V. I. Fesenko V. V. Fesenko*

State Establishmenе «MZ Dnipropetrovsk Medical Academy» of Ukraine»

Kryvyi Rih College of Economics and Management

State Educational Establishment

“Kyiv National Economic University by Vadym Het’man”*

Candidial lesions of the oral cavity and its correction in persons living in industrial area

Summary The application results of the Bactulin medication in a combination treatment of candidal lesions of the oral cavity are presental in this article. There is also a significant improvement in the general condition of the patients and the achievement of the normalization of the microbial landscape of the mouth, which indicates the effectiveness of Bactulin for the treatment of the candidal stomatitis and for the prevention of the recurrence thereof.

Keywords: candidiasis, Bactulin, treatment

The analysis of the incidence of fungal infection conducted by the World Health Organization (WHO) in industrialized countries, proved continued spread of both surface and deep forms of the candidiasis [3, 10].

Among the diseases of the mucous membrane of the oral cavity (MMOC), the fungal lesion holds the dominant position. The place of the normal existence of small amounts of the Candida species fungi is the biotope of the mucous membranes (MM), so disturbances of the competitive interaction of fungi with bacteria of the regular microflora of the host, the influence of different environmental factors, changes in environmental conditions that lead to a decrease in the immunological defense, play, therefore, an important role in the development of candidiasis. Circumstances of the environment serve as contributing or reinforcing factors. This and other things result in a significant rate of the MMOC candidiasis, the dominance of chronic forms of the disease and the susceptibility to frequent recurrence [5,7,9].

The purpose of the combination therapy of the candidiasis-induced lesions of the MMOC is to provide not only an immediate effect, but also the prevention of the disease recurrence. The treatment should be comprehensive and based on the principles of an individualized approach, with the general condition of the patient and his/her dental status taken into account [2,4,7]. The success of treatment of the candidiasis-induced lesions of the MMOC is largely dependent on the combination of antifungal medications and drugs that enhance the immunological reactivity of the organism as a whole [5]. However, the azole and polyene antifungal medications therapy involves the risk of side effects (primarily hepatotoxicity). The main problem with the treatment of some forms of superficial candidiasis is that a certain part of the Candida species is resistant to systemic antifungal drugs. The intestinal tract is the source of highly virulent strains of fungi that cause damage to the MMOC, so without an adequate destruction of fungi in it, such therapy is usually ineffective [2].

Lately, increasingly more clinical data have suggested great prospects for the use of bacterial medications for the correction of the oral cavity dysbiosis [1, 6, 8].

Purpose of the research.

Improvement of the treatment efficiency and the recurrence prevention of the candidiasis-induced lesion of the oral cavity in patients who are affected by iron-mining industrial zone conditions, through the use of a therapeutic and preventive combination, which includes the Bactulin medication.

Materials and methods of the research.

Our study involved 17 people who had been diagnosed with the chronic candidal stomatitis and who lived in industrial area. The age of the patients ranged from 25 to 35 years. Of those surveyed 12 patients were diagnosed to have the hyperplastic candidiasis, 5 persons were registered with the atrophic one. 88.2 % of the patients were diagnosed with the mycotic glossitis. The desquamative and infiltrative forms were more common. The complaints, the patients drew attention to, were: pain while taking irritating foods, burning sensation and dryness in the mouth; the presence of accretions, different in texture and color and in different parts of the MM, more often in the mucosa of the tongue; foul breath.

The treatment plan was prescribed strictly individually on the basis of the clinical and laboratory data, and was agreed upon with the gastroenterologist. Particular attention was paid to the patient's instruction in the hygiene of the oral cavity. If the furring of the tongue was closely adjacent to the MM, cleaning with special curettes was prescribed. All patients underwent the oral cavity sanitation.

The survey of the patients envisaged the assessment of their clinical status according to the nature of the complaints and the objective changes in the MMOC: the degree of hyperemia and edema; the presence of hypertrophy and desquamation; accretions, different in texture and color. The hygienic condition was evaluated by the Fyodorov-Volodkina method. For all the patients, the microscopic and microbiological examination of the material from the foci of the lesions was conducted. To account for the quantitative composition of the microorganisms, the determination of the bacterial count by means of the decimal logarithm of the CFU (LgCFU/ml) was used. A prerequisite was to determine the susceptibility of the bacteria inoculated to the antiseptics. The clinical efficacy of the therapeutic effect of the medications was determined by comparing subjective data obtained during interviews with the patients and the bacteriological examination. Monitoring the effectiveness of the therapy was performed on the 7th and the 14th day from the start of the treatment. In the event of recurrence, a retreatment was conducted.

