Oral thrush to candidemia: a morbid outcome

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.