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Oral candidiasis: the clinical challenge of resistance and management

I M Hoepelman1, B Dupont

  • 1Department of Medicine, Section of Infectious Diseases and Eijkman-Winkler Laboratory for Medical Microbiology, University Hospital, PO Box 85500, 3508 GA Utrecht, The Netherlands.

International Journal of Antimicrobial Agents
|February 1, 1996
PubMed

Insights

Oral candidiasis, common in immunocompromised patients like those with AIDS, is often treated with azole antifungals. Preventing antifungal resistance is crucial, especially with increasing fluconazole resistance in AIDS patients.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Immunology

Background:

  • Oral candidiasis is a frequent opportunistic infection in immunocompromised individuals, notably cancer patients undergoing chemotherapy and individuals with Acquired Immunodeficiency Syndrome (AIDS).
  • In HIV-infected patients, a diminished CD4 T-cell count is a significant risk factor for oral candidiasis.
  • Candida albicans is the predominant causative agent, but non-albicans Candida species are increasingly identified.

Purpose of the Study:

  • To review the current understanding of oral candidiasis in immunocompromised patients.
  • To highlight the role of azole antifungals in treatment and the emerging challenge of antifungal resistance.
  • To emphasize the need for strategies to prevent the spread of resistant strains and cross-resistance.

Main Methods:

  • Literature review focusing on oral candidiasis, causative agents, predisposing factors, and antifungal treatments.
  • Analysis of the current status of azole antifungal efficacy and resistance patterns, particularly in AIDS patients.
  • Examination of the established NCCLS reference method for in vitro susceptibility testing.

Main Results:

  • Oral candidiasis affects a high percentage of AIDS patients, with decreased CD4 counts being a major predisposing factor.
  • Systemic azoles (ketoconazole, fluconazole, itraconazole) are beneficial, but fluconazole resistance is a growing concern in AIDS.
  • While a reference method for susceptibility testing exists, more data are needed to correlate in vitro resistance with clinical outcomes.

Conclusions:

  • Effective management of oral candidiasis in immunocompromised patients requires vigilance regarding antifungal resistance.
  • Preventive measures against the spread of resistant strains and the development of cross-resistance are essential.
  • Further research is necessary to establish a clear correlation between in vitro antifungal resistance data and clinical treatment failures.

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