Candidoses oropharyngées (COP) et cancers solides
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Résumé
La candidose oropharyngée (COP) est une pathologie fréquente en cancérologie. Son impact est sous-estimé par rapport aux traitements qui la favorisent: chimiothérapie, radiothérapie, corticoïdes. Des spécialistes multidisciplinaires (oncologues, mycologues, infectiologues, ORL, stomatologues) se sont réunis pour élaborer des recommandations de prise en charge diagnostique et thérapeutique de la COP selon une méthodologie bien établie et détaillée dans l’article. Trois populations ont été étudiées: patientes traitées pour un cancer du sein, patients traités pour un cancer ORL et patients âgés traités pour un cancer. Les grands principes issus de cette réflexion sont la recherche de facteurs favorisants, l’examen systématique et précis de la cavité buccale (le diagnostic de la COP est clinique) et la mise en route immédiate d’un traitement antifongique qui doit prendre en compte l’augmentation des candidas non albicans et des candidas albicans résistants au fluconazole. Le traitement de première intention de la COP est local, et ce n’est qu’en cas d’échec d’un traitement bien conduit dont l’observance aura été contrôlée qu’un prélèvement mycologique est à envisager.
Mots clés
Candidose oropharyngée Infection mycotique Épidémiologie Cancer Mucite TraitementOropharyngeal candidiasis (OPC) and solid tumors
Abstract
Oropharyngeal candidiasis (OPC) is a common infection in cancer patients. Its burden is underestimated compared to antineoplastic treatments that are risk factors: chemotherapy, radiotherapy, corticosteroids. Multidisciplinary specialists (oncologists, mycologists, infectious disease specialists, ENT, stomatologists) have developed recommendations to support diagnosis and treatment of OPC, based on a well established methodology which is detailed in this article. Three populations were studied: patients treated for breast cancer, patients treated for head and neck cancer and elderly patients treated for cancer. This workshop identified risk factors, recommended the systematic and accurate examination of the oral cavity (the diagnosis of OPC is clinical) and the immediate initiation of an antifungal treatment taking into account the increased incidence of Candida non-albicans and Candida albicans fluconazole-resistant strains. The first-line treatment of oropharyngeal candidiasis is local and it is only in case of failure with a correct treatment for which compliance has been checked, that a mycological sampling would be considered.
Keywords
Orophayngeal candidiasis Fungal infection Epidemiology Cancer Mucositis TreatmentPreview
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