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Examination of Oral Candida Infection in Primary Sjögren's Syndrome Patients
Published on: March 1, 2024
Pseudomembranous candidiasis in HIV/AIDS patients in Cali, Colombia
Luz Ángela Castro1, María Inés Álvarez, Ernesto Martínez
1School of Bacteriology and Clinical Laboratory, Universidad del Valle, Cali, Colombia.
Abstract:
Candida albicans is the most frequently isolated yeast from the oral cavity of HIV/AIDS individuals. The use of fluconazole has increased the number of resistant or less-sensitive Candida species different than C. albicans. The purpose of this study was to identify the Candida species producing pseudomembranous candidiasis in patients suffering from AIDS, their relationship with CD4(+) counts and their sensitivity to fluconazole and itraconazole. We studied 71 patients at a hospital in the city of Cali. Samples of white plaque were seeded on CHROMagar Candida, yeast identification was done with API 20C Aux, and susceptibility testing was determined by E test. Ninety-three yeast isolates were obtained, 52 single and 41 mixed. C. albicans was the most isolated, followed by C. glabrata. An increased frequency of isolates and variety of Candida species occurred in patients with a CD4(+) cell count ≤100 cells/mm(3) without significant differences (p = 0.29). The susceptibility study showed that 8 (8.6%) isolates were resistant to fluconazole and 11 (11.8%) to itraconazole, while 6 (8.8%) C. albicans were simultaneously resistant. No association was found between the isolates of C. albicans or Candida species different than C. albicans and the use of fluconazole (p = 0.21). The results of this study indicate that in the tested population, fluconazole continues to be the best treatment option for oropharyngeal candidiasis in patients suffering from AIDS (HIV/AIDS); however, susceptibility tests are necessary in patients who present therapeutic failure.
Insights
Candida albicans is the most common cause of oral thrush in individuals with HIV/AIDS. Fluconazole remains the preferred treatment, but antifungal susceptibility testing is crucial for patients experiencing treatment failure.
Area of Science:
- Medical Mycology
- Infectious Diseases
- HIV/AIDS Research
Background:
- Oropharyngeal candidiasis is a common opportunistic infection in individuals with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS).
- The increasing use of azole antifungals like fluconazole has led to the emergence of less-sensitive or resistant Candida species beyond Candida albicans.
- Understanding the spectrum of Candida species and their antifungal susceptibility patterns in this vulnerable population is critical for effective management.
Purpose of the Study:
- To identify Candida species causing pseudomembranous candidiasis in patients with AIDS.
- To investigate the relationship between Candida species distribution, CD4(+) T-cell counts, and antifungal drug resistance.
- To determine the in vitro susceptibility of isolated Candida species to fluconazole and itraconazole.
Main Methods:
- Prospective study of 71 HIV/AIDS patients with pseudomembranous candidiasis in Cali.
- Yeast isolation using CHROMagar Candida and identification via API 20C Aux system.
- Antifungal susceptibility testing performed using the E test method for fluconazole and itraconazole.
Main Results:
- Ninety-three yeast isolates were obtained, with Candida albicans being the most frequent, followed by Candida glabrata.
- An increased frequency and variety of Candida species were observed in patients with CD4(+) counts ≤100 cells/mm(3), though not statistically significant (p=0.29).
- Resistance was noted in 8.6% of isolates to fluconazole and 11.8% to itraconazole, with 8.8% of C. albicans isolates showing dual resistance.
Conclusions:
- Fluconazole remains a primary treatment option for oropharyngeal candidiasis in HIV/AIDS patients in this population.
- Antifungal susceptibility testing is recommended for patients with HIV/AIDS who experience therapeutic failure to guide treatment decisions.
- The study highlights the importance of monitoring Candida species and their resistance patterns in immunocompromised individuals.
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