A Literature Review On The Antifungal Activity of Oil Extract Cocos Nucifera (Coconut Tree) Against Candida Albicans

UNIVERSITY OF SANTO TOMAS SENIOR HIGH SCHOOL PAGE i
A LITERATURE REVIEW ON THE ANTIFUNGAL ACTIVITY OF OIL
EXTRACT COCOS NUCIFERA (COCONUT TREE) AGAINST CANDIDA
ALBICANS
A Review Paper Presented to the Senior High School
University of Santo Tomas
Manila, Philippines
In Partial Fulfillment of the
Requirements for Inquiries, Investigations, and Immersion
by
ACOSTA, ANGELICA BUEN S.
CABAILO, FRANCINE GAYLE Y.
CABILDO, ELIANA CARIS G.
CALARO, IMEE CLAIRE M.
CANDIDO, EZER ERIC P.
CUYUGAN, RICHIE CARLO A.
DELA CRUZ, ZACH DANIEL S.
LOBOS, ALESSANDRA PATRICIA MARGREAT P.
DECEMBER 2020
UNIVERSITY OF SANTO TOMAS SENIOR HIGH SCHOOL PAGE ii
ACKNOWLEDGEMENT
The completion of this literature review would not be made possible
without the people who continuously supported and assisted the
researchers in the development of the manuscript. All praise and glory to
God for giving knowledge, strength, patience and wisdom in exploring
things, for the guidance in helping the researchers surpass all of the trials
they have encountered and for giving the determination to pursue and finish
this paper.
Whatever has been accomplished and whatever has been the result
of every endeavor, there is a great source of all effort, striving, guidance
and blessings without whom this task would have not been possible.
The group would like to express their deepest appreciation and
indebtedness particularly to the following people:
To the researchers’ family and friends, for their unconditional love and
emotional support since the beginning of the research process. For
understanding their lack of time to bond due to their dedication for
improvement.
To Mrs. Arleen B. Alferos, Ms. Rochelle Palomo, and Mr. John
Medina, our advisers in Research I, II, and III, for sharing their knowledge
UNIVERSITY OF SANTO TOMAS SENIOR HIGH SCHOOL PAGE
and suggestions in producing a great research paper. For patiently guiding
the researchers to further improve their paper.

iii
To the University of Santo Tomas for giving the researchers’ this
opportunity to explore and discover new things for the betterment of society.
For inspiring the researchers to become an instrument for change.

UNIVERSITY OF SANTO TOMAS SENIOR HIGH SCHOOL PAGE iv
ABSTRACT
Candidiasis is considered to be one of the top bloodstream related
infections in the world, which is mainly caused by fungus Candida albicans.
The review aimed to assess coconut oil as an alternative product to combat
the antifungal drug resistance of the fungus and to lessen the adverse side
effects of existing medications. The review provided a bridge to the
inconsistencies and gaps of the different studies by analyzing the different
methods used in the different experiments. It was notable that the method
used, as well as the methodological conditions influenced the results of the
outcome of the analysis. An agreement was established regarding the
resistance of Candida albicans to synthetic fungal drugs upon reviewing the
gathered articles. Supporting findings of the review, along with similar and
related literature and studies, substantiate Cocos nucifera oil to be
comparable to that of synthetic antifungal drugs due to its medium-chain
fatty acids.
Keywords: drug resistance, fungal infection, coconut oil

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TABLE OF CONTENTS
Title Page i
Acknowledgement ii
Abstract iv
Table of Contents v
List of Tables vii
List of Figures viii
Chapter 1: INTRODUCTION 1-6

1.1 Background of the Study 1
1.2 Objectives 3
1.3 Statement of the Problem 4
1.4 Scope and Limitations 4
1.5 Significance of the Review 5
Chapter 2: REVIEW OF LITERATURE AND STUDIES 7-38

2.1 Review of Related Literature 7
Candida infections 7
Candida albicans 9
Candida Infection Treatment 11
Antifungal Drug Resistance of Candida Albicans 12
Cocos nucifera 15
Properties of Cocos nucifera oil 16
Antimicrobial and antifungal activities of Cocos nucifera oil 19
Methods for susceptibility determination 23
Disk Diffusion Method 23
Routine Culture Methods 26
Coconut Oil-Core Nanocapsule 26
Agar Well Diffusion Technique 27
Direct Fluorescence-Based Live/Dead Staining 28
Broth Microdilution Method 28
2.2 Analysis and Synthesis 29
Search Strategies 29
Inclusion and Exclusion Criteria 30
Search Outcomes 30
Data Extraction 31
2.3 Discussion 31
Main Findings 31
Antifungal Drug Resistance of Candida albicans 31
Cocos nucifera as an Antifungal Agent 32
Antifungal Properties of Cocos nucifera Oil 33
Limitations and Reliability of the Review 34
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Strengths and Weaknesses of the Review 35

Implications 36
Chapter 3: SUMMARY, CONCLUSION, RECOMMENDATIONS 39-43

3.1 Summary 39
3.2 Conclusions 40
3.3 Recommendations 42
BIBLIOGRAPHY 44-54
APPENDICES 55-71
Appendix A 55
Appendix B 65
Appendix C 70
UNIVERSITY OF SANTO TOMAS SENIOR HIGH SCHOOL PAGE vii
List of Tables
Table 1. A table containing data on the growth resistance of Candida
albicans against certain drugs.
Table 2. The concentrations of Cocos nucifera oil used by different studies
with different methods to test its antifungal activity.
Table 3. Overview of the antifungal properties present in Cocos nucifera
oil.
UNIVERSITY OF SANTO TOMAS SENIOR HIGH SCHOOL PAGE viii
List of Figures
Figure 1. A flow chart illustrating the search outcomes of the review.

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CHAPTER 1
INTRODUCTION
This first chapter of the review opens with the background of the review
followed by the objectives, statement of the problem, scope and limitations,
and significance of the review.
1.1 Background of the Study
Fungal infections affect a person when the body’s immune system
cannot handle a spreading fungus taking over a certain part of the body.
Fungi can be seen anywhere. They reside in the air, soil, water, and plants
while there are also some fungi that live naturally in the human body (Pauw,
2011).
In 2016, a total of 1,852,137 were affected by severe fungal
infections in the Philippines. 80.40% of these cases were constituted by
Candidiasis. Types of infections include recurrent vulvovaginal candidiasis,
oral and esophageal candidiasis, candidemia, and Candida peritonitis. As
of 2019, there are only four known classes of drugs that can be used for the
systematic treatment of Candidiasis. Such drugs include azoles, polyenes,
echinocandins, and pyrimidine (Juayang et al., 2019).
Candida has the ability to create drug-resistant biofilms and this factor
contributes largely to human disease, like the vast majority of microbial
biofilms. The perpetuation of Candida infections are affected by biofilms as
it affects its ability to adhere to various medical devices. As a consequence,

it is crucial to formulate new products with effective antifungal activities to
lessen the adverse side effects of existing medications and the formation of
biofilms in medical devices and tissues (Sardi, Scorzoni, Bernardi, Almedia,
& Giannini, 2013).
Over the years, it has been documented that virgin coconut oil (VCO)
has a wide range of antimicrobial and antifungal activity against Gram-
positive bacteria such as Staphylococcus aureus, Listeria and
Streptococcus pyogenes Monocytogenes; Bacteria Gram-negative, such as
Cholerae vibrio and Escherichia coli; and fungi, which include Candida
krusei, Candida albicans and Pityrosporum ovale (Mukhtar et al., 2019).
In Indian classics, the Coconut tree was referred to as “Kalpavriksha” which
means the all-giving tree. Coconut (Cocos Nucifera) is a tree that is known
for its multiple utilities varying from nutritional and medicinal uses. The tree
is considered a source of various natural products for the development of
medicines against various diseases, while some parts of the tree are also
commonly used for development of industrial products (DebMandal &
Mandal, 2011).
The coconut palm Cocos nucifera belongs to the palm family, one of
the largest in the monocotyledon group. The coconut palm is tall and stately
in appearance and usually reaches a height of about 15–30 meters when
fully mature. Among different herbal oils, Coconut oil was studied to contain
the most concentrated commodity source of medium chain fatty-acids

(MCFAs). According to research, MCFAs derived from coconut oil possess
unique properties with important nutritional and medical applications
(Pham, 2016).
This study aims to explore the effectiveness of utilizing the plant
Cocos nucifera as an alternative medicine to inhibit the growth of the fungus
Candida albicans. The production of traditional and alternative approaches
to health in addressing health system gaps is a holistic approach to health
and wellness, aligned with the third research priority of the National Unified
Health Research Agenda 2017-2022 (NUHRA).
1.2 Objectives
The chief objective of this literature review is to investigate the
antifungal effects of Cocos nucifera on fungus Candida albicans.
Specifically, it aims:
1. To summarize and identify the relationship of published research
studies that tackle the antifungal components of Cocos nucifera.
2. To compare the zones of inhibitions of Cocos nucifera to Candida
albicans obtained from different methods, specifically (Disk Diffusion
Method, Routine Cultures Method, Coconut Oil-Core Nanocapsule,
Agar-well Diffusion Technique, Direct Fluorescence-Based
Live/Dead Staining, and Broth Microdilution Method).
3. To compare the zones of inhibition of Candida albicans in Cocos
nucifera and synthetic antifungal drugs, under in-vitro application.

