Introduction: Radiotherapy-induced hyposalivation encourages oral Candida colonization that often leads to oral/pharyngeal candidiasis. The objective of this study was to identify the Candida species in lesions of oropharyngeal candidiasis in patients undergoing radiotherapy for head and neck cancers and to find out antifungal susceptibility pattern.

Material and methods: Swabs were collected from 60 patients who developed lesions suggestive of oral candidiasis at the end of 1st week of radiation therapy. Antifungal susceptibility of each of the isolated species was done using disc diffusion method following CLSI guidelines.

Results: Candida was isolated in 13 cases. C. albicans (7) was the most predominant species; a small number of other species have also been identified. Few strains (3) of Candida showed variable resistance to the commonly used antifungal drugs.

Discussion: The colonization of Candida may lead to development of infections with drug-resistant strains, and hence the patients receiving radiation for head and neck cancers should undergo microbiological study for oral candidiasis.

A 15-month survey of 412 bloodstream yeast isolates from 54 Belgian hospitals was undertaken. Candida albicans was the most common species (47·3%) followed by C. glabrata (25·7%), C. parapsilosis (8·0%), C. tropicalis (6·8%) and Saccharomyces cerevisiae (5·1%). Common predisposing factors were antibacterial therapy (45%), hospitalization in intensive care units (34%), presence of in-dwelling catheters (32%), underlying cancer (23%) and major surgery (11%). Most patients had more than one predisposing factor. Fluconazole alone or in combination with another antifungal agent was the treatment of choice for 86·6% of the cases. Susceptibility testing revealed that 93·5% were susceptible to amphotericin B, 39·6% to itraconazole, 42·8% to fluconazole and 87% to voriconazole. Resistance to azoles was more common among C. glabrata isolates.

The presence of a mass in a jejunal free flap that causes dysphagia less than two years after a pharyngolaryngectomy for carcinoma usually indicates tumour recurrence. We present a case of invasive candidiasis of a jejunal free flap presenting with dysphagia and a mass. To our knowledge this is previously unreported. Such a cause should always be considered in the differential diagnosis, as early recognition and treatment are likely, to result in a favourable outcome.

Upper airway obstruction is always a serious condition. In patients who have previously been irradiated for a laryngeal malignancy, it normally implies either residual or recurrent disease. We report a case of stridor due to invasive laryngeal candidiasis in a patient who had undergone radiotherapy for a T1a N0 squamous cell carcinoma of the glottis eight months earlier. Extensive investigation failed to identify recurrence of disease and the patient responded to prolonged topical antifungal therapy. Infection with Candida species is most frequently found in debilitated or immunocompromised patients. Although cases of upper airway obstruction in children secondary to idiopathic laryngeal candidiasis have been reported, to our knowledge no such presentation has been described in adults. This report highlights the difficulty of diagnosis and treatment. Familiarity with candidal infection is important for early diagnosis and appropriate treatment.

A patient with unilateral tonsillar enlargement secondary to locally invasive candidal infection is presented. This was not associated with any history of immunosuppression or prolonged use of broad-spectrum antibiotics. Invasive candidal infection of the tonsil has not previously been reported.

Laryngeal chondroradionecrosis is an unusual condition which may present many years after the initial radiotherapy. We present a case of late onset chondroradionecrosis which was complicated by invasive candidiasis of the arytenoid cartilages which had themselves been extruded through the laryngeal mucosa.