Oral Candida colonization and virulence in children with orofacial clefts: a cross-sectional study

BACKGROUND: Orofacial clefts (OFCs) are congenital anomalies which include cleft palate (CP) and cleft lip and palate (CLP). These anatomical mal-fusion of the palate may favor the abnormal overgrowth of oral microorganisms, such as Candida spp. This study aimed to address the colonization rate of Candida spp. found in the oral cavity of children with OFCs compared to children with NP. Since Candida spp. vary in their pathogenicity and response to antifungals, determining the oral carriage rate of Candida spp. and assessing their virulence factors is important to determine the need for administering antifungal therapy to OFC patients and identify if specific types of clefts are more prone to colonization than others. Moreover, determining whether enzyme production by different Candida spp. is accentuated among OFCs would help understand the pathogenesis of oral candidiasis among this group of patients. METHODS: A comparative cross-sectional study included 40 children with OFCs and 40 others with normal palate (NP). Data on oral hygiene and feeding habits was collected. Oral swabs were obtained from both study groups and were cultured for Candida species counting and presumptive identification using CHROM agar. Phospholipase and hemolysin enzymatic activities were determined for all Candida species as determinants of virulence. RESULTS: Positive Candida colonization was found in 80% of OFCs children and 57.5% of NP children, with C. albicans being the predominant species in both study groups. The median Candida count was higher in OFCs children than in NP children (p < 0.001). C. albicans was the most prevalent species in patients with bilateral cleft lip and palate (CLP) (75% n = 15), soft and hard CP (n = 5, 38.5%), unilateral CLP (n = 3, 30%), and soft CP (n = 1, 11.1%), respectively. There was no significant association between colonization and pathogenicity using hemolysin or phospholipase activity with any particular species or study group (p > 0.05). CONCLUSION: This study demonstrates differences in oral Candida colonization between children with OFCs and those with NPs, with variation in colonization burden and species distribution between the two groups. The assessment of key virulence factors did not reveal group- or species-specific associations. These findings highlight the importance of comprehensive assessment of oral Candida colonization in pediatric populations with OFCs.