We have correlated the in vitro results of testing the susceptibility of Cryptococcus neoformans to fluconazole with the clinical outcome after fluconazole maintenance therapy in patients with AIDS-associated cryptococcal disease. A total of 28 isolates of C. neoformans from 25 patients (24 AIDS patients) were tested. The MICs were determined by the broth microdilution technique by following the modified guidelines described in National Committee for Clinical Standards (NCCLS) document M27-A, e.g., use of yeast nitrogen base medium and a final inoculum of 10 4 CFU/ml. The fluconazole MIC at which 50% of isolates are inhibited (MIC 50 ) and MIC 90 , obtained spectrophotometrically after 48 h of incubation, were 4 and 16 g/ml, respectively. Of the 25 patients studied, 4 died of active cryptococcal disease and 2 died of other causes. Therapeutic failure was observed in five patients who were infected with isolates for which fluconazole MICs were >16 g/ml. Four of these patients had previously had oropharyngeal candidiasis (OPC); three had previously had episodes of cryptococcal infection, and all five treatment failure patients had high cryptococcal antigen titers in either serum or cerebrospinal fluid (titers, >1:4,000). Although 14 of the 18 patients who responded to fluconazole therapy had previously had OPC infections, they each had only a single episode of cryptococcal infection. It appears that the clinical outcome after fluconazole maintenance therapy may be better when the infecting C. neoformans strain is inhibited by lower concentrations of fluconazole for eradication (MICs, <16 g/ml) than when the patients are infected with strains that require higher fluconazole concentrations (MICs, >16 g/ml). These findings also suggest that the MICs determined by the modified NCCLS microdilution method can be potential predictors of the clinical response to fluconazole therapy and may aid in the identification of patients who will not respond to fluconazole therapy.Cryptococcosis is an infection caused by the ubiquitous fungus Cryptococcus neoformans, an encapsulated yeast-like fungus. The most frequent clinical presentation of the disease is meningoencephalitis (5, 6, 12, 18, 19; M. S. Saag, Editorial Response, Clin. Infect. Dis. 21:35-36, 1995); 75 to 90% of AIDS patients infected with C. neoformans will develop meningitis (5). Cryptococcosis in AIDS patients is seldom cured, and fluconazole is the drug of choice for the necessary lifelong suppressive (maintenance) therapy (17). Use of fluconazole for long-term suppressive therapy may be associated with the development of azole resistance in cryptococcal infections in AIDS patients (21).Methods for testing the antifungal susceptibility of C. neoformans could become important tools in the selection and monitoring of an appropriate antifungal drug for the treatment and prophylaxis of cryptococcal infections. Ghannoum et al. (9) developed a broth microdilution method for measuring the susceptibility of cryptococci to fluconazole, which is described as an alternative a...

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In this report we compare the activity of two new antifungal agents, voriconazole (UK-109,496) and LY303366 with the activities of other antifungals including fluconazole, itraconazole, 5-fluorocytosine (5FC) and amphotericin B against 219 oral Candida spp. isolates from HIV-infected patients. We used the broth microdilution method following the guidelines of the NCCLS. The in-vitro activity of voriconazole (UK-109,496) (MIC(90) 0.12 mg/L) and LY303366 (CMI(90) 0.25 mg/L) against clinical isolates of Candida spp. was excellent and comparable with that of amphotericin B (MIC(90) 0.5 mg/L), and better than those of fluconazole (MIC(90) > or = 64 mg/L), itraconazole (MIC(90) 4 mg/L) and 5FC (MIC(90) 1 mg/L).

A case of tinea faciae caused by Trichophyton equinum affecting a 5-year-old boy is described. The boy had ridden a pony a month earlier and responded to a 6-week course of treatment with oral and topical terbinafine.

The significance of Candida albicans in the development of denture stomatitis (DS), as well as the clinical and microbiological efficacy of treatment with fluconazole and itraconazole was studied in 115 patients affected with DS and 200 controls (100 healthy patients with dental prosthesis and 100 healthy patients without prosthesis). Specimens were taken from all patients; subsequently all patients with positive culture of the DS group were treated with fluconazole. A second specimen was taken after 15 days of treatment with fluconazole, and if the results were positive again, treatment with itraconazole was instituted and the patients were given appointments for taking a third specimen. The incidence of C. albicans was 92% in the group of patients with DS. After treatment with fluconazole, a clinical cure of 97% and a microbiological cure of 78% was obtained in the patients with DS. In 3.2% of the cases strains resistant to fluconazole were found. The cases of microbiological resistance to fluconazole were treated with itraconazole resulting in a clinical cure of 100% and a microbiological cure of 77%. The results show the poor correlation of the clinico-microbiological response after treatment with these antifungal agents in denture stomatitis.