Sage Journals: Discover world-class research

Abstract

Clinical resistance in oropharyngeal candidosis is an increasingly significant management problem in HIV-seropositive patients. This study was undertaken to identify predisposing risk factors including the isolation of particular species of Candida which may be associated with the development of clinical resistance. The effect of particular antifungal prescribing regimens was also assessed.

Data were compiled by chart review of 2 groups, each of 10 HIV-seropositive CDC stage IV patients with recurrent oropharyngeal candidosis.

All patients had swabs taken at intervals during treatment and all Candida isolates were species typed. The patients in group 1 exhibited Candida infections which did not respond clinically to standard therapeutic regimens. The second patient group did respond to standard oral antifungal therapies.

An association was found between the frequent utilization of azoles, particularly fluconazole and the development of clinically resistant oral candidosis. The number of Candida isolates grown from the initial swab was also significantly related to the development of resistance.

Keywords

HIV Candida antifungal resistance

Get full access to this article

View all access options for this article.

References

Klein

Harris

Small

C Butkins

Moll

Lesser

Friedland

GH.

Oral candidosis in high risk patients as the initial manifestation of the acquired immunodeficiency syndrome. N Engl J Med 1984;311:354.

Tavitian

Ranfmar

J-P

Rosenthal

LE.

Oral candidosis as a marker for esophageal candidosis in the acquired immunodeficiency syndrome. Ann Intern Med 1986;104:54.

Phelan

Sltzman

Friedland

Klein

RS.

Oral findings in patients with acquired immunodeficiency syndrome. Oral Surg Oral Med Oral Pathol 1987;64:50.

Syrjanen

Valle

Antonen

Oral candidal infections as a sign of HIV infection in homosexual men. J Oral Surg 1988;65:36.

Samaranayake

Holmstrup

Oral candidiasis and human immunodeficiency virus infection. J Oral Pathol Med 1989;18:554.

Samaranayake

LP.

Oral candidosis: An old disease in new guises. Dental Update 1990;17:36.

Eisentein

BI.

New opportunistic infections—more opportunities. N Engl J Med 1990;323:1625.

Tang

Cohen

Diagnosing fungal infections in immunocompromised hosts. J Clin Pathol 1992;45:1.

Selik

Stavcher

Curran

JW.

Opportunistic diseases reported in AIDS patients: Frequencies, associations and trends. AIDS 1988;1:175.

10.

Nelson

Ghazal

Wiley

CA.

Role of opportunistic viral infections in AIDS. AIDS 1990;4:1.

11.

Spencer

Jackson

GG.

Fungal and mycobacterial infections in patients infected with the human immunodeficiency virus. J Antimicrob Chemother 1989;23(suppl A):171.

12.

Samaranayake

LP.

Oral mycoses in HIV infection. Oral Surg Oral Med Oral Pathol 1992;73:171.

13.

McCarthy

Mackie

Koval

Sandhu

Daley

TD.

Factors associated with increased frequency of HIV related oral candidiasis. J Oral Pathol Med 1991;20:332–6.

14.

Classification and diagnostic criteria for oral lesions in HIV infection. EC clearing house on oral problems related to HIV infection and WHO Collaborating Centre on oral manifestations of the immunodeficiency virus.

15.

British Society for Antimicrobial Chemotherapy Working Party. Antifungal chemotherapy in patients with acquired immunodeficiency syndrome. Lancet 1992;340:648–51.

16.

Harvard

P Fan

Capano

Smith

Mangia

Eng

RHK.

Development of resistance in Candida isolates from patients receiving prolonged antifungal therapy. Antimicrob Agents Chemother 1991;35:2302–5.

17.

Fox

Neal

Leen

CLS

Nellis

Mandal

BKM.

Fluconazole resistant Candida in AIDS. J Infect 1991;22:201–4.

18.

Kitchen

Savage

Harris

JRW.

Candida albicans resistance in AIDS. J Infect 1991;22:204–5.

19.

Gallagher

Bennett

Henman

Reduced azole susceptibility of oral isolates of Candida albicans from HIV positive patients and a derivative exhibiting colony morphology variation. J Gen Microbiol 1993;138:1901–11.

20.

Powderly

WG.

Mucosal candidiasis caused by non-albicans species of candida in HIV positive patients. AIDS 1992;6:746.

21.

Casasnovas

Caullot

Solary

Prophylactic fluconazole and Candida krusei infections. N Engl J Med 1992;326:891.

22.

Warnock

Burke

Cope

Johnson

VonFraunhofer

Williams

EW.

Fluconazole resistance in Candida glabrata . Lancet 1988;ii:1310.

23.

Coleman

Bennett

Sullivan

Oral Candida in HP/infection and AIDS: New perspectives/new approaches. Crit Rev Microbiol 1993;19:61–82.

24.

Just

Stemhamer

Schellback

Bottinger

Helin

Stille

Treatment in AIDS patients. New York: Plenum, 1990;179–285.

25.

Smith

Midgley

Allan

Connolly

Gazzard

Itraconazole versus ketoconazole in the treatment of oral and oesopharyngeal candidosis in patients infected with HIV. AIDS 1991;5:1367–71.

26.

De Wit

Weerts

Goosens

Clumeck

Comparison of fluconazole and ketoconazole for oropharyngeal candidiasis in AIDS. Lancet 1989;i:746–47.

27.

Leen

CLS

Dunbar

Ellis

Mandal

BK.

Once weekly fluconazole to prevent recurrence of oropharyngeal candidiasis in patients with AIDS related complex: A double blind placebo-controlled study. J Infect 1990;21:55–60.

Clinical Parameters Associated with Recalcitrant Oral Candidosis in HIV Infection: A Preliminary Study

Abstract

Keywords

Get full access to this article

References