The epidemiology of non‐albicans Candida in oropharyngeal candidiasis in HIV patients

Abstract

Oropharyngeal candidiasis (OPC) is the most common fungal infection in patients with HIV infection. Fluconazole has been proven to be very effective in treating this infection, but decreased susceptibility of Candida to this drug has emerged. Certain non-albicans species such as C. glabrata and C. krusei are commonly less susceptible to fluconazole than C. albicans and are being isolated with increased frequency in HIV patients. The purpose of this study was to determine if the presence of non-albicans Candida with OPC in HIV patients had an impact on clinical presentation. This study shows that late-stage HIV patients have a high prevalence of Candida with decreased susceptibility to fluconazole, especially non-albicans species. OPC episodes with non-albicans isolates were more likely to require higher doses of fluconazole to achieve clinical cure. Also, the presence of non-albicans Candida was more frequently associated with severe symptoms.

Oral Candida flora from Brazilian human immunodeficiency virus-infected patients in the highly active antiretroviral therapy era

“…Non-C. albicans spp. have been associated with severe symptoms in oral candidosis and have had a major impact in clinical presentation (Redding et al 2000). In addition, Colombo et al (1999) indicated that candidemia due to non-C. albicans is increasing in Brazilian tertiary hospitals.…”

In vitro antifungal susceptibility of Candida spp. oral isolates from HIV-positive patients and control individuals

“…7 Certain non-albicans species, such as C. glabrata and C. krusei, are inherently less susceptible to fluconazole than C. albicans and have been isolated with increasing frequency in HIV-infected patients. 7,8,9,10,11 The increasing resistance to antifungal treatments and expanding drug therapy options has prompted the need for clinically relevant antifungal susceptibility testing; these results could act as a guide in the selection and control of antifungal therapy. For this purpose, the Clinical and Laboratory Standards Institute (CLSI) proposed a reference method for yeast antifungal susceptibility testing using serial dilutions and obtained values of minimal inhibitory concentration.…”

Multiple Patterns of Resistance to Fluconazole in Candida glabrata Isolates from a Patient with Oropharyngeal Candidiasis Receiving Head and Neck Radiation

“…In the past, most investigators felt that C. glabrata was simply a commensal organism and did not contribute to infection (7). However, OPC infections with mixed C. albicans and C. glabrata in HIV patients tend to be more clinically severe and require larger doses of fluconazole for clinical cure than infections with C. albicans alone (16).…”