Oral Thrush to Candidemia: A Morbid Outcome

Abstract

A 35-year-old female living with AIDS presented with oral thrush 3 months after the initiation of antiretroviral therapy (ART). On investigation, it was found to be due to Candida albicans. She was started on fluconazole. After 4 months on ART, she presented with fever. Blood culture was performed. After 4 days, she expired due to septic shock. Two days after her death, C albicans strain was isolated from the blood culture which was similar to the C albicans strain (by DNA fingerprinting) isolated from oral thrush. Both strains of C albicans were found to be resistant to fluconazole by broth microdilution method. A high index of suspicion in high-risk patients along with early and aggressive management of the patient with antigen detection would go a long way in the management of these patients. Guidelines for treatment of candidiasis need to be re-evaluated, keeping in mind the increasing emergence of resistance to azoles and its effect on morbidity outcome.

Keywords

oral thrush candidemia

References

Cheng MF , Yang YL , Yao TJ , et al. Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species. BMC Infect Dis. 2005;5(1):22.

Cheng YR , Lin LC , Toung TG , Liu CE , Chen CH , Tsay RW Risk factors for Candidemia-related mortality at a medical centre in central Taiwan. J Microbiol Immunol Infect. 2006; 39(2):155-161.

Tumarello M. , Tacconelli E. , de Gaetano Donati K. , Morace G. , Fadda G. , Cauda R. Candidemia in HIV-infected subjects. Eur J Clin Microbiol Infect Dis. 1999;18(7):478-483.

World Health Organization. Anti-Retroviral Therapy Guidelines for HIV-Infected Adults and Adolescents Including Post-Exposure Prophylaxis. New Delhi, India: NACO, Ministry of Health & Family Welfare, Government of India; 2007.

Forbes BA , Sahm DF , Weissfeld AS Bailey and Scott’s ‘‘Diagnostic Microbiology’’ . 11th ed. St Louis, MO: Mosby Inc; 2002.

Mosaid AA , Sullivan D. , Salkin IF , Shanley D. , Coleman DC Differentiation of Candida dubliniensis from Candida albicans on staib agar and caffeic acid-ferric citrate agar. J Clin Microbiol. 2001;39(1):323-327.

National Committee for Clinical Laboratory Standards. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts M27-A2. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002 .

Mukhopadhyay K. , Prasad T. , Saini P. , Pucadyil TJ , Chattopadhyay A. , Prasad R. Membrane sphingolipidergosterol interactions are important determinants of multidrug resistance in Candida albicans. Antimicrob Agents Chemother. 2004;48(5):1778-1787.

Girishkumar H. , Yousuf AM , Chivate J. , Geisler E. Experience with invasive Candida infections . Postgrad Med J. 1999; 75(881):151-153.

10.

Bennett JE Candidiasis. In: Kasper DL , Braunwald E , Fauci AS , Hauser SL , Longo DL , Jameson JL , eds. Harrison’s Principle of Internal Medicine. 1 6th ed. New York, NY: McGraw Hill ; 2005:1186-1188.

11.

Launay O. , Lortholary O. , Bouges-Michel C. , Jarrousse B. , Bentata M. , Guillevin L. Candidemia: a nosocomial complication in adults with late-stage AIDS. Clin Infect Dis. 1998;26(5): 1134-1141.

12.

Bertagnolio S. , de Gaetano Donati K. , Tacconelli E. , et al. Hospital-acquired candidemia in HIV-infected patients. Incidence, risk factors and predictors of outcome. J Chemother. 2004;16(2):172-178.

13.

Guidelines for prevention and management of common opportunistic infections/malignancies among HIV-infected adult and adolescent. New Delhi, India: NACO, Ministry of Health & Family Welfare, Government of India; May 2007.