Dorsal tongue porphyrin autofluorescence and Candida saprophytism: A prospective observational study

Autoři: Massimo Petruzzi aff001;  Fedora della Vella aff001;  Andrea Cassandro aff001;  Adriana Mosca aff001;  Mariasevera Di Comite aff002;  Maria Contaldo aff003;  Felice Roberto Grassi aff002;  Dorina Lauritano aff004
Působiště autorů: Interdisciplinary Department of Medicine, University “Aldo Moro” of Bari, Bari, Italy aff001;  Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari “Aldo Moro”, Bari, Italy aff002;  Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, Naples, Italy aff003;  Department of Medicine and Surgery, University Milano-Bicocca, Monza, Italy aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223072



To investigate the correlation between the dorsal tongue porphyrin autofluorescence, revealed using VELscope, and Candida saprophytism.

Material and methods

Consecutive patients underwent an autofluorescence examination by the VELscope device to establish the presence or absence of porphyrin fluorescence. A tongue swab was collected for the Candida cultural test. Sensitivity, specificity, accuracy, negative predictive value and positive predictive value were calculated considering the oral swab as the gold standard. The degree of agreement between the two tests was calculated using Cohen's K coefficient.


One hundred twenty-six patients were enrolled. Porphyrin fluorescence method showed a sensitivity of 78%, specificity of 76% and an accuracy of 78%. Negative predictive value and positive predictive value were respectively 90% and 59%. The strength of agreement between the two methods resulted to be moderate (k = 0.551).


Off-label use of tongue autofluorescence examination to detect the presence of Candida species is characterized by a loss of porphyrin fluorescence. The high negative predictive value of porphyrin fluorescence loss suggests its use in preliminary selection of Candida carriers, in order to plan preventive and therapeutic strategies.

Klíčová slova:

Artificial light – Candida – Candida albicans – Fungi – Porphyrins – Tongue – Fluorescence – Candidiasis


1. Lane PM, Gilhuly T, Whitehead P, Zeng H, Poh CF, Ng S, et al. Simple device for the direct visualization of oral-cavity tissue fluorescence. J Biomed Opt. 2006 Mar-Apr;11(2):024006. doi: 10.1117/1.2193157 16674196

2. Na R, Stender IM, Henriksen M, Wulf HC. Autofluorescence of human skin is age-related after correction for skin pigmentation and redness. J Invest Dermatol. 2001 116(4), 536–40. doi: 10.1046/j.1523-1747.2001.01285.x 11286620

3. Waterhouse DJ, Joseph J, Neves AA, di Pietro M, Brindle KM, Fitzgerald RC, et al. Design and validation of a near-infrared fluorescence endoscope for detection of early esophageal malignancy. J Biomed Opt. 2016 Aug 1;21(8):84001. doi: 10.1117/1.JBO.21.8.084001 27490221

4. Jo JA, Cheng S, Cuenca-Martinez R, Duran-Sierra E, Malik B, Ahmed B et al. Endogenous Fluorescence Lifetime Imaging (FLIM) endoscopy for early detection of oral cancer and dysplasia. Conf Proc IEEE Eng Med Biol Soc. 2018; 3009–3012. doi: 10.1109/EMBC.2018.8513027 30441030

5. Petruzzi M, Lucchese A, Nardi GM, Lauritano D, Favia G, Serpico R, Grassi FR. Evaluation of autofluorescence and toluidine blue in the differentiation of oral dysplastic and neoplastic lesions from non-dysplastic and neoplastic lesions: a cross-sectional study. J Biomed Opt. 2014; 19(7):76003. doi: 10.1117/1.JBO.19.7.076003 24996662

6. McAlpine JN, El Hallani S, Lam SF, Kalloger SE, Luk M, Huntsman DG et al. Autofluorescence imaging can identify preinvasive or clinically occult lesions in fallopian tube epithelium: a promising step towards screening and early detection. Gynecol Oncol. 2011; 120(3) 385–92. doi: 10.1016/j.ygyno.2010.12.333 21237503

7. de Veld DC, Skurichina M, Witjes MJ, Duin RP, Sterenborg DJ, Star WM, Roodenburg JL. Autofluorescence characteristics of healthy oral mucosa at different anatomical sites. Lasers Surg Med. 2003; 32(5), 367–76. doi: 10.1002/lsm.10185 12766959

8. Hamad LO, Vervoorts A, Henning T, Bayer R. Ex vivo photodynamic diagnosis to detect malignant cells in oral brush biopsies. Lasers Med Sci. 2010; 25(2), 293–301. doi: 10.1007/s10103-009-0712-1 19662485

9. Akpan A, Morgan E. Oral candidiasis. Postgrad Med J, 2002. 78(922), 455–459. doi: 10.1136/pmj.78.922.455 12185216

10. Cannon RD, Chaffin WL. Oral colonization by Candida albicans. Crit Rev Oral Biol Med. 1999; 10(3), 359–83. 10759414

11. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977, 33(1), 159–174. 843571

12. Ganga RS, Gundre D, Bansal S, Shirsat PM, Prasad P, Desai RS. Evaluation of the diagnostic efficacy and spectrum of autofluorescence of benign, dysplastic and malignant lesions of the oral cavity using VELscope. Oral Oncol. 2017; 75, 67–74. doi: 10.1016/j.oraloncology.2017.10.023 29224826