4. To determine the gaps found in relevant published studies for the
establishment of the need for further research.
1.3 Statement of the Problem
The goal of this review is to explore the antifungal activity of Cocos
nucifera and its potential utilization in Candidiasis. Specifically, this review
aims to answer the following questions:
1. What are the antifungal properties present in Cocos nucifera oil?
2. Can Cocos nucifera oil be used as a considerable substitute to the
synthetic antifungal drug? Based on the findings of the review, what
can be recorded?
3. What method can be most effective in assessing the susceptibility of
Candida albicans to Cocos nucifera?
1.4 Scope and Limitations
This review focuses on the antifungal effects of Cocos nucifera
against a common fungus, Candida albicans which causes candidiasis. The
review also addresses the comparability of Cocos nucifera to synthetic
antifungal drugs. Apart from this, this review is limited only to the antifungal
properties present in Cocos nucifera against the fungus Candida albicans
and Disk Diffusion, Routine Cultures, Coconut Oil-Core Nanocapsule, Agar-
well Diffusion, Direct Fluorescence-Based Live/Dead Staining, and Broth
Microdilution methods of susceptibility determination. Inhibition of other

types of Candida species and other susceptibility determination methods
are not covered in this review.
1.5 Significance of the Review
Candidiasis is a fungal infection that can contribute to several health
alarming issues. The species Candida albicans is found to be the
predominant cause of candidiasis. As this disease continues to spread,
Candida albicans has shown resistance to the synthetic antifungal drugs
being made through time. With this, it is recommended to formulate new
and more potent antifungal agents to optimize treatment for antifungal
resistance.
Cocos nucifera was found to exhibit antifungal properties. With
further research and experimentation, a cost-effective alternative fungal
agent may be produced against a common fungus like Candida albicans.
Moreover, this review may aid researchers specifically in the field of
pharmaceutical drugs to establish which naturally sourced compounds of
the Cocos nucifera can be used to formulate new and more potent
antifungal agents. Expected beneficiaries of the review include people with
compromised immune systems such as babies, women, elderly people who
are highly susceptible to Candidiasis. This review also benefits farmers who
grow coconut trees as it opens ideas for the commercial use of its oil from
its fruit. Lastly, this review would be useful to future researchers as it
provides necessary information regarding Cocos nucifera and Candida

albicans to save time. Furthermore, the potential medical use of Cocos
nucifera to patients with Candidiasis are included as well as the academe
for the compiled findings of its effectiveness.

CHAPTER 2
REVIEW OF RELATED LITERATURE
This chapter exhibits the past studies that have been done related to
medicinal oil extracts, Cocos nucifera and its antimicrobial activities,
Candida Albicans, and the antifungal effect of Cocos nucifera oil extract to
Candida Albicans. It introduces the framework for the review that comprises
the main focus of the research described in this paper.
2.1. Review of Related Literature
Candida infections
One of the top 5 healthcare-associated bloodstream related
infections in the world is Candidiasis that is caused by Candida species.
Infections caused by the mentioned fungus include recurrent vulvovaginal
candidiasis, oral and esophageal candidiasis, Candidemia, and Candida
peritonitis (Juayang et al. 2019). With the continuous increase of
antimicrobial resistance, incidents and cases of fungal infections have also
significantly increased. Different Candida species contribute to the
superficial and life-threatening fungal infections such as AIDS, which can
then lead to malnutrition and interfere with the absorption of the medication.
The perpetuation of these infections is affected by biofilms as it affects its
ability to adhere to various medical devices. In another study, Sheidaei,
Jafarnejad, Rajabi, and Najafzadeh (2019) stated that candida vagina
infection is the second most common cause of vaginal infection in women

and is diagnosed in more than 40 percent of people. Candida vagina
infection is the first cause of vaginal infection in Europe and the second
cause in the United States. Worldwide, women of all ages and genders are
infected with candida vagina and the disease is one of the most critical and
most regenerative of all. The first line of treatment is the combination of
topical azole community, including clotrimazole, for the treatment of vaginal
candidiasis. However, painful urination, chronic ingestion vomiting, itching,
dermatitis, burning and itching in the partner's penis, and blood leakage are
also side effects of local antifungal medicines. Spampinato & Leonardi
(2013) also stated in their study that there are limitations when using
commercial antifungal drugs and can often be life-threatening due to
inefficient diagnostic methods and inappropriate initial antifungal therapies.
The first reported case of Acute eosinophilic pneumonia (AEP) was
found to be caused by C. albicans. An in-depth clinical examination was
held in which the C. albicans were positive on Arthus (8h) and delay (24h)-
type skin tests. The said species also appeared positive on a lymphocyte-
stimulation test. In determining the etiology of the AEP, the clinical course,
skin tests conducted by intradermal injection using fungal antigens,
detection of IL-5 development from PBMCs and reaction to the provocation
test were useful. There was no indication listed on how to cure such rare
cases yet (Matsuno et al., 2007).

Thus, it is recommended to search for new products with effective antifungal
activities to lessen the adverse side effects of existing medications and the
formation of biofilms in medical devices and tissues (Sardi et al., 2013).
Candida albicans
Candida albicans are microbial microorganisms that can easily adapt
to the immune responses of the host, allowing it to evolve its resistance to
traditional microbial medications (Vila, Sultan, Jauregui, & Rizk, 2020). The
broadest fungi type in the human tissues and biofluids is Candida Albicans
(Nobile & Johnson, 2015). Moreover, Candida Albicans was held as the
most common fungal infection which compasses from mucocutaneous non-
life-threatening diseases to life-threatening organ diseases (Pappas et al.,
2004). Candida albicans often begin with yeast cells, initiating, maturing,
dispersing, and repeating and are usually observed to grow on warm and
moist places such as the mouth and vagina. The said fungi are multidrug-
resistant which usually causes pain on the host tissues (Gulati & Nobile,
2016). It is a prevalent opportunistic human fungal pathogen, the
disseminated forms of the disease can be life-threatening with mortality
rates of 40 to 60 percent among immunocompromised (Seleem, Chen,
Benso, Pardi, Murata, 2016). According to a study by LaFleur, Kumamoto,
and Lewis (2006), Candida albicans are pathogens that affect patients
chiefly when the immune system is depressed. These pathogens are
commonly found as a member of the human oral and gastrointestinal

microflora. Sari et al. (2019) mentioned in their study that Candida Albicans
increased the pathogenicity of children with early childhood caries (EEC);
dental caries that is a common chronic disease in children. According to
Bassetti, Peghin, and Timsit (2016), the infection of Candida family’s
epidemiology was altered for the ten years that have passed because of the
effects of local-hospital elements, the patient’s liability to control, and
antifungal medications used. One hundred species of Candida are known
today and its method of affecting others depends on the geographic
location. Agreed treatment is not fully effective because of its side effects,
that is why research for drugs and natural treatments has become crucial
(Pinho et al., 2016).
Models such as the mouse model of oropharyngeal candidiasis and
the rat model of denture stomatitis were used in order to fully understand
and explore things pertaining to Candidiasis and how to fully understand it
to avoid health alarming issues. Some factors which can cause the start of
Candida albicans in the body are the following: Salivary hypofunction,
denture wearing, corticosteroid therapy, smoking, and many more.
Although Candida albicans may be harmless at first, things can get more
complicated when it is left unattended especially due to some fast-
developing diseases which can also affect the said bacteria (Vila et al.,
2020).
Candida Infection Treatment
According to Juayang et al. (2019), as the infectious diseases
caused by Candida albicans continue to spread, the Candida species
showed resistance to certain antifungal drugs through time. With this, it is
recommended for future researchers to closely monitor the fungus species
distribution and suspect to have more antifungal drugs be made to optimize
treatment for antifungal resistance. Pappas et. al. (2004) stated that since
Candida albicans is broad when it comes to fungal illnesses, the treatments
of this should also have a strategy in regards to diagnosis and therapies for
it. Licensed drugs such as Pilocarpine hydrochloride were highlighted in the
study of Nile et al. (2019). It was pointed out that the repurposing of this
drug can regulate immune responses to reduce damage on vital tissues that
will be affected. It is crucial to find an effective solution to defeat C. albicans
due to its resistance to a commercial drug that targets cholinergic receptors
with limited tissue damages. By using Pilocarpine hydrochloride, there
would be a great possibility that this may lead to important findings added
to find a therapeutic solution on attacking C. albicans.
Mayer, Wilson, and Hube (2013) stated that normal ways of killing
pathogenic microorganisms in the past have shown no large difference
especially when it comes to such normal yeast fungi that even medications
made for it has no effect due to its biofilm that protects the bacteria itself.
The introduction to heat shock response was tackled to be quite unique

when targeting fungi. The manipulation of zinc, iron, manganese, and
copper homeostasis is also mentioned and can be a source of therapeutic
treatments used to attack nutrition eating fungi. These are some of the latest
findings of therapeutic strategies on Candida species reduction in our body.
Antifungal Drug Resistance of Candida Albicans
Over the past few decades, the emergence of useful medicinal
products, let it be organic or commercial has expanded in terms of creating
a cure for diseases. But prior to one’s knowledge, bacteria or fungal
infections such as Candida albicans also begins to evolve due to
environmental factors and the exposure of different types of substances to
test its effectivity on the bacteria. There are also some Candida species
other than Candida albicans that were exposed to these types of
experimentation, allowing them to adapt to the environment, which is the
primary cause of the said bacteria becoming antifungal resistant (Sheikh,
Jahagirdar, Kothadia, & Nagoba, 2013).
The different Candida species differ in their weakness to the accessible
antifungal operators. The inborn protection from antifungal treatment seen
in certain species, alongside the advancement of gained obstruction during
treatment in others, is turning into a significant issue in the administration of
Candida contaminations. Antifungal weakness testing has in this manner
become fundamental for compelling patient administration and obstruction
reconnaissance (Sanguinetti & Posteraro, 2015).

