Oropharyngeal candidiasis in patients with human immunodeficiency virus: correlation of clinical outcome with in vitro resistance, serum azole levels, and immunosuppression

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
S WalmsleyS Richardson

Abstract

Azole-resistant thrush has emerged as a problem in people who are infected with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), especially those who have low CD4 cell counts who have had a previous relapse of oral candidiasis, and in those who require long-term suppressive antifungal therapy. Because of the development of a standardized methodology for antifungal susceptibility testing and interpretive criteria for resistance testing, studies of the clinical predictive value of in vitro results are possible. In this study, 61% of organisms isolated from patients who were receiving azole therapy and who had clinically resistant thrush had minimal inhibitory concentration values that would classify the isolate as "resistant" or "susceptible dose dependent." In contrast, 86% of isolates from patients with thrush that was clinically responsive to an azole were classified in vitro as "susceptible" or "susceptible dose dependent." No resistant isolates were detected in samples obtained from asymptomatic control patients who were not exposed to azole drugs. Serum levels of azole and CD4 cell counts were also important parameters with regard to prediction of response. We conclude that in vivo and in vit...Continue Reading

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Citations

Feb 11, 2011·Current Infectious Disease Reports·Susanne PerkhoferCornelia Lass-Flörl
Oct 2, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·John H Rex, Michael A Pfaller
Oct 18, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Sofia Perea, Thomas F Patterson
Jul 29, 2005·Antimicrobial Agents and Chemotherapy·Cornelius J ClancyM Hong Nguyen
Mar 24, 2007·Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics·Jonathan A ShipStephen J Challacombe
Jul 1, 2009·Expert Review of Clinical Pharmacology·Michael D Nailor, Pranatharthi H Chandrasekar
Oct 23, 2012·Mycopathologia·Luz Ángela CastroErnesto Martínez

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