Signs, symptoms and the prevalence of fungi detected from the oral cavity and pharynx of radiotherapy subjects with head and neck tumors, and their susceptibility to chemotherapeutics

Radio- and chemotherapy for malignant neoplasms, especially in head and neck region, is associated with a greater risk of fungal infections due to secondary alterations in the mucous membranes. The study had three aims: 1. to determine the signs and symptoms which occur among patients undergoing radiotherapy; 2. to determine the fungi prevalence in the mouth and throat of patients before, during and after radiotherapy; 3. to examine the sensitivity of strains to antimycotic drugs. The study comprised 44 patients (11 female, 33 male) with head and neck cancers, examined at the following stages: before radiotherapy (44 patients – batch 1), 3rd week of therapy (30 of the 44 patients – batch 2), last day of therapy (28 of batch 2 – batch 3) and the 6th week after completion of radiotherapy (10 of batch 3 – batch 4). Clinical examination was performed and mycological status was estimated from an oral rinse on a selected medium. The fungal strains were isolated and sensitivity to antifungal drugs was determined. The most common symptoms were pain, dysphagia, and dysgeusia. Physical examination revealed signs of mucositis mainly among patients from batches 2 and 3. The presence of fungi in the mouth and throat was noted in over 2/3 (66.2%) of the patients from batch 1, and in 4/5 (80%) of batch 2. The fungi were detected in over half (57.1%) of patients from batch 3 and also in patients from batch 4. In all cases, fungi of various Candida species were identified: 6 species in batch 1, 8 in batch 2, 6 in batch 3 and 5 in batch 4. The most frequently detected species was C. albicans, constituting 40–60%; the other species detected are known to be resistant to antimycotic drugs. The isolated strains were the most sensitive to nystatin and miconazole, and the least to ketoconazole and fluconazole. Conclusions: 1. Patients undergoing radiotherapy complain of pain, dysphagia, and dysgeusia; in most cases mucositis is diagnosed. 2. The high prevalence of fungi in the mouth and throat of patients treated by radiotherapy reinforces the need to perform mycological examinations in this group of patients to detect fungi, identify their species and determine of their sensitivity to drugs in order to prevent complications. 3. The species most frequently isolated from the patients are C. albicans and C. glabrata. The latter is characterized by resistance to the majority of antimycotic medications. 4. Most of the isolated strains are sensitive to nystatin and miconazole (applied locally) and to itraconazole (absorbed from the gastrointestinal tract).