The study of Sardi et al. (2013) also observed a significant increase
in cases of fungal infections. Different Candida species contribute to the
superficial and life-threatening fungal infections such as AIDS, which can
then lead to malnutrition and interfere with the absorption of the medication.
The perpetuation of these infections is affected by biofilms as it affects its
ability to adhere to various medical devices. Infections caused by Candida
and Cryptococcus are leading to high rates of morbidity and mortality
worldwide. Thus, it is crucial to develop new alternative drugs against
Candida and Cryptococcus (Monteiro & Santos, 2019). It is recommended
to search for new products with effective antifungal activities to lessen the
adverse side effects of existing medications and the formation of biofilms in
medical devices and tissues.
The defiance of antifungal drugs shows imperatively due to point
mutations in either drug targets or transcription factors regulating players of
the resistance. Having that, high kinds of diagnostic tools could be used in
the treatment stage of fungal infections in order to determine resistance and
adjust the ways accordingly before any clinical evidence and therefore allow
a fast adjustment of the antifungal treatment (Vandeputte, Ferrari, & Coste,
2012).
Antifungal resistance in the Candida albicans is caused by a
multifactorial occurrence, involving molecular changes often linked to the
mechanisms of action of the drug itself. The capacity to form biofilm depicts
a problem in the circumstances of the antifungal drug-resistance. According
to Morace, Perdon, and Borghi (2014), Echinocandin- and azole-resistance
is commonly reported in non-albicans Candida from cases of invasive
Candidiasis. A sensible use of antifungal drugs in clinical practice could
prevent and reduce the emergence of resistant strains. Candida albicans
are pathogens that affect patients only or chiefly when the immune system
is depressed. These pathogens are commonly found as a member of the
human oral and gastrointestinal microflora. Biofilms of C. albicans often
cultivate on indwelling devices, such as blood and urinary catheters and
heart valves. These infections are essentially untreatable by antifungals and
can develop into life-threatening diseases with a mortality rate approaching
forty percent. Given their resemblance to bacterial biofilms, we can say that
fungal biofilms may similarly produce persister cells. The study promulgates
that C. albicans biofilms contain highly drug-tolerant persisters that may
largely account for biofilm multidrug tolerance (LaFleur et al., 2006).
Candida species are observed to be 84%, 62%, 60%, 76%, 46%, 30%, and
22% multi-drug resistant against common antifungal drugs such as
fluconazole, clotrimazole, Amphotericin B, itraconazole, ketoconazole,
miconazole, and nystatin respectively. With the continuous growth of the
resistance of the species, potential alternatives to antibiotics should be
studied to avoid their overuse and side effects on human health and the
environment. Upon testing, plant extracts that contain alcoholic extracts

have significant activity against multi-drug resistant pathogenic Candida
spp. The data gathered is comparable to the commonly used antifungal
drugs mentioned (Pfaller, 2012).
According to Kumar et al. (2012), Fluconazole is the major antifungal
drug being used to treat Candida albicans, the most commonly isolated
organism from bloodstream infections. Fluconazole and Amphotericin B are
the drugs that are generally used against human pathogenic fungi.
However, these drugs show some side effects and toxicity. Aside from that,
antifungal resistance to this drug has also been increasing in the past years.
Azole antifungals contain components that battled microbes such as
Candida species for a very long period of time until it was recently
discovered that some of the Candida species learned to be drug-resistant
due to the frequent testing of azole antifungals, exposing it to foreign
substances, making the bacteria stronger and immune towards it. Candida
species typically grows on hot and moist places on a human’s body such as
the mouth or vagina, affecting its health, weakening its immune system and
the way he/she functions when Candida albicans are not exposed to
fluconazole, a type of antifungal containing azole (Whaley et al., 2017).
Cocos nucifera
In Indian classics, the Coconut tree was referred to as “Kalpavriksha”
which means the all-giving tree (DebMandal & Mandal, 2011). Coconut
(Cocos Nucifera) is an important member of the family of Arecaceae (palm

tree) and it is originally from Southeast Asia (Lima et al., 2015). DebMandal
& Mandal (2011) stated that the tree is known for its multiple utilities varying
from nutritional and medicinal uses because it contains microminerals and
nutrients which are essential to human health. Thus, throughout history, this
plant has been considered a source of various natural products for the
development of medicines against various diseases. The constituents of its
fruit such as the coconut water and coconut kernel have proven various
medicinal properties which include antibacterial, antifungal, antiviral,
antiparasitic, antidermatophytic, antioxidant, hypoglycemic,
hepatoprotective, and immunostimulant. In addition, some uses of the plant
were confirmed through the study of Lima et al. (2015), demonstrating its
anti-inflammatory, antinociceptive, antimicrobial, and antitumor activities.
Properties of Cocos nucifera oil
A study by Ghani et al. (2018) investigated the physicochemical
properties of virgin coconut oil, the purest form of coconut oil. The results
showed that the physicochemical properties of the coconut oil are within
the acceptable and recommended range given by the Asian Pacific
Coconut Community (APCC). Furthermore, these findings ensure that
virgin coconut oil has good quality and is safe to be used for consumption
and utilization.
Coconut oil is basically water-clear or colorless. It consists primarily
of fatty acids saturated with medium-chain components or medium-chain

fatty acids (MCFAs). These components were said to have an antimicrobial
potential. These MCFAs include lauric, caproic, caprylic, myristic, and
stearic acid and these compounds are also responsible for the antifungal
effect of coconut oil (Sheidaei et al., 2019). Thus, the biological properties
of virgin coconut oil (VCO) have been widely explored and investigated for
over many decades. Currently, coconut oil and its MCFAs have been
commonly used against fungi and most research has concentrated on
Candida albicans, the human body's most abundant and often isolated
fungus. (Nasir, Abllah, Jajaludin, Shahdan, & Manan, 2018). Furthermore,
a study from Elmore, Pharm, BCPS, Nance, Singleton & Lorenz, L. (2014)
concluded that the use of MCFAs can be used by patients suffering from
mild skin infections as an anti-infective alternative.
This study by Azevedo et al. (2020) focuses on the physicochemical
characterization (moisture, density, and saponification, iodine, and acidity
values), fatty acid composition as determined by a gas chromatograph
mass spectrometry (GC/MS), total phenolic content (TPC), and antioxidant
activity (DPPH and ABTS radical scavenging assay) of cacay oil, coconut
oil and a coconut/cacay oil blend, also known as cacay butter. The
antibacterial activity of cacay oil was additionally evaluated. Fatty acids
were initially obtained using the conventional methylation procedure,
methanolic extraction was performed according to the methodology with
modifications. The results showed that saturated fatty acids are dominant
for coconut oil (78.4%) and cacay butter (69.1%), especially lauric acid.
Cacay oil, coconut oil, and cacay butter presented similar percentages of
oleic acid among the detected monounsaturated acids. Coconut oil and
cacay butter showed high potential to oxidative stability due to high contents
of saturated fatty acids such as lauric, myristic, and palmitic acids, which
influenced the iodine value.
Dubey (2018) summarized the reviews of in vivo and in vitro studies of
topical anti-infective properties of coconut oil and the medium-chain fatty
acids contained within, and described the proposed use of coconut products
for dermal infections. From the review, it was proven coconut oil can be
used to treat atopic dermatitis, propionibacterium acne, and moderate
xerosis, which are bacterial and fungal diseases.
Owing to the high content of medium-chain fatty acid, coconut oil differs
from most other dietary oils (Peedikayil, 2019). Verallo-Rowell, Dillague,
and Syah-Tjundawan (2008) compared the effectiveness of virgin coconut
oil and virgin olive oil in removing Staphylococcus aureus from colonized
atopic dermatitis skin. The results showed that virgin coconut oil had greater
potential in treating atopic dermatitis colonization in post-treatment than
virgin olive oil.
Lauric acid, which is prevalent in coconut oil, has been shown to
have anti-inflammatory, antiviral, and antimicrobial effects. On the other
hand, the most powerful of the fatty acids in battling Candida species is the
caprylic acid, which functions by breaching the cell walls of the Candida,
leading to its rupture by inhibition of growth and ultimately killing it
(Peedikayil, 2019). According to Nasir, Abllah, Shahdan, and Jalaludin
(2018), the monolaurin makes coconut oil due to its high concentration of
medium-chain fatty acids. Therefore, as a daily supplement or alternative
treatment against microbial infections, coconut oil may be used.
Antimicrobial and antifungal activities of Cocos nucifera oil
Agarwal, Lal, and Pruthi (2010) aimed to isolate new antifungal
agents from plant extracts and oils to discover new chemical structures
without having the mentioned disadvantages or side effects. Eighteen of
the selected plant oils were found to be effective. Cocos nucifera was said
to belong in the less effective group with a zone of inhibition at 4.0mm.
Moreover, in vitro antifungal activity of Cocos nucifera and white palm
kernel oil on the growth of six species of the genus Candida was evaluated
using agar disc diffusion for sensitivity tests and macro-dilution. It showed
that among the species of Candida, C. Albicans was the least susceptible
to Virgin Coconut Oil with a maximum inhibition percentage of only 59.85%
when the concentration of the oil was 100 mg/ml (Kamga et al., 2019).
According to Widianingrum, Noviandi, and Salasia (2019), a research was
conducted for finding a new antimicrobial from VCO as a strategy to
improve the current situation in the present time. Another experiment was
conducted to study the effect of VCO enriched with Zn to the amount of

