Molecular Characterization of Fungal Colonization on the Provox™ Tracheoesophageal Voice Prosthesis in Post Laryngec-tomy Patients

Hasti Kamali  Sarvestani; Roshanak Daie  Ghazvini; Seyed Jamal  Hashemi; Mohsen Gerami Shoar; Saham  Ansari; Zahra  Rafat; Aslan  Ahmadi; Pedram  Borghei; Miad Elahi; Abbas  Rahimi Foroushani; Muhammad Ibrahim Getso; Shima  Aboutalebian; Fatemeh  Safari; Pegah  Ardi

doi:10.18502/ijph.v51i1.8306

Hasti Kamali Sarvestani Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Roshanak Daie Ghazvini Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Seyed Jamal Hashemi Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Mohsen Gerami Shoar Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Saham Ansari Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Zahra Rafat Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Aslan Ahmadi Head and Neck Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
Pedram Borghei Department of Head and Neck Surgery, Amir A’lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
Miad Elahi Department of Head and Neck Surgery, Amir A’lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abbas Rahimi Foroushani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Muhammad Ibrahim Getso Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Shima Aboutalebian Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Fatemeh Safari Department of Microbiology, Islamic Azad University, Falavarjan Branch, Isfahan, Iran
Pegah Ardi Department of Medical Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijph.v51i1.8306

Keywords: Voice prostheses; Fungal colonization; Antifungal susceptibility test; Candida

Abstract

Background: Tracheoesophageal voice prostheses (TVPs) have been the gold standard in rehabilitation, after laryngectomy, producing faster and premier voicing towards esophageal speech. Fungal colonization shortens the device’s lifetime and leads to prosthesis dysfunction, leakage, and subsequent respiratory infection. Therefore, in the current study, we aimed to investigate the fungal colonization patterns and to propose prophylactic measures that shall increase the longevity of voice prosthesis.

Methods: Failed TVPs were removed - due to leakage and/or aspiration - from 66 post laryngectomy patients and examined. They were referred to Amiralam and Rasoul Hospital, the main centers of Ear, Nose, and Throat in Tehran, Iran from April 2018 to January 2020. Fungal colonization patterns were assessed using DNA sequencing techniques. Furthermore, the susceptibility to fluconazole, amphotericin B, nystatin, and white vinegar was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Resident fungal species from the upper airways colonized all the 66 TVPs (100%). Diabetes (31%) and smoking (98%) were the predominant underlying disease and predisposing factors, respectively. Among the 79 fungal agents isolated from the 66 TVPs, Candida glabrata (n=25, 31.7%) was the most common. A significant reduction in minimum inhibitory concentration (MIC) values were observed for white vinegar when used alone (P<0.05).

Conclusion: White vinegar at a very low concentration could decrease the amount of fungal colonization on TVPs without any adverse effects; its wide accessibility and affordability ensure a decrease in the overall health cost.