Fluconazole-resistant candidosis in an HIV cohort

Baily, Guy; Perry, Fiona; Denning, David W.; Mandal, B K

doi:10.1097/00002030-199406000-00010

Cited by 124 publications

(49 citation statements)

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“…This is probably an unwise practice in light of past experience with the development of azole resistance in Candida species in HIVinfected and AIDS patients receiving azoles prophylactically (1,49,62).…”

Section: Discussionmentioning

confidence: 99%

Microbiological Screening of Irish Patients with Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy Reveals Persistence of Candida albicans Strains, Gradual Reduction in Susceptibility to Azoles, and Incidences of Clinical Signs of Oral Candidiasis without Culture Evidence

et al. 2011

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Patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) are prone to chronic mucocutaneous candidiasis, which is often treated with azoles. The purpose of this study was to characterize the oral Candida populations from 16 Irish APECED patients, who comprise approximately half the total number identified in Ireland, and to examine the effect of intermittent antifungal therapy on the azole susceptibility patterns of Candida isolates. Patients attended between one and four clinical evaluations over a 5-year period, providing oral rinses and/or oral swab samples each time. Candida was recovered from 14/16 patients, and Candida albicans was the only Candida species identified. Interestingly, clinical diagnosis of candidiasis did not correlate with microbiological evidence of Candida infection at 7/22 (32%) clinical assessments. Multilocus sequence typing analysis of C. albicans isolates recovered from the same patients on separate occasions identified the same sequence type each time. Fluconazole resistance was detected in isolates from one patient, and isolates exhibiting a progressive reduction in itraconazole and/or fluconazole susceptibility were identified in a further 3/16 patients, in each case correlating with the upregulation of CDR-and MDR-encoded efflux pumps. Mutations were also identified in the ERG11 and the TAC1 genes of isolates from these four patients; some of these mutations have previously been associated with azole resistance. The findings suggest that alternative Candida treatment options, other than azoles such as chlorhexidine, should be considered in APECED patients and that clinical diagnosis of oral candidiasis should be confirmed by culture prior to the commencement of anti-Candida therapy.

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Section: Discussionmentioning

confidence: 99%

Microbiological Screening of Irish Patients with Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy Reveals Persistence of Candida albicans Strains, Gradual Reduction in Susceptibility to Azoles, and Incidences of Clinical Signs of Oral Candidiasis without Culture Evidence

et al. 2011

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“…The remaining 27 publications contain enough information to allow at least some interpretation. All but three (6,57,58) provide information on in vitro susceptibility determined by either the In the typical scenario, a patient with advanced AIDS (CD4 ϩ cell counts were reported in 13 publications and were Ͻ50/mm 3 in the majority of patients [6,10,37,54,57,58,62,68,71,75,76,83,85]) has relapsing oropharyngeal candidiasis that has been treated variously with topical agents or ketoconazole and then finally with either repeated courses of therapy or prolonged therapy with low doses of fluconazole. These therapies are often effective for an extended period of time (estimated at an average of 13 prior relapses in one report [83]), but finally a relapse fails to respond clinically to a course of 100 to 200 mg of fluconazole per day.…”

Section: Reports Of Fluconazole Resistancementioning

confidence: 99%

Resistance of Candida species to fluconazole

Rex¹,

Rinaldi²,

Pfaller³

1995

Antimicrob Agents Chemother

774

491

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“…Candida resistance to the azoles has been frequently attributed to a selective pressure caused by the use of these antifungal drugs as OPC prophylaxis or treatment (Barchiesi et al 1996, Dronda et al 1996. Many studies have estimated the incidence of clinical fluconazole resistance to be from 6 to 36%, depending on the patient group studied and the case definition used (Baily et al 1994, Chavanet et al 1994, Johnson et al 1995. The advent of highly active antiretroviral therapy (HAART) has permitted suppression of viral replication to very low levels and a partial recovery of CD4 T cell count in HIV infected patients.…”

mentioning

confidence: 99%