Original Research Article In Vitro Antifungal Susceptibility Pattern of Oropharyngeal and Oesophageal Candida Species in HIV Infected Patients (original) (raw)
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Clinical Infectious Diseases, 1997
We evaluated 119 episodes of oropharyngeal candidiasis due to C. albicans to study the patterns of fluconazole susceptibility of the isolates and the characteristics of the patients and to confirm the correlation between fluconazole susceptibility of isolates and therapeutic outcome. Sixty-one isolates were considered susceptible to fluconazole (MICs, 0.5 Ag/mL), 33 were intermediate (MICs, 1.0-8.0 ,ug/mL), and 25 were resistant (MICs, 16.0 aug/mL). Patients infected with resistant strains had significantly lower CD4+ cell counts and a less recent AIDS diagnosis than patients infected with intermediate or susceptible strains. Previous fluconazole therapy and prophylaxis were significantly more frequent for patients infected with resistant and intermediate strains (P < .001). Decreased susceptibility to ketoconazole and itraconazole was observed in resistant and intermediate strains. Fluconazole treatment was ineffective for patients infected with resistant isolates; however, high doses of ketoconazole or itraconazole were successful for nine (81%) of them. Different patterns of fluconazole susceptibility among C. albicans strains are correlated with patients' characteristics and with therapeutic outcomes. Oropharyngeal candidiasis is the commonest opportunistic infection in patients infected with HIV, occurring in up to 90% of them. Candida albicans is the species most frequently isolated from patients with AIDS who have oral thrush [1], and antifungal therapy without microbiological confirmation is appropriate. Treatment with azole derivatives is effective for both oral thrush and esophageal candidiasis [2-4]. Fluconazole is an orally active, triazole antifungal agent that is less toxic, is better tolerated, and has greater in vivo activity against C. albicans than ketoconazole, and it is absorbed more reliably [5]. Fluconazole is associated with significantly greater rates of endoscopic and clinical cure than is ketoconazole for HIV-infected patients with oral or esophageal candidiasis [2, 3]. However, oropharyngeal or esophageal, candidiasis recurs
Journal of Antimicrobial Chemotherapy, 1998
Over a 16 month period we conducted a prospective study in a cohort of 45 HIV-positive patients to detect the development of resistance to fluconazole and to analyse the epidemiology of oropharyngeal candidosis (OPC). Each episode was treated with fluconazole 100 mg/day po for 10 days. All yeast isolates were tested for their in-vitro susceptibility to fluconazole. Multiple strains of Candida albicans simultaneously isolated from a given patient were typed by electrophoretic karyotyping. Overall, 106 episodes of OPC were diagnosed among the 45 patients: 18/45 patients (40%) had only one episode, 11/45 (24%) had two episodes, and the remaining 16/45 (36%) had three or more episodes (range 3-7). Cure (complete resolution of signs and symptoms and negative post-treatment cultures) and improvement (complete resolution of signs and symptoms but positive post-treatment cultures) were observed in 30/106 (28%) and 69/106 (65%) episodes of OPC, respectively. Failure (absence of improvement or exacerbation of signs and symptoms) was observed in seven episodes (7%) from four patients. In two of these four patients a significant and progressive increase in fluconazole MICs was observed: from 0.25 to 16 mg/L in one patient, and from ≤0.125 to 32 mg/L in the second one. Tests on multiple colonies from individual isolation plates showed that it was not unusual to obtain different fluconazole MICs, indicating that, in order to avoid misleading results, one should perform in-vitro susceptibility testing by using a multiple colony inoculum rather than an inoculum made from a single colony. A total of 213 strains of C. albicans isolated from seven patients who suffered from four or more episodes of OPC through the course of the study were typed by electrophoretic karyotyping. Five individuals (71%) were infected with yeasts with only one DNA type, while the other two patients showed the presence of two or three different DNA types. The simultaneous presence of multiple types was found only in one of the seven subjects. Our data confirm the efficacy of fluconazole 100 mg/day for the treatment of OPC in HIV patients. Isolation of fluconazoleresistant strains of C. albicans with this regimen is rare. The vast majority of HIV patients are infected with a unique strain of C. albicans throughout each episode of infection. A minority of patients, however, can harbour strains of C. albicans with variable patterns of fluconazole susceptibility simultaneously.
The Southeast Asian journal of tropical medicine and public health, 2008
Oropharyngeal candidiasis (OPC) continues to be a common opportunistic infection in patients infected with Human Immunodeficiency Virus (HIV) and is predictive of increasing immunosuppression. Though Candida albicans remains the predominant isolate, a rise in the frequency of isolation of non-albicans Candida (NAC) species is being observed. The levels of virulence and the sensitivities to available antifungal drugs vary among these species. Of 340 HIV seropositive patients in this study, 132 (38.8%) had oral lesions suggestive of candidiasis. Samples were collected from the lesion using sterile cotton swabs. Isolation and speciation were done by standard techniques. Antifungal drug susceptibility testing was done by macro broth dilution. The total number of Candida isolates was 135, of which, 45 (33.3%) were NAC species and 90 were C.albicans (66.6%). Of the NAC species, C. dubliniensis was the predominant pathogen (22,48.9%). Antifungal susceptibility testing showed that 14 (31.1%...
