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Consultar: Programa de Ps-Graduao em Cincias da Sade

Incio > Dissertaes e Teses > Cincias da Sade > Medicina > Programa de Ps-Graduao em Cincias da Sade

Ttulo [PT]: "Condies clnicas e a presena de leveduras em cavidade bucal de pacientes portadores de doena renal crnica"
Ttulo [EN]: Clinical conditions and the presence of yeast in the oral cavity of patients with chronic kidney disease
Autor(es): Nel Pieralisi
Palavras-chave [PT]:

Insuficincia renal crnica. Dilise renal. Transplante de rim. Sade bucal. Micologia. Brasil.
Palavras-chave [EN]:
Chronic renal Insufficiency. Renal dialysis. Kidney transplantation. Oral health. Mycology. Brazil.
Titulao: Doutor em Cincias da Sade
Banca:
Terezinha Inez Estivalet Svidzinski [Orientador] - UEM
Giovani de Oliveira Corra - UEL
Clverson de Oliveira Silva - UNING
Mitsue Fujimaki - UEM
rica Seki Kioshima - UEM
Resumo:
Resumo: As condies imunossupressoras da doena renal crnica (DRC), sob tratamento hemodiltico (HD) ou ps transplante renal (TX), predispem o paciente ao desenvolvimento de leses bucais (LB) e colonizao por leveduras na cavidade bucal, estas ltimas com alto risco de evolurem para infeco fngica, como a candidemia. No entanto, as informaes sobre esses temas devem ser exploradas devido sua escassez e contradies. Assim, o objetivo geral desta tese foi avaliar se h correlao entre colonizao e espcies de leveduras com as condies bucais de pacientes portadores de DRC sob HD e TX. Os objetivos especficos foram verificar, em cavidade bucal de pacientes com DRC:(1) a frequncia de leveduras, associando com a presena de LBs e o uso de prtese dentria; (2) a frequncia de lngua saburrosa (LS) e a presena de leveduras; e (3) o ndice de colonizao por leveduras em pacientes, aps um ano de TX, e sua associao com condies clnicas bucais e sistmicas. A populao do estudo compreendeu pacientes portadores de DRC, estgio 5 sob HD e TX. Foram realizados: teste de fluxo salivar estimulado, anamnese e exame fsico da mucosa bucal, com registro dos hbitos e das condies clnicas sistmicas e bucais. Amostras salivares e linguais foram coletadas e analisadas por exames micolgicos. No primeiro estudo, 42,31% dos pacientes estavam colonizados por leveduras, 100% pertencentes ao gnero Candida, com predomnio de C. albicans (69,23%). Metade dos pacientes apresentava algum tipo de leso bucal, sendo a maioria (63,33%) sugestivas de candidase. A presena de LB e o uso de prtese aumentaram as chances de isolamento de leveduras em 6,33 e 2,62 vezes, respectivamente. No segundo estudo, LS foi a LB mais frequente (78,26%). Dentre as amostras coletadas, 13 (72,22%) do dorso lingual e uma (5,55%) da saliva foram positivas para leveduras. A presena de leveduras foi significativa (p = 0,0106) no dorso da lngua em relao saliva. Houve predomnio da C. albicans (55,55%), enquanto que C. parapsilosis compunha 50% das espcies Candida no albicans. No ltimo estudo, as culturas salivares foram positivas para leveduras em 29% dos pacientes. Houve associao significativa entre a presena de leveduras com xerostomia, diabetes mellitus, hipertenso arterial e falta de ateno odontolgica na fase pr TX. Todas as leveduras eram do gnero Candida, com predomnio da C. albicans. Pode-se concluir que: (1) em paciente sob HD, as taxas de colonizao por leveduras a ocorrncia de leses bucais foram altas, principalmente em pacientes usurios de prtese dentria removvel; (2) a LS foi a LB mais comum, com elevada frequncia de leveduras, sugerindo ser um biofilme lingual; 3 - Pacientes TX com xerostomia, diabetes mellitus, hipertenso e sem histria de ateno odontolgica na fase pr TX devem ser monitorados por exames clnicos odontolgicos e micolgicos. Essas aes contribuiriam no direcionamento da anamnese nefrolgica, prevenindo problemas como candidase oral e, consequentemente, reduziria o risco de infeces sistmicas tais como a candidase disseminada.

Abstract: Immunosuppressive conditions of the chronic kidney disease (CKD) on hemodialysis (HD) or post-kidney transplant (TX), predispose patients to the development of oral lesions (OL) and colonization by yeasts in the oral cavity, the latter with high risk of progressing to fungal infections such as candidemia. However, the scarce and contradictory information on the issue indicate the need for further investigations. Thus, the general objective of this thesis was to evaluate the correlation between the colonization by, and the different species of, yeasts with the oral status of patients with CKD under HD and TX. The specific objectives were to verify, in the oral cavity of patients with CKD: (1) the incidence of yeasts in association with the presence of OLs and the use of dental prostheses; (2) the incidence of tongue coating (TC) and the presence of yeasts on it; and (3) the rate of colonization by yeasts in patients one year after TX, and its association with their oral and systemic clinical status. The study population was comprised by patients with CKD stage 5 in HD and TX. Stimulated salivary flow test, and anamnesis and physical examination of the oral mucosa, in which patients' habits and systemic and oral clinical status were registered, were conducted. Salivary and tongue samples were collected and analyzed by mycological examinations. In the first study, 42.31% of patients were colonized by yeasts, 100% of them belonging to the genus Candida, with predominance of C. albicans (69.23%). Half of the patients presented some type of OL, the majority (63.33%) suggestive of candidiasis. The presence of OL and the use of prosthesis increased the chances of yeast isolation in 6.33 and 2.62 times, respectively. In the second study, TC was the most common OL (78.26%). Among the samples collected, 13 (72.22%) from the tongue dorsum, and one (5.55%) from the saliva were positive for yeasts. The presence of yeasts on the tongue dorsum was significant (p = 0.0106) in relation to the saliva. There was a predominance of C. albicans (55.55%) while C. parapsilosis comprised 50% of non-albican Candida species. In the last study, the salivary cultures were positive for yeasts in 29% of the patients. There was a significant association between the presence of yeasts with xerostomia, diabetes mellitus, hypertension and lack of oral care in the pre-TX phase. All yeasts were of the Candida genus, with predominance of C. albicans. It can be concluded that: (1) in HD patients, the occurrence of OLs and the colonization rates by yeasts were high, especially in patients with removable dental prosthesis; (2) TC was the most common OL, with high incidence of yeasts, suggesting tongue biofilm formation; 3 - TX patients with xerostomia, diabetes mellitus, hypertension and no history of oral care in the pre-TX phase should be monitored through oral and mycological clinical examinations. Such actions would help guiding the nephrology anamnesis, preventing problems such as oral candidiasis, and would consequently reduce the risk of systemic infections such as disseminated candidiasis.
Data da defesa: 10/2015
Cdigo: vtls000220679
Informaes adicionais:
Idioma: Portugus
Data de Publicao: 2015
Local de Publicao: Maring, PR
Orientador: Prof. Dr. Terezinha Inez Estivalet Svidzinski
Instituio: Universidade Estadual de Maring. Centro de Cincias da Sade
Nvel: Tese (doutorado em Cincias da Sade)
UEM: Programa de Ps-Graduao em Cincias da Sade

Responsavel: edson
Categoria: Aplicao
Formato: Documento PDF
Arquivo: Neli Pieralise.pdf
Tamanho: 2491 Kb (2551191 bytes)
Criado: 24-05-2016 13:22
Atualizado: 24-05-2016 13:30
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