment alone or in combination with chemotherapy. Clin Transl Oncol 2012;14:740-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22960994" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mitchell KG, Bradley JA, Ledingham IM, Hamilton DN. Candida colonization of the oral cavity. Surg Gynecol Obstet 1982;154:870-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7079931" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lim WH, Kireta S, Leedham E, Russ GR, Coates PT. Uremia impairs monocyte and monocyte-derived dendritic cell function in hemodialysis patients. Kidney Int 2007;72:1138-48. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17728708" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ahmadieh A, Baharvand M, Fallah F, Djaladat H, Eslani M. Oral microflora in patients on hemodialysis and kidney transplant recipients. Iran J Kidney Dis 2010;4:227-31. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20622312" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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              ]
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                0 => array:3 [
                  "referenciaCompleta" => "Al-Attas SA, Amro SO. Candidal colonization, strain diversity, and antifungal susceptibility among adult diabetic patients. Ann Saudi Med 2010;30:101-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20220258" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
            ]
            31 => array:3 [
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                0 => array:3 [
                  "referenciaCompleta" => "Salerno C, Pascale M, Contaldo M, Esposito V, Busciolano M, Milillo L, et al. Candida-associated denture stomatitis. Med Oral Patol Oral Cir Bucal 2011;16:e139-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20711156" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Li L, Redding S, Dongari-Bagtzoglou A. Candida glabrata: an emerging oral opportunistic pathogen. J Dent Res 2007;86:204-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17314251" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Redding SW. The role of yeasts other than Candida albicans in oropharyngeal candidiasis. Curr Opin Infect Dis 2001;14:673-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11964883" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Merenstein D, Hu H, Wang C, Hamilton P, Blackmon M, Chen H, et al. Colonization by Candida species of the oral and vaginal mucosa in HIV-infected and noninfected women. AIDS Res Hum Retroviruses 2013;29:30-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23098053" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
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              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "de la Rosa E, Cruz S, Mondragón A. Tooth loss in diabetic patients with and without chronic kidney disease and dialysis. Nefrologia 2008;28:645-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19016639" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
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              "identificador" => "bib37"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yazdani M, Jahanshahi GR, Mahdavi KN, Asadian F. Study of the relationship between oral Candida colony counts and time on hemodialysis at Khorshid Hospital, Isfahan, Iran. Transplant Proc 2003;35:2580-1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14612025" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Khan FY, Elsayed M, Anand D, Abu Khattab M, Sanjay D. Fungal peritonitis in patients undergoing continuous ambulatory peritoneal dialysis in Qatar. J Infect Dev Ctries 2011;5:646-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21918305" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Picazo JJ, González-Romo F, Candel FJ. Candidemia in the critically ill patient. Int J Antimicrob Agents 2008;32 Suppl 2:S83-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19013345" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
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            ]
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              "identificador" => "bib40"
              "etiqueta" => "40"
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                0 => array:3 [
                  "referenciaCompleta" => "García-Martos P, Gil de Sola F, Marín P, García-Agudo L, García-Agudo R, Tejuca F, et al. Fungal peritonitis in ambulatory continuous peritoneal dialysis: description of 10 cases. Nefrologia 2009;29:534-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19935997" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Giri S, Kindo AJ. A review of Candida species causing blood stream infection. Indian J Med Microbiol 2012;30:270-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22885191" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Martínez RF, Jaimes-Aveldañez A, Hernández-Pérez F, Arenas R, Miguel GF. Oral Candida spp carriers: its prevalence in patients with type 2 diabetes mellitus. An Bras Dermatol 2013;88:222-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23739717" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            ]
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              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Blake PG. Adequacy of peritoneal dialysis and chronic peritoneal dialysis prescription. In: Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. Fourth ed. Lippincott Williams & Wilkins 2007. pp. 387-409."
                  "contribucion" => array:1 [
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Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.pre2013.Aug.11790

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	10	11	21
2024 October	64	92	156
2024 September	78	58	136
2024 August	75	70	145
2024 July	71	38	109
2024 June	111	60	171
2024 May	96	39	135
2024 April	71	52	123
2024 March	43	24	67
2024 February	37	51	88
2024 January	31	25	56
2023 December	47	43	90
2023 November	57	58	115
2023 October	44	54	98
2023 September	56	39	95
2023 August	54	32	86
2023 July	57	45	102
2023 June	89	33	122
2023 May	77	52	129
2023 April	44	40	84
2023 March	59	29	88
2023 February	41	21	62
2023 January	38	32	70
2022 December	64	43	107
2022 November	55	36	91
2022 October	80	60	140
2022 September	49	41	90
2022 August	66	73	139
2022 July	55	58	113
2022 June	50	52	102
2022 May	45	56	101
2022 April	63	67	130
2022 March	52	61	113
2022 February	49	43	92
2022 January	80	46	126
2021 December	58	56	114
2021 November	44	47	91
2021 October	79	62	141
2021 September	65	67	132
2021 August	58	56	114
2021 July	54	44	98
2021 June	47	36	83
2021 May	53	53	106
2021 April	121	78	199
2021 March	85	61	146
2021 February	114	40	154
2021 January	69	42	111
2020 December	80	30	110
2020 November	88	25	113
2020 October	71	19	90
2020 September	79	23	102
2020 August	68	23	91
2020 July	88	33	121
2020 June	88	35	123
2020 May	142	24	166
2020 April	81	28	109
2020 March	121	33	154
2020 February	114	34	148
2020 January	141	36	177
2019 December	144	39	183
2019 November	124	41	165
2019 October	75	28	103
2019 September	99	32	131
2019 August	66	26	92
2019 July	97	38	135
2019 June	92	30	122
2019 May	117	30	147
2019 April	179	40	219
2019 March	119	33	152
2019 February	40	24	64
2019 January	67	16	83
2018 December	134	48	182
2018 November	212	47	259
2018 October	191	57	248
2018 September	147	23	170
2018 August	82	21	103
2018 July	91	21	112
2018 June	82	25	107
2018 May	97	18	115
2018 April	68	8	76
2018 March	105	15	120
2018 February	70	10	80
2018 January	96	10	106
2017 December	77	16	93
2017 November	83	10	93
2017 October	70	13	83
2017 September	74	13	87
2017 August	75	27	102
2017 July	67	13	80
2017 June	72	20	92
2017 May	74	20	94
2017 April	60	18	78
2017 March	51	17	68
2017 February	110	18	128
2017 January	57	15	72
2016 December	116	10	126
2016 November	151	18	169
2016 October	220	20	240
2016 September	332	16	348
2016 August	423	20	443
2016 July	327	17	344
2016 June	194	0	194
2016 May	176	0	176
2016 April	146	0	146
2016 March	128	0	128
2016 February	140	0	140
2016 January	140	0	140
2015 December	148	0	148
2015 November	105	0	105
2015 October	127	0	127
2015 September	100	0	100
2015 August	100	0	100
2015 July	112	0	112
2015 June	61	0	61
2015 May	65	0	65
2015 April	5	0	5

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