Non-albicans Candida species had higher rates of resistance to fluconazole than did C. albicans (44 of 395 [11.2%] vs 9 of 237 [3.8%]; P = .002). The increasing rate of fluconazole resistance in C. tropicalis (15%) is important because C. tropicalis is one of the most commonly isolated non-albicans Candida species.

To understand the Candida colonization of human immunodeficiency virus (HIV)-infected outpatients inTaiwan, we have conducted a prospective cohort study of Candida colonization and its risk factors at the National Taiwan University Hospital from 1999 to 2002. More than 50% of the patients were colonized with Candida species, and 12% developed symptomatic candidiasis. Patients colonized with fluconazole-resistant strains of Candida species had a higher prevalence of candidiasis than those colonized with susceptible strains. Our analysis found that antibiotic treatment and lower CD4؉ counts (<200 cells/mm 3 ) increased the rate of oropharyngeal candidiasis in HIV-infected patients, while antiretroviral therapy protected patients from the development of candidiasis.Mucosal candidiasis, including oropharyngeal, esophageal, and vaginal candidiasis, is common among human immunodeficiency virus (HIV)-infected patients (4, 11). In particular, oropharyngeal candidiasis occurs in up to 90% of patients during the course of HIV infection (17). Progressive cellmediated immunodeficiency, with CD4 ϩ lymphocyte counts less than 200 cells/mm 3 , is a risk factor for colonization with Candida species and the development of candidiasis (3). The widespread use of azole antifungal agents for the treatment of mucosal candidiasis results in colonization with less susceptible organisms and the development of resistance (4, 15). Thus, oropharyngeal candidiasis due to drug-resistant fungi is an emerging problem for patients infected with HIV (18).The overall prevalence of known HIV infection in Taiwan remains relatively low (0.01%) (9). As in most other industrialized countries, the majority of HIV-infected patients in Taiwan receive care in the outpatient setting. Therefore, to better understand the epidemiology of Candida species carriage among HIV-infected outpatients in Taiwan, we undertook a study to determine the prevalence of oropharyngeal colonization. Our objectives were to assess the colonization status and the risk factors for colonization and the development of candidiasis in HIV-infected outpatients in Taiwan. The susceptibilities of those Candida isolates to antifungal drugs were also determined. MATERIALS AND METHODSStudy population and data collection. HIV-infected patients were monitored regularly in the outpatient infectious diseases clinic of National Taiwan University Hospital, a major referral hospital for the management of HIV-related complications. The patients were enrolled after they provided informed verbal consent. This was a prospective study performed by the use of three surveys, conducted from May to June 1999, May to September 2001, and January to April 2002. A standardized data collection form was used to retrieve demographic information, the most recent CD4 ϩ lymphocyte count, and the highly active antiretroviral therapy (HAART) prescribed. In addition, clinical information for the previous 3 months was obtained and included information on whether the patient had a history of oral or esophageal candidiasi...

No abstract

The cph1/cph1 efg1/efg1 Candida albicans mutant cells were non-lethal in a mouse model of systemic infection. We investigated in vivo proliferation and invasion of C. albicans cells in infected mice to elucidate the interaction between the host and the pathogen. Homogenates of kidneys from the mice infected with the wild-type and the mutant C. albicans cells yielded a mean of 2.1 × 107 CFU/g and 2.2 × 106 CFU/g, respectively. The kidneys from the mice infected with the wild-type cells showed extensive renal cortical necrosis associated with neutrophilic infiltration. There were also wild-type hyphal cells present in abundance. Hence, tubular necrosis leading to renal failure in the mice may be the cause of death. Although the cph1/cph1 efg1/efg1 mutant cells were not lethal, they were capable of establishing restricted zones of infection and colonization near the renal pelvis instead of simply being cleared by the immune system in mice.

A total of 3,926 yeast isolates were isolated from 24 hospitals participating in the Taiwan Surveillance of Antimicrobial Resistance of Yeasts (TSARY) from July to September 2002. Candida albicans (69.1%) was the most common species, followed by Candida tropicalis (12.9%), Candida glabrata (8.3%), Candida parapsilosis (2.7%), Candida krusei (0.6%), and others (6.4%). To study the distribution and antifungal susceptibility of Candida species according to sources and patient ages, we have collected and analyzed the clinical data of 861 isolates. Of those 861 isolates, urine was the most common source (40%) followed by sputum (22.1%), blood (13.5%), central venous catheter (5.5%), wound (5.2%), and others (13.7%). With increasing age, we observed a significant increase in the percentage of isolates from urine (P=0.00005) and a parallel reduction from blood (P=0.009). As expected, more elder patients were hospitalized than younger ones (P=0.05). In total, 2.7% and 1.9% of isolates were resistant to amphotericin B and fluconazole, respectively. Antifungal susceptibilities of isolates from different age groups were not significantly different.