Point Prevalence of Oropharyngeal Carriage of Fluconazole‐ResistantCandidain Human Immunodeficiency Virus–Infected Patients

Abstract

To estimate the prevalence of both clinically evident and asymptomatic carriage of fluconazole-resistant Candida, we prospectively surveyed 128 adults infected with human immunodeficiency virus (HIV). The patients had an average CD4 cell count of 206/mm3. Ninety-seven isolates of Candida were obtained from the oropharynx of 82 patients (64%). Of these 82 patients, 76% carried C. albicans alone; 18%, both albicans and non-albicans isolates; and 6%, non-albicans species alone. Oropharyngeal candidiasis was evident in only 38 (46%) of the 82 patients for whom a culture was positive and was never seen unless C. albicans was present. When MICs were measured by using the National Committee for Clinical Laboratory Standards M27-T methodology and grouped by using recently proposed breakpoints, we found that eight of the 38 patients with oropharyngeal candidiasis and six of the 44 patients who were asymptomatically colonized carried C. albicans isolates resistant to fluconazole (MIC, > or = 64 micrograms/mL); estimated rates of carriage were 21% (95% confidence interval, 10%-37%) and 14% (95% confidence interval, 5%-27%), respectively. Carriage of resistant isolates of C. albicans by HIV-infected adults is more common than previously suspected, and clinicians should be alert to the possible need for either higher doses of fluconazole or alternative treatment modalities.

Yeasts in Apical Periodontitis

“…This may be due to the infrequent use of 5-fluorocytosine in dentistry. Varying susceptibility of the tested isolates to the azolegroup antifungal agents is in accordance with recent reports of oral yeast isolates (Martins et al, 1997;Monteil et al, 1997;Hunter et al, 1998). In addition, in this study, a few oral isolates showed cross-resistance to the azoles.…”

Transcriptional Regulation of MDR1 , Encoding a Drug Efflux Determinant, in Fluconazole-Resistant Candida albicans Strains through an Mcm1p Binding Site

“…In one study, approximately onethird of late-stage AIDS patients carried drug-resistant C. albicans in their oral cavities (35). Fluconazole-resistant (FLC R ) C. albicans is now seen in both HIV and non-HIV patients who have never been exposed to fluconazole (38).…”

OralCandidaIsolates Colonizing or Infecting Human Immunodeficiency Virus-Infected and Healthy Persons in Mexico

“…Antifungal resistance to fluconazole (FCZ), itraconazole (ITZ), and ketoconazole (KTZ) has been described and particularly in the setting of oral candidiasis in HIV/AIDS patients (6,14,15,25,26). Cross-sectional surveys have indicated a prevalence of FCZ-resistant oral C. albicans isolates of 12 to 19% (20).…”

“…Cross-sectional surveys have indicated a prevalence of FCZ-resistant oral C. albicans isolates of 12 to 19% (20). Before the use of HAART, Martins et al (14,15) found a prevalence of Candida spp. resistant to FCZ of 22% in North Americans with oral candidiasis and of 14% in asymptomatically colonized patients.…”