Colonization by Candida spp. In oral mucosa lesions: a cross-sectional study on prevalence, risk factors, and antifungal resistance
- 1Dental Sciences, Federal University of Espírito Santo, Av. Marechal Campos – Maruípe CEP 29040-090, Vitória - ES, Espírito Santo, 1468 Brazil
- 2Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- 3Department of Biological Sciences, Federal University of São Paulo, Diadema, São Paulo Brazil
Abstract
Background: Candida spp. are microorganisms present in the microbiota of healthy adults. An imbalance between the microbiota and the host can cause oral candidiasis. Candida spp. infection has been linked to altered salivary gland function and specific oral mucosa lesions. However, there is limited research on the prevalence of Candida spp. in different oral mucosal lesions. This study aimed to evaluate the prevalence of Candida spp. across various oral mucosa lesions, regardless of symptom presence, and to contribute to delineating the profile of colonization/infection, by identifying predisposing local and systemic risk factors, performing molecular identification of Candida species, and evaluating the antifungal susceptibility of the isolated yeasts.
Methods: A cross-sectional study was conducted, involving the collection of oral mucosal samples with sterile swabs from two sites: the lesion and the control site. Patients were excluded if they received antifungal, corticosteroid, or local antibiotic therapy within 15 days, or systemic antibiotics within 30 days before consultation. The samples were processed using CHROMagar Candida, followed by identification through biochemical and morphological tests. The MALDI-TOF MS methodology confirmed the identification of all isolates. The isolates were then evaluated for in vitro antifungal susceptibility. In addition, general and dental health data were collected to identify predisposing factors. Pearson’s chi-square test, McNemar’s test, Fisher’s exact test, or Student’s t-test was applied. A significance level of p < 0.05 was used.
Results: 40% of the 80 patients tested positive for Candida spp. within the oral mucosal lesions, with C. albicans (62.5%) being the most common isolated species. Diabetes was significantly associated with Candida spp. colonization (p = 0.01), and elevated nystatin minimum inhibitory concentrations (MICs) were observed in 37 isolates. It was further observed that oral lesions associated with risk factors influence Candida spp. colonization.
Conclusion: A high prevalence of Candida spp. was observed in oral mucosal lesions, particularly among patients with diabetes mellitus. In the absence of established clinical breakpoints or epidemiological cutoff values (ECOFFs) for nystatin, elevated MICs values may suggest reduced susceptibility among certain isolates; however, such interpretations should be made with caution. Although these results do not indicate resistance, they serve as a caution to clinicians regarding the potential for decreased antifungal effectiveness.
Clinical trial: Not applicable.
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BibTeX
@article{feletti2026colonization,
title = {{Colonization by Candida spp. In oral mucosa lesions: a cross-sectional study on prevalence, risk factors, and antifungal resistance}},
author = {Mariana Pires Feletti and Vinícius Matos Novo and Jhully Pimentel and Simone Maifrede Bravim and Danielle Resende Camisasca and Rodrigo Cayô da Silva and Sarah Santos Gonçalves and Tânia Regina Grão-Velloso},
journal = {BMC Infectious Diseases},
year = {2026},
month = jul,
doi = {10.1186/s12879-026-14145-1},
url = {https://doi.org/10.1186/s12879-026-14145-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Colonization by Candida spp. In oral mucosa lesions: a cross-sectional study on prevalence, risk factors, and antifungal resistance
AU - Mariana Pires Feletti
AU - Vinícius Matos Novo
AU - Jhully Pimentel
AU - Simone Maifrede Bravim
AU - Danielle Resende Camisasca
AU - Rodrigo Cayô da Silva
AU - Sarah Santos Gonçalves
AU - Tânia Regina Grão-Velloso
PY - 2026
DA - 2026/07/31
JO - BMC Infectious Diseases
DO - 10.1186/s12879-026-14145-1
UR - https://doi.org/10.1186/s12879-026-14145-1
AB - Background: Candida spp. are microorganisms present in the microbiota of healthy adults. An imbalance between the microbiota and the host can cause oral candidiasis. Candida spp. infection has been linked to altered salivary gland function and specific oral mucosa lesions. However, there is limited research on the prevalence of Candida spp. in different oral mucosal lesions. This study aimed to evaluate the prevalence of Candida spp. across various oral mucosa lesions, regardless of symptom presence, and to contribute to delineating the profile of colonization/infection, by identifying predisposing local and systemic risk factors, performing molecular identification of Candida species, and evaluating the antifungal susceptibility of the isolated yeasts. Methods: A cross-sectional study was conducted, involving the collection of oral mucosal samples with sterile swabs from two sites: the lesion and the control site. Patients were excluded if they received antifungal, corticosteroid, or local antibiotic therapy within 15 days, or systemic antibiotics within 30 days before consultation. The samples were processed using CHROMagar Candida, followed by identification through biochemical and morphological tests. The MALDI-TOF MS methodology confirmed the identification of all isolates. The isolates were then evaluated for in vitro antifungal susceptibility. In addition, general and dental health data were collected to identify predisposing factors. Pearson’s chi-square test, McNemar’s test, Fisher’s exact test, or Student’s t-test was applied. A significance level of p < 0.05 was used. Results: 40% of the 80 patients tested positive for Candida spp. within the oral mucosal lesions, with C. albicans (62.5%) being the most common isolated species. Diabetes was significantly associated with Candida spp. colonization (p = 0.01), and elevated nystatin minimum inhibitory concentrations (MICs) were observed in 37 isolates. It was further observed that oral lesions associated with risk factors influence Candida spp. colonization. Conclusion: A high prevalence of Candida spp. was observed in oral mucosal lesions, particularly among patients with diabetes mellitus. In the absence of established clinical breakpoints or epidemiological cutoff values (ECOFFs) for nystatin, elevated MICs values may suggest reduced susceptibility among certain isolates; however, such interpretations should be made with caution. Although these results do not indicate resistance, they serve as a caution to clinicians regarding the potential for decreased antifungal effectiveness. Clinical trial: Not applicable.
SN - 1471-2334
ER -