Association between carriage of oral yeasts, malnutrition and HIV-1 infection among Tanzanian children aged 18 months to 5 years

Community Dent Oral Epidemiol. 1997 Jun;25(3):193-8. doi: 10.1111/j.1600-0528.1997.tb00925.x.

Abstract

The objective was to determine whether there is an association between carriage of oral yeasts, malnutrition and HIV-1 infection among Tanzanian children. A case-control study design within a cross-sectional study was used, and the outcome was carriage of oral yeasts. The exposure variables were malnutrition and HIV-1 antibody, and confounders to be adjusted for were age, sex, and breastfeeding. The study was carried out in Dar-es-Salaam, Tanzania, in two maternal and child health (MCH) clinics that offer routine medical checkups to all expectant mothers and children aged between 0 and 5 years in the catchment area. A total of 882 children aged between 18 months and 5 years participated. Smears from the tongue and buccal mucosa were examined for oral yeasts. Malnutrition was categorized according to standards on the MCH chart and World Health Organization/Centers for Disease Control (WHO/CDC) standards as weight-for-height (wasted), weight-for-age (underweight), and height-for-age (stunted). HIV-1 infection was determined by an enzyme-linked immunosorbent assay. Reactive sera were confirmed by Western Blot. About 27% of the children were slightly or severely malnourished according to standards on the MCH chart. According to WHO/CDC standards, 2.6% were wasted, 16.3% were underweight, and 29.6% were stunted. Fourteen (1.6%) were seropositive for HIV-1 antibody. Hyphal forms and blastospores were much more frequent among children infected with HIV-1 with odds ratios ranging from 3.8 (95% CI: 1.3;11.2) to 6.2 (95% CI: 2.1;18.4) depending on categorization of malnutrition. Malnutrition was a risk factor, too, albeit to a much lesser and insignificant degree. The study supports our previous findings that malnutrition may predispose to carriage of oral yeasts and subsequent infection. However, in this study population HIV infection was clearly the predominant risk factor.

PIP: The association between carriage of oral yeasts, malnutrition, and HIV-1 infection was investigated in a case-control study involving 403 girls and 479 boys 18 months-5 years of age attending 2 maternal-child health clinics in Dar-es-Salaam, Tanzania, in a 4-month period in 1994. The children designated as cases had Candida-like microorganisms on smears from the tongue and buccal mucosa. 14 children (1.6%) were HIV-positive; 11 of these children were under 3 years of age. 241 (27%) were moderately or severely malnourished. 20.0% had hyphal forms and 17.5% had blastospores. Presence of HIV infection was the most significant risk factor for hyphal forms or blastospores consistent with Candida-like microorganisms (unadjusted odds ratios, 5.5 and 3.8, respectively). Although malnutrition was also a risk factor for oral yeasts, the association was not significant. The study findings suggest that malnutrition may predispose to carriage of oral yeasts and subsequent infection. The rates of oral yeasts detected among these children were lower than expected and may reflect a reduced secretion of stimulated whole saliva associated with malnutrition and HIV infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology*
  • Candida / isolation & purification
  • Candidiasis, Oral / epidemiology*
  • Candidiasis, Oral / etiology
  • Carrier State
  • Case-Control Studies
  • Child Nutrition Disorders / complications*
  • Child Nutrition Disorders / microbiology
  • Child, Preschool
  • Cross-Sectional Studies
  • HIV Infections / epidemiology
  • HIV Seropositivity / diagnosis
  • HIV-1 / isolation & purification*
  • Humans
  • Infant
  • Logistic Models
  • Mouth Mucosa / microbiology
  • Nutrition Assessment
  • Odds Ratio
  • Protein-Energy Malnutrition / complications
  • Risk Factors
  • Spores, Fungal / isolation & purification
  • Tanzania / epidemiology