neutrophil and lymphocyte subset cells and the level of IL-2 and IgG in
vaginal candidiasis patients. The results led to the conclusion that VCO
enriched with Zinc supplementation maintains the number of neutrophil
cells in the normal range so that its activity is optimal to fight C. albicans
(Winrasi, Hernayanti, and Purwanto, 2008). And with the aim of finding
other alternative medications and treatment against C. albicans, Kumar et
al. (2012) used four natural oils namely almond oil, coconut oil, clove oil,
and lemongrass oil to test their antifungal activity against yeasts. Among
all the oils tested, Coconut oil showed maximum activity against C.
albicans B-1622/09 with a 4 mm zone of inhibition at 2 µl volume and 6
mm zone of inhibition at 4 µl volume.
The study conducted by Shino et al. (2016) tested the susceptibility
of Candida albicans isolated to coconut oil and compared their antifungal
efficacy with chlorhexidine and ketoconazole, which is a standard
antifungal agent commonly used to control candidiasis. Using Kirby
Bauer’s Disc Diffusion method, it showed that C. albicans was susceptible
to ketoconazole, chlorhexidine, and coconut oil. Therefore proving that
Cocos nucifera oil extract is comparable to ketoconazole. However, the
effect of the Cocos nucifera oil was less than that of chlorhexidine. In a
similar study determining the efficacy of coconut oil as a natural antifungal
agent in the treatment of oral candidiasis using the agar well diffusion
method, it was able to evaluate the antifungal activity of the coconut oil by
measuring the complete growth of inhibition of the Candida albicans to the
coconut oil and Clotrimazole (control group) in separate plates. It is found
that coconut oil can be an alternative antifungal agent to Clotrimazole as
it proved its strong potential antifungal activity to Candida albicans
(Natarajan & Mohammed, 2014). Activated virgin coconut oil (AVCO) also
has great potential as a new oral candidiasis antifungal therapy and will
help decrease the invasion of the fungus and eliminate oral cases acquired
in hospitals Candidiasis. Although, further analysis should be undertaken
of AVCO and its compositions to study their effects on Candida albicans
(Mukhtar et al., 2019).
Candida albicans are susceptible to fatty acids such as capric and
lauric acid and their 1-monoglycerides with the use of a transmission
electron microscope (TEM) with the ability to disintegrate the cytoplasm of
́ sson,
the all three strains of C. albicans (Bergsson, Arnfinnsson, Steingrım
& Thormar, 2001). The antimicrobial spectrum of monolaurin, a chemical
derived from lauric acid and glycerin, and a byproduct of coconut fat, is
broad including fungal species such as Aspergillus sp., Penicillium sp.,
Cladosporium sp., Fusarium sp., Alternaria sp., C. albicans, Fonsecaea
pedrosoi, and Cryptococcus neoformans. Parts of the coconut tree are
known to contain microminerals and nutrients as well, which are essential
to human health (DebMandal & Mandal, 2011). Fifty-two isolates of
Candida species were used to determine their susceptibilities to coconut

oil and fluconazole by using the Agar well diffusion technique. Candida
albicans were found to be highly susceptible to coconut oil. Thus it can be
said that coconut oil is active in killing C. albicans and other Candida
species which causes infection to the body. The study concluded that
coconut oil can be used as alternative antifungal medicine, especially in
this era of emerging drug-resistant fungi species (Ogbolu, Oni, Daini, &
Oloko, 2007).
The development of the extraction method of Cocos nucifera in
producing high-quality VCO was conducted by Handayani, Sulistyo, and
Rahayu (2008). It was found that there were clear zones surrounding the
paper disc after submerging into the virgin coconut oil, onto agar media
grown with a strain of Salmonella, indicating that this oil exhibited activity
against the growth of the tested microbial strain. It appeared that the stain
of Lactobacillus bulgaricus could effectively extract the virgin coconut oil
higher than the other tested microbial strains. Coconut oil is then added
as an active ingredient on a cream suitable for reducing antimicrobial
activities concerning the skin. Using the fusion method, the creams were
created with a 5 to 40% pure concentration of VCO and were tested using
various methods, such as antimicrobial screening of different bacteria
common for skin infections and standard method of testing. The data
gathered states that coconut oil mixed as an ingredient in a cream showed

no results of incompatibleness and is an effective use on the skin as an
antimicrobial product (Oyi, Onalapo, & Obi, 2010).
The study of Udensi et al. (2019) aims to determine the fungicidal
potency of virgin coconut oil on the Candida albicans, Aspergillus niger,
and mould species. They extracted the oil through the process of
fermentation. They studied and analyzed the antifungal potency of the
virgin coconut oil through the use of agar-well diffusion technique. The
results show that C. albicans is highly susceptible to the virgin coconut oil.
The range of the inhibition zone diameter of the C. albicans ranged from
8mm-18mm. This study showed that the coconut oil is active against the
species of C. albicans especially at 100% concentration.
Methods for susceptibility determination
Disk Diffusion Method
The disk diffusion method (DDM) is known as an agar diffusion
method (ADM) since the plant extract to be tested diffuses through the agar
medium seeded with the microorganism tested from its reservoir. The
reservoir is usually a filter paper disk mounted on top of an agar surface
(Horvath, Bencsik, Acs, & Kocsis, 2016).
An experiment was conducted by Silalahi, Permata, and Putra (2014)
examining the influence of the partial hydrolysis of VCO using the diffusion
agar method on its activity against different bacterias. The un-hydrolyzed

VCO did not show antibacterial activity but the hydrolyzed oil did. The longer
incubation time and the higher amount of NaOH used in the hydrolysis
increased antibacterial activity. VCO hydrolyzed by enzyme was more
effective than those hydrolyzed by sodium hydroxide. Hydrolyzed VCO was
more effective against Pseudomonas aeruginosa than Staphylococcus
aureus, Staphylococcus epidermidis, and Propionibacterium acnes. Kumar
et al. (2012) also used the Disk Diffusion Method in studying the antifungal
activity of four essential oils namely almond oil, coconut oil, clove oil, and
lemongrass oil. The cultures of Candida spp. were cultivated on Sabouraud
dextrose agar (HiMedia) at 25ºC for 48 hours. Suspensions of yeasts were
prepared in saline solution of 25% ± 2% turbidity, obtained at 580 nm, using
a suitable spectrophotometer (Systronics). Seeded agar plates were
prepared by pouring 20 mL of SDA into each sterile plate. After solidification
of the medium, each plate was overlaid with 5 mL of SDA, which was
previously inoculated with 1%(v/v) of the suspensions of yeasts. The four
essential oils to be observed were applied on filter paper (2.0 and 4.0
µL/disk) disks of 6 mm in diameter separately. 0.3 mg/mL of a Fluconazole
was used as a positive control. These disks were placed on the surface of
seeded agar plates at equal distance. All plates were incubated at 25ºC for
24 hours. Among all the oils tested, lemongrass oil showed maximum
antifungal activity followed by clove oil and coconut oil whereas, almond oil
showed the least activity. Coconut oil showed maximum activity against C.
albicans B-1622/09 with a 4 mm zone of inhibition at 2 µl volume and 6 mm
zone of inhibition at 4 µl volume).
Moreover, another experiment was conducted to determine the
effect of plant oils on Candida albicans. The inhibitory effect of 30 different
plant oils on Candida albicans isolated from clinical samples was evaluated.
The antifungal agent fluconazole was used as a positive control. Plant oils
were tested at concentrations from 0.03% to 3% (v/v) to determine the
minimum inhibitory concentration and minimum fungicidal concentration
(MFC) using agar dilution and macro broth dilution assays. This was done
through the disk diffusion method. The minimum inhibitory concentrations
(MICs) of the 18 effective oils and fluconazole against biofilm-forming C.
albicans were determined. The oils exhibited concentration-dependent
inhibition of growth. Fluconazole (4 μg/mL) completely inhibited the growth
of C. albicans. To determine the MFC, the researchers analyzed the lowest
concentration of oil resulting in the death of 99.9% of the inoculum.
Therefore MFC values were greater than their respective MIC values. The
results clearly demonstrate that peppermint, eucalyptus, ginger grass, and
clove oils not only act as potent antifungal agents against C. albicans, but
also perform better than fluconazole. Coco nucifera was said to belong in
the less effective group with ZOI at 4.0mm (Agarwal & Pruthi, 2010).
Routine Culture Methods
Juayang et al. (2019) studied the antifungal resistance of Candida
species in Bacolod City, Philippines. He obtained his data from the records
of patients with culture results of Candida species (either due to colonization
or infection) in the Microbiology Section of a tertiary hospital in Bacolod
City. The laboratory isolated the Candida species through routine culture
methods using Blood Agar Plate and Chocolate Agar Plate.
Blood Agar is a general-purpose enriched medium often used to
grow fastidious organisms and to differentiate bacteria based on their
hemolytic properties (Buxton, 2005). The composition of Chocolate Agar
and the Blood Agar is the same and the only difference is while preparing
chocolate agar, the red blood cells are lysed.
Coconut Oil-Core Nanocapsule
Santos et al. (2014) aimed to propose coconut oil-core nanocapsules
prepared from Eudragit ® RS100, a cationic polymer, and assess their
potential for vaginal clotrimazole delivery in candidiasis. Interfacial
deposition of Eudragit ® RS100 prepared nanocapsule suspensions filled
with clotrimazole at 1.0 and 3.0 mg / mL. The physicochemical
characterization showed an average diameter below 200 nm, low
polydispersity index, positive zeta potential (+10.94 to +14.57 mV), acid pH
values (5.4–5.7), and nearly 100 percent encapsulation performance. The
nanocapsules were relatively stable after 60 days of storage at room