  The therapeutic and preventive combination proposed by us included the bacterial medication Bactulin, part of which was Inulin with bifid bacteria and lactobacilli. Such a composition helps normalize the biotope stimulating the bowel and liver functions. The medication was administered as follows: 1 tablet 2 times a day for 6 to 7 weeks. The therapy was supplemented with the vitamin drug Supradyn: 1 sugar-coated tablet 1 time a day for 1 month. Taking into account the sensitivity of the yeast fungi to the antiseptic medication Givalex, the latter was administered to irrigate the oral cavity 1 time per day. The treatment was supplemented with the local introduction of Diflucan into lesion foci for 7 to 10 minutes using ultraphonophoresis. For this purpose, 50 mg of the drug were mixed with the liquid paraffin to a homogeneous mass. The combination of the bactericidal effect of the ultrasound with the pharmacological action of the drug helps achieve the inhibition of the fungi activity. The course of treatment depended on the severity of the disease and the course thereof. Given the chronic nature of the stomatitis and recommendations with respect to its therapy, the patients underwent Bactulin retreatment after 6 and 12 months. The data obtained were processed using the method of analysis of variance.
The findings of the research and their discussion.
 The analysis of the survey of the clinical condition of the MMOC and the nature of the biotope changes revealed different clinical developments of the candidiasis-induced lesions. The hygienic condition of the patients surveyed was evaluated as unsatisfactory, i.e. 2.5±0.2 points.
 In most of the patients (58.8%), clinical manifestation of the fungal stomatitis was characterized by the presence of grayish white and in some cases brown furring on the mucosa of the dorsum of the tongue. After the removal of this furring, an algetic, eroded, sometimes bleeding surface appeared. In 41.2% of the patients, isolated pockets of furring on the oral mucosa were found. This furring can be easily removed leaving a hyperemic surface and bleeding fissures in the corners of the mouth. A substantial role in the dental status of the patients, in your opinion, plays the impact of adverse circumstances of the mining and smelting complex, as a factor contributing to the reduction in the efficiency of the body's defense mechanisms, including the oral mucosa. As the length of service and the age of the residents of the industrial area grow, so does the activity of the clinical nature of the candidiasis. 76.5% of the persons surveyed reported the recurring nature of the disease.
 The analysis of the patients' bacteriological research data obtained allowed us to draw a conclusion about a significant level of the insemination of the MMOC through aerobic and anaerobic bacteria – the bacterial count (lg) CFU was 4.6±0.4. In 82.3% of the cases, the Candida fungi were found in the association. S. pyogenes, S. sanguis, Fusobacterium spp. were the most frequent associates, which were inoculated in a concentration of 104-108 CFU/ml, while the Candida fungi occurred in the oral cavity in a concentration of 103-106CFU/ml.
 In addition, there were manifestations of the candidiasis-induced intestinal dysbacteriosis of varying degrees in this cohort. In the majority (52.9%) of the patients, the intestinal dysbiosis was characterized by a moderate decrease in the number of bifid bacteria (107-109 CFU/g) and lactic ones (105-108 CFU/g) with a simultaneous increase in the number of bacterioids and the Candida fungi (103-104 CFU/g). The microbial ecology disorders in the intestinal tracts of 29.4% of the individuals surveyed were characterized by the decrease in the number of bifid bacteria almost twofold (105-106 CFU/g), the number of yeast-like fungi increased (104-106 CFU/g), and also noted was the emergence of hemolytic and lactose-negative forms of the Escherichia coli. Two patients surveyed showed an increase in the number of Escherichias with bifid and lactic bacteria having a normal ratio.
 An in-depth analysis of the effectiveness of the combination therapy, suggested by us, for this cohort of patients showed a positive clinical and bacteriological effect, the parameters of which depended on the initial severity of the stomatitis and the pronounced character of the dysbacteriosis. So, after two weeks from the beginning of the treatment, 88.2% of the patients surveyed reported disappearance of the clinical manifestations of the candidal stomatitis. In 47.1% of the patients, the eradication of fungi was observed. 41.1% showed a decrease in the fungi concentration way back to normal, which was confirmed by the results of the microscopic examination. The therapy was of little effect with respect to two patients. Alongside the normalization of the oral cavity microflora, an improvement in the biotope of the intestinal tract was recorded, in particular the increase in the amount of the full-fledged Escherichia coli, lactic and bifid bacteria, a decrease in the number and the complete absence of the Candida genus fungi. 
 After 12 months after the treatment, 76.4% of the patients had clinical criteria of recovery reported and no fungal infestation in the oral cavity, as evidenced by the findings of the mycological research.
 
 
Conclusion.
 Suggested method, of correcting the candidal stomatitis in people who live in the industrial area of a mining and smelting complex, using the Bactulin, Supradyn and Givalex medications as well as the Diflucan medication ultraphonophoresis in a combination therapy, creates favorable conditions for the rehabilitation of this cohort of patients due to the normalization of the microflora of the oral cavity and that of the lower gastrointestinal tract, as confirmed by the bacteriological and clinical data.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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