In vitro susceptibilities and biotypes of Candida albicans isolates from the oral cavities of patients infected with human immunodeficiency virus

Abstract

Candida albicans strains were isolated from the oral cavities of 62 human immunodeficiency virus (HIV)-infected patients at different stages of HIV infection. Only patients with persistent generalized lymphadenopathy-acquired immunodeficiency syndrome (AIDS)-related complex or full-blown AIDS showed typical clinical symptoms for oral candidiasis. In general, the microbiological recovery of Candida strains from the oral cavity increased with more advanced stages of HIV infection. The antifungal activity of ketoconazole, itraconazole, nystatin, amphotericin B, and flucytosine against all 62 strains was evaluated by means of a photometer-read broth microdilution method for determination of the 30% inhibitory concentrations of the drugs. The 95% ranges of 30% inhibitory concentrations were as follows: 50.063 to 32 ,ug/ml for ketoconazole, 50.063 to 8 ,ig/ml for itraconazole, 0.5 to 4 ,ug/ml for nystatin, 50.063 to 4 ,ig/ml for amphotericin B, and 50.063 to 8 fig/ml for flucytosine. Two strains were resistant to flucytosine, one was resistant to ketoconazole, and three were resistant to itraconazole. Isolates from patients with full-blown AIDS showed significantly less susceptibility to itraconazole, amphotericin B, and flucytosine. Strains were biotyped by using the API 20C carbohydrate assimilation system. The major biotype accounted for 63.9% of the isolates. At repeated evaluation, a change in biotype pattern was seen in 27.3%.

Asymptomatic oral Candida albicans carriage in HIV‐infection: frequency and predisposing factors

“…Indeed, the occurrence of thrush was a strong correlate of CD4 depletion in a prospective analysis of the Multicenter AIDS Cohort Study (16), as well as in other studies (3,8,13,17). A good correlation was also found with a reversed CD4/CD8 ratio (5,13) and with symptomatic HIV infection (3,5,18). The present data showed that laboratory and clinical markers of disease progression also influenced the incidence of oral C alhieans carriage in HIV-infected subjects with no clinical evidence of oral candidiasis.…”

“…In the same study, no statistically significant differences in T-cell subpopulations were observed with respect to oral Candida carriage, although there was a tendency towards a decreasing number of CD4-f-cells in subjects with mycelial fungal elements in smears as compared to tho.se with a negative smear. We are aware of only one pub-lished study from which could be calculated an asymtomatic oral C. albieans carrier rate in HIV infection (5). In this paper, C. alhieans could be isolated from the oral cavities of 37 subjects without oral candidiasis out of 84 evaluated (44%).…”

Sensitisation of Candida albicans to killing by low‐power laser light

“…More promising results have been achieved with systemic antifungal agents such as ketoconazole, fiucona-zole and itroconazole. Apart from the problem of side effects accompanying the use of the above-mentioned antifungal agents, which may be exacerbated by long-term use to prevent relapses and to treat recurrent infections, development of resistance, including cross-resistance, to these agents has been detected (5)(6)(7).…”

Autopsy findings in the tongues of 20 patients with AIDS

“…There appears to be a consistently higher rate of candidosis and Candida! isolation as the disease progresses (19)(20)(21) with the average frequency being around 30-50% (18). In particular, pseudomembranous candidiasis increases significantly with decreasing CD4 counts (3).…”