temperature and shielded from light. Studies of photodegradation indicated
that nanoencapsulation improved the stability of clotrimazole against UV
radiation. Hence coconut oil-core nanocapsules loaded with clotrimazole
pose promising alternatives to vulvovaginal candidiasis therapy.
Agar Well Diffusion Technique
The technique of Agar well diffusion is commonly used to test the
antimicrobial activity of microbial extracts or plants. The agar plate surface
is inoculated by spreading a volume of the microbial inoculum over the
whole agar surface, similar to the technique used in the disk-diffusion
process (Balouiri, Sadiki, Ibnsouda, 2016).
To determine the antifungal activity of coconut oil and its
effectiveness in the treatment of oral candidiasis, Natarajan & Mohammed
(2014) conducted an experiment wherein Candida albicans were
subcultured in Sabouraud Dextrose agar and virgin coconut oil was
dispensed on the plates. The plates were then incubated at 37 C for 24
hours. The same volume of Clotrimazole was used on another plate as
control. The diameters of the zones of inhibition around each disc were
examined, measured, and recorded as the mean diameter of complete
growth inhibition. Ogbolu et al. (2007) also assessed the effectiveness of
Virgin Coconut Oil as an antifungal agent against Candida Species using
the Agar well diffusion technique. 52 isolates of Candida species were

obtained and their susceptibilities to virgin coconut oil and fluconazole were
studied.
Direct Fluorescence-Based Live/Dead Staining
Mukhtar et al. (2019) evaluated the antifungal activity of AVCO and
VCO using the LIVE/DEAD bacterial viability kit. This process used SYTO
9 and propidium iodide (PI) to stain cells of the Candida albicans. First, the
cells of C. albicans were cultured in yeast peptone dextrose (YPD) for 24
hrs. The culture was incubated with AVCO and VCO with the minimum
fungicidal concentration (MFC) of 6.24 mg/mL for 1 hr, 2 hrs, and 3 hrs
separately. Using fluorescence microscopy, the stained cells of the C.
albicans were observed. More dead cells were observed in C. albicans
that were treated with AVCO compared to VCO. However, VCO showed
a minimal activity against C. albicans.
Broth Microdilution Method
The broth microdilution is a method used in measuring the minimum
inhibitory concentration of antimicrobial substances against a bacterial
culture (Garcia, 2010). In this method, broth containing different
concentrations of the antimicrobial substance is poured into wells. These
are then inoculated with bacteria and incubated overnight. From this, the
minimal inhibitory concentration (MIC) is determined (Jorgensen, 2011). In
a study by Kumar (2019), he screened the MIC of neem oil, tea tree oil, and
coconut oil using the broth microdilution method. Culture of C. albicans was
inoculated in Tryptone Soya Broth, and then incubated overnight at 37 C.
In a 96-well plate, 1.5 μl of C. albicans culture and 7.5 μl of different
concentrations (5%, 10%, 15%, 20%, 25%, 30%, 35%, and 40%) of the
three oils were added. Among the three oils, Cocos nucifera oil presented
an antifungal activity with a percentage increase in the mean of inhibition
from 15% to 20% concentration. The 20% concentration of Cocos nucifera
oil was observed to be the most effective antifungal concentration.
2.2. Analysis and Synthesis
Search Strategies
In order to establish a literature review that answers the research
questions, online academic journals in the field of botany, biotechnology,
and microbiology were reviewed and evaluated according to their
significance and sufficiency that best fits the literature review topic.
Electronic databases that were used in gathering studies include Google
Scholar, Scientifica, and ResearchGate. Furthermore, a search strategy
was applied to efficiently access available studies that are helpful for the
review. The researchers used four search terms in relation to the concepts
needed for the study. The search terms are as follows: Cocos nucifera,
Candida albicans, Antifungal activity of Cocos nucifera oil extract, and
Candida albicans antifungal drug resistance.

Inclusion and Exclusion Criteria
Articles published from the years 1971 to 2020 were covered.
Sources such as raw experimentations, previous studies, articles and peer-
reviewed journals were used to gather data needed for the review. Mainly,
this review is focused on existing research that addressed the antifungal
activity of the oil extract from Cocos nucifera (Coconut Tree) and its
physicochemical properties against Candida species, specifically Candida
albicans. Several factors were taken into consideration in terms of the
credibility of the information acquired such as ensuring that the publishers
were different, the relevance and consistency of the data and the
credentials of the authors are lined with the field of the chosen study.
Search Outcomes
Through the use of search strategies and online databases, A total
of 56 existing articles were gathered, and 14 out of these 56 articles best
relate to the antifungal activity of Cocos Nucifera against Candida species,
particularly against C. albicans. These 14 articles were considered as the
main articles and whose data were used as sources of main findings. We
came up with effective search strategies that helped us extract significant
journals to include in our literature review. There were 59 articles retrieved;
retrieved studies passed the abstract screening. However, 3 journal articles
were excluded after the whole article evaluation, considering the said
journals' purpose is found unrelated to the literature review. Moreover, we

grouped the 56 included studies according to their topic value and
effectiveness. A chart illustrating the search outcomes of the literature
review is available in the appendices section (See Figure 1).
Data Extraction
Upon identification and selection of studies, a total of 56 journal
articles were able to provide sufficient information in relation to the
antifungal activity of oil extract from Cocos nucifera (Coconut Tree) against
Candida albicans. All the information gathered from the 56 articles were
synthesized using a matrix that allowed classification of the articles
according to four dimensions namely their study purpose and setting, data
collection technique, salient findings, and their conclusions (See Appendix
A in appendices). Moreover, paraphrased notes were also accomplished for
each article to provide a summary of the main findings and important
information about the topic and its corresponding sub-topics.
2.3. Discussion
Main Findings
Antifungal Drug Resistance of Candida albicans
Among the several studies used in this study, there is agreement
regarding the resistance of Candida albicans to synthetic fungal drugs, that
makes finding a new antifungal component important. Due to environmental
factors and exposure of different types of substances during the testing on

its effectivity on the bacteria, the species of Candida Albicans also begins
to evolve as time passes by. Because of this exposure, some Candida
Albicans have well adapted to the particular environment which causes the
antifungal resistance of Candida Albicans (Sheikh, Jahagirdar, Kothadia, &
Nagoba, 2013).
Morace et al. (2014) suggested that a reasonable use of these
antifungal drugs in clinical practice may reduce the development of resistant
strains. Fluconazole and Amphotericin B have been used widely to treat
human pathogenic fungi. Despite its good antifungal properties, these drugs
have shown some side effects and toxicity. In the past years, It has also
been observed that the antifungal resistance of these drugs have increased
(Kumar et al., 2014).
A table containing data on the growth resistance of Candida albicans
against certain drugs can be seen in Table 1 in the appendices section.
Cocos nucifera as an Antifungal Agent
Nine experimental studies were assessed according to their
gathered data in correspondence to the concentrations of Cocos nucifera
oil, the data collection method, and how it affected the growth inhibition of
Candida albicans. The average data of the nine studies depicts Cocos
nucifera as an effective antifungal agent.
Four studies made use of the Disk diffusion method, three used the
Agar well diffusion technique, one made use of Microdilution method and
the conducted Direct Fluorescence-based live/dead staining. Due to
different methodological conditions and data collection methods, there is a
remarkable difference between the zone of inhibitions collected by each
experiment. However, among the different data collection methods that
were executed, the use of the Agar well diffusion method provided the most
precise data, showing Cocos nucifera oil as an effective antifungal agent
against Candida albicans. Disk diffusion method provided the least precise
data wherein Shino et al. (2016) yielded 16.88mm ZOI, while Agarwal et al.
(2010) and Kumar et al. (2019) yielded 4mm ZOI which led to contrasting
conclusions on the effectiveness of Cocos nucifera oil as an antifungal
agent. Meanwhile, there are insufficient amounts of studies that made use
of the Microdilution method and the Direct Fluorescence-based live/dead
staining to assess its reliability.
Additional research that made use of Cocos nucifera as an antifungal
agent are illustrated on Table 2 in the appendices section.
Antifungal Properties of Cocos nucifera Oil
There is agreement amongst several studies attesting the
effectiveness of Cocos nucifera oil against several types of Candida
species. Several studies determined and investigated the components of
Cocos nucifera oil that could potentially combat the growth of fungi. Cocos
nucifera oil contains medium-chain fatty acids, namely lauric, caproic,
caprylic, myristic, monolaurin, and stearic acid (Sheidaei et al., 2019).