The antifungal susceptibilities of oral Candida spp isolates from HIV-infected patients
African Journal of Microbiology Research, 2010
Oropharyngeal candidiasis (OPC) is the most common HIV related oral lesion. Most patients are infected with a strain originally present as a commensal of the oral cavity. The resistance of Candida isolates to antifungal drugs is important due to morbidity and mortality. The aim of our study was to investigate the antifungal susceptibility profiles of oral Candida spp. which were isolated from HIVinfected patients. In vitro susceptibility tests were performed using the broth microdilution method recommended by the Clinical and Laboratory Standard Institute (CLSI). A total of 67 oral Candida isolates from colonized HIV-infected patients, which were previously isolated and identified were included in this study. MIC ranges were 0.12-4.0, 0.12-16, 0.03-1.0, 0.03-1.0, and 0.03-0.25 µg/ml for amphotericin B, fluconazole, itraconazole, ketoconazole and voriconazole, respectively. All isolates were fully susceptible to voriconazole. Sixty five (97%) of all isolates were determined fully susceptible to amphotericin B, 66 (98.5%) to fluconazole, 64 (95.5%) to ketoconazole and 50 (88%) to itraconazole. No resistance was detected to fluconazole and voriconazole in oral Candida strains isolated from colonized Turkish HIV positive patients. Antifungal resistance was detected in 8.96% (6 strains) of all isolates tested.
Journal of clinical microbiology, 2000
Oropharyngeal and esophageal candidiasis (OPEC) is a frequent opportunistic mycosis in immunocompromised patients. Azole-resistant OPEC is a refractory form of this infection occurring particularly in human immunodeficiency virus (HIV)-infected patients. The procedures developed by the Antifungal Subcommittee of the National Committee for Clinical Laboratory Standards (NCCLS) are an important advance in standardization of in vitro antifungal susceptibility methodology. In order to further understand the relationship between NCCLS methodology and antifungal therapeutic response, we studied the potential correlation between in vitro susceptibility to fluconazole and in vivo response in a rabbit model of fluconazole-resistant OPEC. MICs of fluconazole were determined by NCCLS methods. Three fluconazole-susceptible (FS) (MIC, </=0.125 microgram/ml) and three fluconazole-resistant (FR) (MIC, >/=64 microgram/ml) isolates of Candida albicans from prospectively monitored HIV-infected ...
Clinical Infectious Diseases, 1998
Signs and symptoms of oropharyngeal candidiasis (OPC) were correlated with microbiology and clinical response to fluconazole in a cohort of patients with advanced human immunodeficiency virus (HIV) infection and recurrent OPC. Sixty-four HIV-infected patients with a median CD4 cell count of õ50/mm 3 (range, 3 -318/mm 3 ) who presented with OPC were enrolled in a longitudinal study. Specimens for cultures were taken weekly until clinical resolution. Therapy with fluconazole was increased weekly as required to a maximum daily dose of 800 mg until resolution of symptoms and oral lesions. Resistant or dose-dependent susceptible yeasts, defined as a minimum inhibitory concentration of §16 mg/mL, were detected in 48 (31%) of 155 episodes. Clinical resolution with fluconazole therapy occurred in 107 (100%) of 107 episodes with susceptible yeasts vs. 44 (92%) of 48 episodes with resistant or dose-dependent susceptible strains (P Å .008). Patients from whom fluconazole-resistant yeasts were isolated required longer courses of therapy and higher doses of fluconazole for response, but overall, excellent responses to fluconazole were seen in patients with advanced HIV infection.
Therapeutic Advances in Infectious Disease, 2024
Background: Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts. Methods: A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate Candida species which were identified using the matrix assisted laser desorption ionization time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of Candida isolates to six antifungal drugs was determined using VITEK® (Marcy-l'Étoile, France) compact system. Data on viral load were retrieved from records, and CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto. Results: The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which Candida albicans comprised of 20 (57.1%) while C. tropicalis and C. glabrata comprised 4 (11.4%) each. C. parapsilosis, C. dubliniensis and C. krusei accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytocine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific specie isolates like C. albicans showed 20% (4/20), C. glabrata 50% (2/4) and C. krusei 50% (1/2) resistance to fluconazole. Additionally, C. krusei showed 50% resistance to flucytosine. Conclusion: The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. C. albicans was the most frequently isolated oropharyngeal Candida species. C. glabrata and C. krusei exhibited the highest AFR among the non-albicans Candida species. The highest resistance was demonstrated to fluconazole.
