Oropharyngeal candidiasis and Candida colonization in HIV positive patients in northern India

Abstract

Introduction: Oropharyngeal candidiasis (OPC) is the most common opportunistic fungal infection reported in human immunodeficiency virus (HIV) positive patients worldwide. This prospective study was undertaken to investigate OPC and Candida colonization (CC) and their correlation with CD4+ cell counts and antiretroviral therapy (ART) in HIV-positive patients. Methodology: In total, 190 HIV-positive patients were enrolled for study in three groups as follows: Group A, 90 patients without ART; Group B, 100 patients undergoing treatment with ART; and Group C, 75 HIV-negative control patients. All HIV patients underwent clinical examination and were subjected to CD4+ cell counts. Swabs were collected from the oral cavity of all individuals and plated on Sabouraud’s dextrose agar. Identification of Candida species was performed by conventional methods. Results: Candida species were isolated in 84/190 (44.2%) and 20/75 (26.6%) of the HIV-positive subjects and controls respectively (p<0.01). OPC was noted in 21/190 (11%) of the HIV-positive patients. Candida albicans was the most frequently isolated species. Patients with CD4+ cell counts ≤ 200 cells/mm3 were significantly (p<0.001) more frequently colonized (37/63; 58.7%) and infected (18/21; 85.7 %) with Candida species. Candida species was seen in patients with CC and OPC with CD4+cell counts between 201 and 500 (21/63; 33.4% vs 3/21; 14.3%) and > 500 cell/mm3 (5/63; 7.9% versus 0/21 0%) respectively. Conclusion: OPC and Candida colonization occur more frequently in HIV-positive patients with CD4+ cell counts ≤200 cell/mm3. ART significantly reduces OPC. C. albicans is the most frequently isolated species in both OPC and colonization, suggesting endogenous infection.

Etiologic Agents and Antifungal Susceptibility of Oral Candidosis from Romanian patients with HIV-infection or type 1 diabetes mellitus

“…Regarding C. albicans proportion within the HIV isolates, values similar to the one in this study (70%) have been reported for Taiwan (Ho et al, 2014), Cameroun (dos Santos Abrantes et al, 2014), USA (Merenstein et al, 2013), Spain (Ramírez et al, 2006) or Turkey (Erköse and Erturan, 2007). Percentages can go as high as 90% in India (Maurya et al, 2013), Italy (Giammanco et al, 2002) or UK (Cartledge et al, 1999), 83% in South Africa (dos Santos Abrantes et al, 2014), 79% in Serbia (Mitrovic et al, 1996), or can go as low as 62% in Turkey (Erköse and Erturan, 2007) or Brazil (Costa et al, 2006). Again, C. glabrata is missing from the isolates in our non-albicans Candida group.…”

Inactivation of genes TEC1 and EFG1 in Candida albicans influences extracellular matrix composition and biofilm morphology

“…candidemia). OPC is an indicator of the development of acquired immune deficiency syndrome (AIDS) and depending on the stage of the infection by human immunodeficiency virus (HIV), about 90% of the patients have OPC [3,4]. Candida albicans is the most prevalent species related to this infection [5][6][7][8].…”

Fungal inhibitory effect of Citrus Limon peel essential oil on Candida albicans

“…An estimated 90% of HIV-AIDS patients is exposed to oral Candidiasis during the progression of the disease, so the infection is closely related to HIV infection. 1,5 In many countries that have not been able to distribute Highly Active Anti-Retroviral Therapy (HAART) evenly, such as in Indonesia, mucosal candidiasis is still the highest cause of morbidity in AIDS patients. 5,13 Sabouraud broth and dextrose agar media were used as media for Candida growth in this research.…”

“…1,5 In many countries that have not been able to distribute Highly Active Anti-Retroviral Therapy (HAART) evenly, such as in Indonesia, mucosal candidiasis is still the highest cause of morbidity in AIDS patients. 5,13 Sabouraud broth and dextrose agar media were used as media for Candida growth in this research. These media have acidic concentration (pH 5.6), so the growth of bacteria that are not acid resistant will be inhibited.…”

“…Oral candidiasis occurs in 50-90% of HIV/ AIDS cases, and an estimated 90% of HIVinfected patients also suffers from this infection during the progression of their disease. 1,5 Mucosal infection is generally not a directly life-threatening disease, but when microorganism can manage to penetrate the epithelial and gain access to the blood circulation, candidemia can trigger to fungal manifestations of fungal infection in kidneys, heart and brain. 6 Citrus Limon is widely grown in Indonesia, China and India.…”