These compounds are said to have an antifungal effect against other fungi,
specifically Candida albicans (Nasir et al., 2018). Elmore et al. (2014) also
supported this claim. Based on the results of their study, they proved that
MCFAs can be used as an anti-infective alternative to treat various skin
infections. Dubey (2018) also stated in his review that MCFAs are used to
treat atopic dermatitis, propionibacterium acne, and moderate xerosis,
which are bacterial and fungal diseases.
Peedikayil (2019) stated in his study that lauric acid has shown to be
an effective anti-inflammatory, antiviral, and antimicrobial agent. His study
indicated that caprylic acid has shown to disrupt the cell walls of the
Candida, ultimately killing the fungus.
A study by Ghani et al. (2018) greatly summarizes the collected
journals in relation to the antifungal properties present in coconut oil. His
study showed that the antifungal properties present in the oil extract are
within the acceptable and recommended range given by the Asian Pacific
Coconut Community (APCC). Furthermore, these findings ensure that
coconut oil is safe and can be utilized as an antifungal agent.
An overview of the antifungal properties present in Cocos nucifera oil is
illustrated in Table 3, which can be found in the appendices.
Limitations and Reliability of the Review
The literature review gathered data from research journals aligned to
the utilization of Cocos nucifera oil as an antifungal and antimicrobial agent

against Candida albicans growth. It contains journal articles that were
mostly dated from the year 1970 to 2020. The majority of the studies
investigated the different MCFA components of Cocos nucifera oil against
several types of Candida species. It was also observed that various studies
used compared the antifungal activity of Cocos nucifera oil to other dietary
oils: white palm kernel oil, plant oils, almond oil, coconut oil, clove oil, and
lemongrass oil; and synthetic antifungal agents, such as Fluconazole,
Ketoconazole, and Clotrimazole. Although, some studies failed to specify
the concentration of the Cocos nucifera oil because of the lack of enough
research in the field. The studies used also have limited information that
can fulfill every criteria that researchers in the field of pharmaceutical drugs
would set as a prerequisite for new antifungal drugs.
Strengths and Weaknesses of the Review
This study aims to review and evaluate the effectiveness of Cocos
nucifera oil as an antifungal alternative medicine against Candida albicans.
Majority of the reviewed studies were able to yield positive results while only
few had negative results. With that being said, the reviewed studies strongly
support the effectiveness of Cocos nucifera oil as a possible substitute for
antifungal drugs against Candida albicans. The review has also tackled the
emerging problems brought by Candida albicans such as the continuous
spread of Candidiasis and the antifungal drug resistance of C. albicans

which further suggests the importance of searching for alternative
medicines that are helpful in treating Candida albicans.
However, there are notable inconsistencies and gaps present in the
reviewed studies, specifically in the results of the experiments. A great
difference in the zone of inhibitions is present in the different studies. In
addition to that, although most of the experiments led to a conclusion that
Cocos nucifera is highly effective in treating Candida albicans, the study of
Agarwal, Lal, & Pruthi (2010) considered the coconut oil as less effective
among other plant oils with 4.00mm zone of inhibition. Other than that, the
data collected from other studies presented a larger zone of inhibition which
proves high susceptibility rate of the fungi against Cocos nucifera.
Upon recognizing the inconsistencies and gaps of the data gathered
from different studies, the review was able to provide a bridge for the gaps
by analyzing the different methods used in the different experiments. It was
notable that the method used, as well as the methodological conditions
influenced the results of the experiment.
Implications
The primary goal of this review was to analyze, identify and compare
the different findings of various past researches about Candida albicans and
the antimicrobial and antifungal effects of Cocos nucifera to C. albicans.
Aside from the said reason, another goal of this review is to list down the
common and possible gaps of one study to another to improve the findings
concerning this topic.
The present review can give the researchers more concentrated
information about the recent researches regarding C. albicans, how it
spreads from one place to another, the organic materials used to test the
said fungi and the antimicrobial activities and importance of coconut oil. It
also provides a list of the tests and experiments held on treating C. albicans
using coconut oil and an in-depth explanation of each results done by the
experiments. It may give future researchers an idea what and how to test
its effectiveness on treating Candidiasis or use other methods to explore
other effects.
Majority of the studies regarding the usage of Cocos nucifera as an
alternative treatment for C. albicans infections and its antimicrobial activities
mentioned that coconut oil can be mixed with dermal solutions and it is
proven to inhibit the growth of C. albicans. It yields positive results that can
be helpful for patients suffering mild diseases associated with the
mentioned fungi without paying a large amount of money for treatment. Still,
the study has proven that it still needs a deeper understanding to update
the recent findings on how to fully avoid the chances of C. albicans related
disease to spread on a human body.
The findings in this study provides the summary and the comparison
of the data gathered from different studies produced by researchers about

Candida albicans and the effectiveness and feasibility of Cocos nucifera to
reduce the rapid growth of the mentioned fungi. The information gathered
is necessary due to the fact that only a few proven studies are considered
to slow down the growth of C. albicans but have no prolonging effect. This
is essential to avoid losing track of finding out other ways to contribute to
exterminating the multidrug resistant fungi on a patient’s body. Researchers
who are also investigating this topic can investigate the data gathered and
other journals.
CHAPTER 3
SUMMARY, CONCLUSION AND RECOMMENDATIONS
This chapter presents a succinct, reiteration of the different related
studies in the literature review. It contains a summary of major agreements
and disagreements in literature and a summary of the general conclusions
drawn.
3.1 Summary
The majority of mucocutaneous non-life-threatening diseases and
life-threatening organ diseases are contributed by common fungi known as
Candida albicans. The evolution of the fungi was studied by numerous
researchers wherein it turns out that Candida spp. are starting to become
antifungal drug-resistant. This pushes the need to study alternative
medicine and treatment for Candida albicans. Cocos Nucifera is known for
its multiple utilities varying from nutritional and medicinal uses because it
contains microminerals and nutrients which are essential to human health.
Coconut oil has a high concentration of medium-chain fatty acids such as
lauric acid and caprylic acid which makes it effective in its mode of action
against pathogenic microorganisms.
Most of the studies manifested the antifungal properties of Cocos
nucifera oil that aided the growth inhibition against Candida albicans.
However, inconsistency was visible among the gathered studies as there

were also few studies that showed Cocos nucifera as a less effective
antifungal agent against Candida albicans. As this research gap was
analyzed by the researchers, it can be observed that the method used for
susceptibility determination greatly affects the result of the experiment. The
use of antifungal drugs through clinical practice will aid and reduce the
development of Candida albicans overtime. Moreover, the utilization of
Cocos Nucifera to Candida albicans was aligned with the journals used in
this study.
3.2 Conclusions
The effectiveness of several synthetic antifungal drugs to treat fungal
infections has been reduced because of the spread of the multi-drug
resistant strains of Candida albicans. Also, common synthetic antifungal
drugs, proven with side effects, are used to treat fungal infections. These
factors have led to this literature review to discuss the potential of Cocos
nucifera oil extract as a naturally sourced compound which can be utilized
to discover more potent antifungal agents that can inhibit the resistant
mechanisms of synthetic antifungal drugs. Moreover, the key objectives of
this review were to unfold and explore the antifungal properties of Cocos
nucifera oil and to compare the effectiveness of it to synthetic antifungal
drugs.
In this review, the researchers attempted to give a comprehensive
overview of the natural components or the MCFAs of Cocos nucifera oil that
have been explored and found to represent antifungal properties against
several types of fungus, which are of great importance to the treatment of
Candidiasis in humans. Supporting findings of the review, along with similar
and related literature and studies, substantiate Cocos nucifera oil to be
comparable to that of synthetic antifungal drugs. Although the researchers
identified several inconsistent findings of the studies, such as great
differences in the zone of inhibition, they were able to bridge the gaps by
analyzing the different methods used in the experiments. Among all the
methods used by each study, the researchers found that the Agar well
diffusion method had the most precise data about the susceptibility of
Candida albicans to Cocos nucifera oil. But overall, the majority of the
studies have concluded that Cocos nucifera is an effective antifungal agent
against Candida albicans, which makes it a considerable substitute for
synthetic antifungal drugs.
Cocos nucifera has a broad use in traditional and complementary
medicine. However, for developing new antifungal agents from the
compounds of Cocos nucifera oil further, research is required. In this view,
it is hoped that further evaluation will be carried out to discover more of the
areas and practical clinical trials of Cocos nucifera as an antifungal agent

