Are postmortem studies of glossal candidal infection useful? An experimental study

Autopsy studies have suggested that candidal pseudohyphae may be found in dorsal glossal epithelium in 38% to 42% of cases. Candidal yeast forms, and occasionally free pseudohyphae, are found as oral commensals in about 44% of the population. This study examined the possible distorting influence in autopsy studies that could be caused by postmortem hyphal transformation of candidal yeast forms followed by saprophytic infestation. Candida albicans yeast forms were topically applied to the middorsal glossal mucosa of five healthy pigs, immediately after killing. Biopsy specimens from this mucosa were subsequently maintained, in vitro, for periods of 12 and 24 hours in humid conditions at different temperature regression rates chosen to approximate those of the oral cavity after death. Biopsy specimens subjected to a temperature regression of 35 degrees C (oral temperature) to 23 degrees C (room temperature) over 11 hours showed infestation of epithelium by pseudohyphae in all cases. Biopsy specimens subjected to a similar temperature regression over 5 hours showed infestation in two of five cases. Control biopsy specimens showed that there was no candidal infection at the time of killing. The results indicate that in vitro saprophytic candidal infestation is possible in the time intervals and the declining oral temperatures preceding autopsy. It suggests that postmortem saprophytic candidal infestation may distort results from autopsy studies that do not anticipate this problem.