Research Square (Research Square), 2024
Background: Oropharyngeal candidiasis (OPC) is the most common opportunistic infection encountered among human immunode ciency virus infected patients and is considered as an independent predictor of immunode ciency in patients with Acquired Immunode ciency Syndrome (AIDS).Though Candida albican is the most frequently isolated species from the oropharyngeal lesions, the change in spectrum of Candida species as causative agent of oropharyngeal candidiasis and increased antifungal drug resistance among HIV infected individuals has made the identi cation of Candida species and determination of its drug resistance pattern is necessary for the routine patient care. Therefore, the aim of the study was to determine the the prevalence, antifungal susceptibility pattern and associated factors of Candida species among HIV positive individuals having oropharyngeal legions in Mekelle health Facilities of Tigray, Ethiopia Method: A cross-sectional study was conducted among 381 HIV positive individuals with oropharyngeal lesion from September 2017 to May 2018 Socio demographic and clinical data and oral swabs were collected from the study participants. Collected swab samples were transported to Microbiology laboratory, College of Health Sciences, Mekelle Universityand were cultured on to Sabouraud dextrose agar having chloramphenicol. All the isolates were characterized using germ tube and HiCrome Candida agar tests. The antifungal susceptibility patterns of all Candida species were determined using disk diffusion method and data were analyzed using STATA version 13.0. Result: Among the 381 study participants, the overall Candida species were isolated from 228(59.8%). A total of 240 Candidaspecies were isolated, of which C. albican was the most predominant 151(62.9%). Among the non-albican Candida species, the most predominant species were Candida glabrata 47(19.6%) followed by Candida tropicalis 26 (10.8%) and Candida krusei 16 (6.7%), and majority of theisolates were from HAART naïve 127(52.9%) and those on HAART were 113 (47.1%). Age group 40-49 years (p = 0.019), previous history of antifungal drug treatment (p=0.039), CD4 counts < 200 cells/mm3 (p=0.003), HAART naïve (p=0.000), body mass indices <15.9 kg/m2 (p=0.002), WHO clinical stage III (p=0.023) and TB co-infection (0.041) were found signi cantly associated with Candida species isolation. Of the isolates, 12.9% and 9.2% of were showed resistance to uconazole and ketoconazole respectively. Least rate of resistance was found to nystatin, 0.8%. Conclusion: Nearly two-third (37.1%) of the Candida species that cause oropharyngeal legion among HIV positive individuals in the study area was non-candidia albicans. The non-candidia albicans groups showed an increasing
Mycopathologia, 2001
Oropharyngeal candidiasis caused by various species of Candida is one of the most common infections in HIV seropositive or AIDS patients. Drug resistance among these yeasts is an increasing problem. We studied the frequency of resistance profile to fluconazole, itraconazole, ketoconazole, amphotericin B and terbinafine of 137 isolates of Candida sp. From HIV positive or AIDS patients with oropharyngeal candidiasis at Instituto de Inmunología, U.C.V. and the Hospital “Jose Ignacio Baldó”, Caracas Venezuela, using the well diffusion susceptibility test (Magaldi et al.). We found that nearly 10% of C. albicans isolates were primarily fluconazole resistant, 45% of C. albicans isolates from patients with previous treatment were resistant to fluconazole, of which 93% showed cross-resistance to itraconazole, and even about 30% of C. tropicalis (n = 13) were resistant to fluconazole and/or itraconazole. To this respect, several recent reports have been described antifungal cross-resistance among azoles. Therefore, we consider that C. tropicalis should be added to the growing list of yeast in which antifungal drug resistance is common. This report could be useful for therapeutic aspect in AIDS patients with oral candidiasis.
Mycopathologia, 2006
In this study, we investigated the yeasts colonization of genus Candida, including C. dubliniensis, isolated of HIV-infected patients oral cavities and we accessed in vitro susceptibility pattern of the Candida isolates to four antifungal agents. Out of 99 patients investigated, 62 (62.6%) were colonized with yeasts. C. albicans was the prevailing species (50%). C. dubliniensis isolates were not recovered in our study. We verified that 8.1% of the yeasts isolated were resistant to fluconazole, 8.1% to itraconazole and 3.2% to voriconazole. The isolates demonstrated very low voriconazole MICs, in which 79% (49/62) presented values of 0.015 μg/ml. All Candida isolates were susceptible to amphotericin B. The results reported here showed that although C. albicans continues to be present in one-half of oral Candida carriage of HIV-infected patients, Candida non-albicans species are increasing among these patients. Besides, the findings of resistant isolates endorse the role of antifungal susceptibility testing whenever antifungal treatment with azoles is planned.