13. Giovannacci I, Meleti M, Corradi D, Vescovi P. Clinical Differences in Autofluorescence Between Viable and Nonvital Bone: A Case Report with Histopathologic Evaluation Performed on Medication-Related Osteonecrosis of the Jaws. J Oral Maxillofac Surg. 2017; 75(6),1216–1222. doi: 10.1016/j.joms.2016.12.011 28061356

14. Rao S, Rajkumar A, Ehtesham M, Prathiba D. Autofluorescence: a screening test for mycotic infection in tissues. Indian J Pathol Microbiol. 2008; 51(2), 215–7. doi: 10.4103/0377-4929.41690 18603685

15. Idriss MH, Khalil A, Elston D. The diagnostic value of fungal fluorescence in onychomycosis. J Cutan Pathol. 2013; 40(4), 385–90. doi: 10.1111/cup.12086 23398499

16. Kumaraswamy Naik LR, Shetty P, Krishna Prasad MS, Karnaker VK, Shroff SE, Madathil LP. Fluorescence of Candida in diagnosis of oral candidiasis. Indian J Dent Res. 2016; 27(6), 618–622. doi: 10.4103/0970-9290.199592 28169259

17. Gabrielli E, Roselletti E, Luciano E, Sabbatini S, Mosci P, Pericolini E. Comparison between bioluminescence imaging technique and CFU count for the study of oropharyngeal candidiasis in mice. Cytometry A. 2015; 87(5), 428–36. doi: 10.1002/cyto.a.22666 25820122

18. Onizawa K, Okamura N, Saginoya H, Yusa H, Yanagawa T, Yoshida T. Analysis of fluorescence in oral squamous cell carcinoma. Oral Oncol. 2002; 38, 343–348. 12076697

19. Hagerman G, Hirschfeld R. On the red fluorescent coating of the normal tongue and its connection with vitamin B metabolism. Acta Derm Venereol. 1947; 27, 369.

20. Costello MJ, Luttenberger LV. Fluorescence with the Wood filter as an aid in dermatologic diagnosis. N. Y. State J. Med. 1994; 44, 1778.

21. Carriè C. Die Ursache der Porphyrin-fluoreszenz in der Mundhöhle und auf der Haut. Dermatol Z. 1935; 70, 189–193 (1935).

22. Tomaszewski W, Poznan MD. The fluorescence phenomenon of the tongue. Brit Med J. 1951; 1(4698), 117–20. doi: 10.1136/bmj.1.4698.117 14812123

23. van der Veen MH, Volgenant CM, Keijser B, Ten Cate JB, Crielaard W. Dynamics of red fluorescent dental plaque during experimental gingivitis—A cohort study. J Dent. 2016; 48,71–6. doi: 10.1016/j.jdent.2016.02.010 26921667

24. Volgenant CM, Hoogenkamp MA, Buijs MJ, Zaura E, Ten Cate JM, van der Veen MH. Red fluorescent biofilm: the thick, the old, and the cariogenic. J Oral Microbiol. 2016; 8, 30346. doi: 10.3402/jom.v8.30346 27060056

25. Lee ES, Yim HK, Lee HS, Choi JH, Lee JH, Kim BI. Clinical assessment of oral malodor using autofluorescence of tongue coating. Photodiagnosis Photodyn Ther. 2016; 13, 323–329. doi: 10.1016/j.pdpdt.2015.09.001 26369605

26. Hitz Lindenmüller I, Weiss P, Volken M, Filippi A. Diagnostics of tongue coating using autofluorescence. Swiss Dent J. 2015; 125(10), 1074. 26472652

27. Blanco KC, Inada NM, Kurachi C, Bagnato VS. Fluorescence diagnosis of upper respiratory tract infections. Biophotonics South America. 2015; 9531. doi: 10.1117/12.2180945

28. Lipson RL, Baldes EJ, Gray MJ. Hematoporphyrin derivative for detection and management of cancer. Cancer. 1967; 20(12), 2255–7. doi: 10.1002/1097-0142(196712)20:12<2255::aid-cncr2820201229>;2-u 6073903

29. Lodi G, Tarozzi M, Sardella A, Demarosi F, Canegallo L, Di Benedetto D et al. Miconazole as adjuvant therapy for oral lichen planus: a double-blind randomized controlled trial. Br J Dermatol. 2007; 156(6), 1336–41. doi: 10.1111/j.1365-2133.2007.07883.x 17535232

30. Trejo-Hernández A, Andrade-Domínguez A, Hernández M, Encarnación S. Interspecies competition triggers virulence and mutability in Candida albicans-Pseudomonas aeruginosa mixed biofilms. ISME J. 2014; 8(10), 1974–88. doi: 10.1038/ismej.2014.53 24739628

31. Moghnie S, Tovmasyan A, Craik J, Batinic-Haberle I, Benov L. Cationic amphiphilic Zn-porphyrin with high antifungal photodynamic potency. Photochem Photobiol Sc. 2017. 16(11), 1709–1716. doi: 10.1039/c7pp00143f 29043356

32. Beirão S, Fernandes S, Coelho J, Faustino MA, Tomé JP, Neves MG, t al. Photodynamic inactivation of bacterial and yeast biofilms with a cationic porphyrin. Photochem Photobiol. 2014; 90(6), 1387–96. doi: 10.1111/php.12331 25112506

33. Liu Z, Gomez J, Khan S, Peru D, Ellwood R. Red fluorescence imaging for dental plaque detection and quantification: pilot study. J Biomed Opt. 2017; 22(9), 1–10. doi: 10.1117/1.JBO.22.9.096008 28925109

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