for the welfare of numerous individuals, especially those who cannot afford
synthetic antifungal drugs.
3.3 Recommendations
The use of Cocos Nucifera oil has been beneficial in fighting Candida
Albicans that makes it a good candidate for an alternative to synthetic
antifungal drugs. Due to the limitations encountered in the existing literature,
further research about other oils and different methods should be done to
discover better ways to increase the effectiveness of the said research. The
following shows the different limitations and its recommendations to be
done to improve the research further:
1. Lack of consistency was evident in the studies collected, as there
were also few studies indicating that Cocos nucifera would be a less
effective antifungal agent against Candida albicans. Because of this,
testing other plant-based alternatives will be helpful to identify the
best alternative that can inhibit the growth of Candida Albicans
2. The method for susceptibility determination has made a great impact
on the result of the experiment therefore it is significant to find a
better method in order to elicit the best result of which plant-based
alternative can be used to hinder the development of Candida
Albicans.
3. Methodological conditions can also greatly influence the outcome of
the analysis therefore the researchers should pay great attention to
the different conditions while doing the experiment.
Because of these gaps encountered, further research about alternative
plant-based medications and methods should be done.

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APPENDICES
APPENDIX A: REVIEW OF RELATED LITERATURE MATRIX

APPENDIX B: FIGURES AND TABLES
Figure 1. A flow chart illustrating the search outcomes of the review.
Table 1. A table containing data on the growth resistance of Candida
albicans against certain drugs.
Title of Authors Name of Drug Concentration Data Growth

Research of drug Collection resistance of
Method Candida
albicans
Antifungal Juayang, Voriconazole N/A Routine 8.4% (CI: 4.9-

Resistance of A.C., et al. culture 13.7)
Candida methods
Species in (Blood Agar
Bacolod City, Plate and
Philippines Chocolate
Agar Plate)
Azole Whaley, S., Fluconazole Minimum N/A 3.5% of

Antifungal Berkrow, inhibitory resistant
Resistance in E., Rybak, concentration isolates
Candida J., range of 0.06
albicans and Nishimoto, - ≥128
Emerging Non- A., Barker,
albicans K., Rogers,
Candida D.
Species
Comparison of Shino, B., Anidulafungin 1mg/mL Antifungal R>1 CLSI

Antimicrobial Peedikayil, (CLSI) susceptibility R>0.03
Activity F. C., 0.03 mg/mL testing (AFST) EUCAST
of Jaiprakash, (EUCAST) specifically
Chlorhexidine, S. R., Clinical
Coconut Oil, Bijapur, G. Caspofungin N/A 1mg/mL and R>0.16 CLSI
Probiotics, A., Kottayi, (CLSI) Laboratory
and S., & Jose, Micafungin 1mg/mL Standards R>1 CLSI

Ketoconazole D. (CLSI) Institute R>0.16
on 0.16 mg/mL (CLSI) and the EUCAST
Candida (EUCAST) AFST
albicans Subcommittee
Isolated in Fluconazole 8mg/mL of the R>8 CLSI
Children with (CLSI) European R>4 EUCAST
Early 4mg/mL Committee for
Childhood (EUCAST) Antimicrobial
Caries: Susceptibility
An In Vitro Itraconazole 0.06mg/mL Testing R>0.06
Study (EUCAST) (EUCAST) EUCAST
Posaconazole 0.06mg/mL R>0.06

(EUCAST) EUCAST
Voriconazole 1mg/mL R>1 CLSI

(CLSI) R>0.12
0.12mg/mL EUCAST
(EUCAST)
Table 2. The concentrations of Cocos nucifera oil used by different studies
with different methods to test its antifungal activity.
Title of Authors Cocos Methodologica Data Growth

Research nucifera oil l conditions Collection inhibition of
concentration Method Candida
that hindered albicans
growth
In vitro Kamga, H., 100 mg/mL The oil was Disk Diffusion Maximum
Evaluation of Essama, S., (maxium extracted and Method growth
Antifungal Napa concentration stored in a dark inhibition
Activity of Tchuedji, Y. ) and sterile percentage
Virgin L. G., Boda, bottle at 4°C of 59.85%
Coconut oil M., Voundi until use.
and White Olugu, S.
Palm Kernel H., Betote
Oil on Diboue, P.,
Candida Mbamyah,
Species- E., Baiye,
Experimental W., Chafa
Study Betbeui, A.,
Ekwin, F., &
Etoa
Comparison Shino, B., N/A N/A Disk Diffusion Mean

of Peedikayil, Method average of
Antimicrobial F. C., 16.8 mm
Activity of Jaiprakash, zone of
Chlorhexidine S. R., inhibition
, Coconut Oil, Bijapur, G.
Probiotics, A., Kottayi,
and S., & Jose,
Ketoconazole D.
on Candida
albicans
Isolated in
Children with
Early
Childhood
Caries: An In
Vitro Study
The influence Kumar, P.S. Minimum The lyophilized Microdilution Percent

of Azadirachta inhibitory culture of method increase in
indica, concentration Candida mean
Melaleuca against albicans was concentratio
alternifolia, Candida inoculated in n of ZOI went
and Cocos albicans was Tryptone Soya from from 15
nucifera on observed Broth and % to 20%.
Candida when 20% incubated at 37
albicans strain coconut oil is ° C overnight.
in tissue present in the
conditioner at media
varying time
intervals
Application of Mukhtar, N., Minimum All samples Direct 1h exposure

direct Abllah, Z., Fungicidal were Fluorescence time = 0.46 ±
fluorescence- Mohamad, Concentration incubated at -based 0.12b
based A., (MFC) of 6.24 room live/dead 2h exposure
live/dead Shahdan, I., mg/mL temperature staining time = 1.67 ±
staining for Long, K., & for 1 hour and 1.48b
assessmen of Haron, U. were 3h exposure
antifungal pelleted by time = 1.90 ±
activity of centrifugation 0.99b
Coconut oil at 10,000 × g
against for 15 minutes.
Candida
Albicans
Antifungal Udensi, J. Minimum N/A Agar well Zone of

Activities of U., Umeh, Inhibitory diffusion inhibition
Virgin S. I., Concentration technique ranged from
Coconut Oil Mgbemena, (MIC) of 8mm-18mm
on Candida I. C., 12.5mg/mL in diameter
albicans, Emeka- (1:8 dilution)
Aspergillus Nwabunia,
niger and I., Ebe, T.
Mould E., Aroh, K.,
Species & Onah, J.
Comparative Natarajan, 500 μl of virgin Candida Agar well Mean

Evaluation of K., & coconut oil albicans ATCC diffusion average of
Antifungal Mohammed was 66396 were technique 19.6mm
Activity of , A. dispensed sub-cultured zone of
Cocos into the wells. onto inhibition
nucifera Oil Sabouraud
against Dextrose Agar
Candida and incubated
albicans for 18 hours at
37°C.
Antifungal Kumar, A., 2 µl volume Cultures of Disk diffusion B-1622/09 (4

Activity of Thakur, S., and 4 µl Candida were method mm zone of
Some Natural Thakur, volume of cultivated on inhibition at 2
Essential Oils V.C., coconut oil Sabouraud µl volume
against Kumar, A., dextrose agar and 6 mm
Candida Patil, S., (HiMedia) at zone of
Species Vohra, M.P. 25ºC for48 inhibition at 4
Isolated from hours. All µl volume)
Blood Stream plates were
Infection incubated at
25ºC for 24
hours.
Effect of Plant Agarwal, V., 1.50% Candida Disk diffusion 4.00mm

Oils on Lal, P., minimum culture was method zone of
Candida Pruthi, V. inhibitory incubated for inhibition
Albicans concentration 24 hours at which is
and 3.00% 35°C with considered
minimum agitation less effective
fungicidal (120 rpm). among other
concentration plant oils
In Vitro Ogbolu, D., Minimum The solutions Agar well 100%

Antimicrobial Oni, A., inhibitory were allowed diffusion susceptibility
Properties of Daini, O., & concentration to diffuse for technique rate
Coconut Oil Oloko, A. (MIC) of 25% 30 minutes in
on Candida (1:4 dilution) the agar
Species in medium, after
Ibadan, which the
Nigeria plates were
then incubated
at 35°C for 24
hours.
Table 3. Overview of the antifungal properties present in Cocos nucifera
oil.
Title of Research Authors Physicochemical Composition Profile

