Journal of Antimicrobial Chemotherapy, Vol 41, 541-548, Copyright © 1998 by The British Society for Antimicrobial Chemotherapy
F Barchiesi, D Arzeni, MS Del Prete, A Sinicco, L Falconi Di Francesco, MB Pasticci, L Lamura, MM Nuzzo, F Burzacchini, S Coppola, F Chiodo and G Scalise
Over a 16 month period we conducted a prospective study in a cohort of 45
HIV-positive patients to detect the development of resistance to
fluconazole and to analyse the epidemiology of oropharyngeal candidosis
(OPC). Each episode was treated with fluconazole 100 mg/day po for 10 days.
All yeast isolates were tested for their in-vitro susceptibility to
fluconazole. Multiple strains of Candida albicans simultaneously isolated
from a given patient were typed by electrophoretic karyotyping. Overall,
106 episodes of OPC were diagnosed among the 45 patients: 18/45 patients
(40%) had only one episode, 11/45 (24%) had two episodes, and the remaining
16/45 (36%) had three or more episodes (range 3-7). Cure (complete
resolution of signs and symptoms and negative post-treatment cultures) and
improvement (complete resolution of signs and symptoms but positive
post-treatment cultures) were observed in 30/106 (28%) and 69/106 (65%)
episodes of OPC, respectively. Failure (absence of improvement or
exacerbation of signs and symptoms) was observed in seven episodes (7%)
from four patients. In two of these four patients a significant and
progressive increase in fluconazole MICs was observed: from 0.25 to 16 mg/L
in one patient, and from < or = 0.125 to 32 mg/L in the second one.
Tests on multiple colonies from individual isolation plates showed that it
was not unusual to obtain different fluconazole MICs, indicating that, in
order to avoid misleading results, one should perform in-vitro
susceptibility testing by using a multiple colony inoculum rather than an
inoculum made from a single colony. A total of 213 strains of C. albicans
isolated from seven patients who suffered from four or more episodes of OPC
through the course of the study were typed by electrophoretic karyotyping.
Five individuals (71%) were infected with yeasts with only one DNA type,
while the other two patients showed the presence of two or three different
DNA types. The simultaneous presence of multiple types was found only in
one of the seven subjects. Our data confirm the efficacy of fluconazole 100
mg/day for the treatment of OPC in HIV patients. Isolation of
fluconazole-resistant strains of C. albicans with this regimen is rare. The
vast majority of HIV patients are infected with a unique strain of C.
albicans throughout each episode of infection. A minority of patients,
however, can harbour strains of C. albicans with variable patterns of
fluconazole susceptibility simultaneously.
REVIEWS
Fluconazole susceptibility and strain variation of Candida albicans isolates from HIV-infected patients with oropharyngeal candidosis [published erratum appears in J Antimicrob Chemother 1998 Sep;42(3):413]
Istituto di Malattie Infettive e Medicina Pubblica, Universita degli Studi di Ancona, Ospedale Umberto Io, Italy. cmalinf@popcsi.unian.it
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