Volatile organic compounds in the breath of oral candidiasis patients: a pilot study

Moritz Hertel, Eyke Schuette, Isabell Kastner, Stefan Hartwig, Andrea Maria Schmidt-Westhausen, Robert Preissner, Sebastian Paris, Saskia Preissner

The aim of the study was to investigate whether specific volatile organic compounds (VOCs) can be detected in oral candidiasis patients using breath analysis in order to develop a point-of-care diagnostic tool. Breath samples of 10 diseased patients and 10 subjects carrying no Candida spp. were analyzed using gas chromatography and mass spectrometry. In infected patients, breath tests were performed before and after antifungal therapy. Breath testing was positive for 143 volatiles in both healthy subjects and diseased patients. Among those, specific signature volatiles known to be emitted by Candida spp. in vitro were not detected. Even though no specific signature was retrieved from the diseased patients, a pattern containing nine compounds (2-methyl-2-butanol, hexanal, longifolene, methyl acetate, 1-heptene, acetophenone, decane, 3-methyl-1-butanol, chlorbenzene) was identified, which showed characteristic changes after antifungal therapy. Focusing on the identified pattern, breath analysis may be applied to confirm the absence of Candida spp. after therapy in terms of a confirmatory test supplementing clinical examination, thereby replacing microbial testing. However, microbial testing will still be needed to initially confirm clinical diagnoses, as no specific signature was found. A breath test may help in avoiding extended antifungal administration resulting in resistance development and might be useful in the monitoring of disease recurrences in vulnerable groups.