Characterization
Physicochemical Azevedo, W., Oliveira, Fatty acids dominant Saturated fatty acids
characterization, fatty L., Alcântara, M., (78.4%); high such as lauric,
acid profile, Cordeiro, A., potential to oxidative myristic, and palmitic
antioxidant activity, Damasceno, K., stability acids
and antibacterial Araújo, N., . . . Junior,
potential of cacay oil, F.
coconut oil and cacay
butter
Is coconut oil good for Peedikayil, F.C High content of Lauric, caproic,
oral health? A review medium-chain fatty caprylic, myristic, and
acid (MCF) stearic acid with lauric
acid being the most
predominant MCF
Physicochemical Ghani, N. A., Channip, Low moisture content, VCO predominantly

properties, antioxidant A., Hwa, P. C., Ja'afar, refractive index, high contains lauric acid
capacities, and metal F., Yasin, H. M., & viscosity, iodine value, which is in the range
contents of virgin Usman, A. saponification value, of 48.40%–52.84% of
coconut oil produced peroxide value, free the fatty acid content.
by fatty acid, and fatty
wet and dry acid content
processes
Virgin Coconut Oil and Nasir, N., Abllah, Z., Large concentration of Lauric acid (LA) and
Its Antimicrobial Jalaludin, A., medium-chain fatty its monoglyceride
Properties against Shahdan, I., Manan, acids (MCFAs) form, monolaurin
Pathogenic W.
Microorganisms: A
Review
APPENDIX C: BIONOTES
Angelica Buen Acosta is a 17-year-old Health Allied

senior high school student at the University of Santo
Tomas. Her past research study focused on the
antifungal activity of plant extracts. She is interested in
providing help to those in need, mathematics, and
science. She plans to pursue B.S. Biology and a
career in the medical field.
Francine Gayle Cabailo is a Grade 12 Health Allied

student from the University of Santo Tomas gathering
information along with her co-researchers about the
significance of organic plant oils on antifungal
activities. She plans to continue doing similar
research in her upcoming years to help utilize natural
resources and develop her medicine journey.
Eliana Caris Cabildo is a Grade 12 student from

University of Santo Tomas under the Health Allied
Strand. Her latest research work dwells on the
antifungal activity of plant oils. She led her research
team in conducting a literature review on this topic.
Moreover, she is interested in research topics under
the medical field and plans to pursue a career in
medicine.
Imee Claire Calaro, a Grade 12 student from the

University of Santo Tomas Senior High School under
the Health Allied Strand has spent her last school year
with her co researchers doing their research about
the antifungal activity of plant oils. Her past research
is about the 21st Century Political Leaders which has
been a great success for her first time. She plans to
take up Pharmacy and hopefully pursue a career in
medicine.
Ezer Eric Candido is a Health Allied Grade 12

student from the University of Santo Tomas. With his
co-researchers, his first and latest research reviews
the effectiveness of the antifungal activity of plant oils.
Furthermore, he is interested in research with regards
to the field of medicine. He also plans to take-up
Nursing as his pre-med course to pursue a career in
medicine.
Richie Carlo Cuyugan is a Grade 12 Health Allied

student from the University of Santo Tomas. His latest
research is about the antifungal activity of plant oils
along with her co-researchers, and hopefully get a
good score on it. He wants to succeed in life by
learning from experiences because he believes that
experience is the best teacher in the game of life.
Zach Daniel Dela Cruz is a Health Allied Grade 12

student from the University of Santo Tomas. His latest
research with his co-researchers investigates the
Antifungal activity of plant oils. His last research is all
about genres of music that are frequently used, a huge
success from his part that he finished it on time.
Moreover, he wants to pursue nursing as a pre-med
course to enter medicine in the near future.
Alessandra Patricia Margreat Lobos is a Grade 12

Health Allied Student from the University of Santo
Tomas. Her latest research concerns the antifungal
activity of plant oils along with her co-researchers.
Some of her past research include Plant-based
Alternatives as a Mosquito Repellant and Hydrogen
Production by Water Electrolysis. She plans on taking
up Nutrition and Dietetics as a pre-med course.
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EXTRACT COCOS NUCIFERA (COCONUT TREE) AGAINST CANDIDA ALBICANS
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the main topic of the
research.
The research questions
are meaningful and are
deemed appropriate to the
topic and design of the
research and is written in a
logical manner.
The chosen theory is
appropriate and related to
the research, its relevance
is well-explained.
The significance of the
study is well-justified and is
realistic
The scope and limitations
of the study is well-
described, and it does not
give rise to confusion on
the area of research
Review of Related There are ≦40 references X3 /15
Literature in this chapter.
It is well written, cohesive,
and arranged in a logical
manner, and is meaningful
Appropriateness of The methodology of the X2 /10

Research research is appropriate,
Methodology/Synthesis the sampling technique is
justified, the data gathering
procedure is well-
explained and detailed,
and the ethical concerns
that may arise in the
conduct of research is
explained and given
attention to.
The synthesis of RRL was

written properly. It
Conclusion The main points of the X2 /10
results and summary of the
study was briefly stated
and provides a provocative
insight. A future course of
action was also provided.
Technical Qualities The output is free of X2 /10
distracting spelling,
punctuation/s, and
grammatical errors.
There are no run-ons, and
there is a clear format.
Follows correct format.
Writing Style There is a logical X2 /10
organization of thoughts, it
is expressed coherent to
the rules of technical
writing, and is interesting.
TOTAL /70
Prepared by:
John Ismael J. Medina, M.Sc.

Research Faculty
Revised by:
Martin Raemond B. Mallabo, RPh., MSc

Research Faculty

A Literature Review On The Antifungal Activity of Oil Extract Cocos Nucifera (Coconut Tree) Against Candida Albicans

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A Literature Review On The Antifungal Activity of Oil Extract Cocos Nucifera (Coconut Tree) Against Candida Albicans

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UNIVERSITY OF SANTO TOMAS SENIOR HIGH SCHOOL PAGE i

A LITERATURE REVIEW ON THE ANTIFUNGAL ACTIVITY OF OIL

EXTRACT COCOS NUCIFERA (COCONUT TREE) AGAINST CANDIDA

A Review Paper Presented to the Senior High School

University of Santo Tomas

In Partial Fulfillment of the

Requirements for Inquiries, Investigations, and Immersion

ACOSTA, ANGELICA BUEN S.

CABAILO, FRANCINE GAYLE Y.

CABILDO, ELIANA CARIS G.

CALARO, IMEE CLAIRE M.

CANDIDO, EZER ERIC P.

CUYUGAN, RICHIE CARLO A.

DELA CRUZ, ZACH DANIEL S.

LOBOS, ALESSANDRA PATRICIA MARGREAT P.

The completion of this literature review would not be made possible

without the people who continuously supported and assisted the

researchers in the development of the manuscript. All praise and glory to

God for giving knowledge, strength, patience and wisdom in exploring

of every endeavor, there is a great source of all effort, striving, guidance

The group would like to express their deepest appreciation and

indebtedness particularly to the following people:

emotional support since the beginning of the research process. For

understanding their lack of time to bond due to their dedication for

To Mrs. Arleen B. Alferos, Ms. Rochelle Palomo, and Mr. John

and suggestions in producing a great research paper. For patiently guiding

the researchers to further improve their paper.

To the University of Santo Tomas for giving the researchers’ this

For inspiring the researchers to become an instrument for change.

Candidiasis is considered to be one of the top bloodstream related

infections in the world, which is mainly caused by fungus Candida albicans.

The review aimed to assess coconut oil as an alternative product to combat

effects of existing medications. The review provided a bridge to the

inconsistencies and gaps of the different studies by analyzing the different

used, as well as the methodological conditions influenced the results of the

outcome of the analysis. An agreement was established regarding the

resistance of Candida albicans to synthetic fungal drugs upon reviewing the

related literature and studies, substantiate Cocos nucifera oil to be

comparable to that of synthetic antifungal drugs due to its medium-chain

Keywords: drug resistance, fungal infection, coconut oil

Chapter 1: INTRODUCTION 1-6

Chapter 2: REVIEW OF LITERATURE AND STUDIES 7-38

Strengths and Weaknesses of the Review 35

Chapter 3: SUMMARY, CONCLUSION, RECOMMENDATIONS 39-43

Table 1. A table containing data on the growth resistance of Candida

albicans against certain drugs.

Table 2. The concentrations of Cocos nucifera oil used by different studies

with different methods to test its antifungal activity.

Table 3. Overview of the antifungal properties present in Cocos nucifera

Figure 1. A flow chart illustrating the search outcomes of the review.

followed by the objectives, statement of the problem, scope and limitations,

and significance of the review.

1.1 Background of the Study

Fungal infections affect a person when the body’s immune system

In 2016, a total of 1,852,137 were affected by severe fungal

infections in the Philippines. 80.40% of these cases were constituted by

Candidiasis. Types of infections include recurrent vulvovaginal candidiasis,

oral and esophageal candidiasis, candidemia, and Candida peritonitis. As

systematic treatment of Candidiasis. Such drugs include azoles, polyenes,

echinocandins, and pyrimidine (Juayang et al., 2019).

contributes largely to human disease, like the vast majority of microbial

biofilms. The perpetuation of Candida infections are affected by biofilms as

it affects its ability to adhere to various medical devices. As a consequence,