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. 1993 Nov;37(11):2449–2453. doi: 10.1128/aac.37.11.2449

Correlation of in vitro fluconazole resistance of Candida isolates in relation to therapy and symptoms of individuals seropositive for human immunodeficiency virus type 1.

M L Cameron 1, W A Schell 1, S Bruch 1, J A Bartlett 1, H A Waskin 1, J R Perfect 1
PMCID: PMC192407  PMID: 8285632

Abstract

Yeast strains isolated from the oropharynx of 87 consecutive patients infected with human immunodeficiency virus type 1 were examined for in vitro susceptibility to fluconazole. Candida albicans was isolated from 73 patients. Fifty-one patients had received antifungal therapy in the month preceding the yeast infection. Thirty-two patients had symptomatic oropharyngeal candidiasis. The MICs were correlated with azole use and with clinical symptoms and signs. Although there is overlap between groups, in vitro testing identified a large group of patients for whose yeast isolates the fluconazole MICs were high and who remained symptomatic while receiving azole therapy. This study supports the ability of in vitro testing to predict the clinical outcome of mucosal fungal infections. The study also demonstrates that azole resistance of oropharyngeal yeasts is a common problem in patients infected with human immunodeficiency virus type 1 and that this azole resistance has clinical relevance.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akova M., Akalin H. E., Uzun O., Gür D. Emergence of Candida krusei infections after therapy of oropharyngeal candidiasis with fluconazole. Eur J Clin Microbiol Infect Dis. 1991 Jul;10(7):598–599. doi: 10.1007/BF01967286. [DOI] [PubMed] [Google Scholar]
  2. Blumberg H. M., Hendershot E. F., Lott T. J. Persistence of the same Candida albicans strain despite fluconazole therapy. Documentation by pulsed-field gel electrophoresis. Diagn Microbiol Infect Dis. 1992 Aug;15(6):545–547. doi: 10.1016/0732-8893(92)90106-4. [DOI] [PubMed] [Google Scholar]
  3. Case C. P., MacGowan A. P., Brown N. M., Reeves D. S., Whitehead P., Felmingham D. Prophylactic oral fluconazole and candida fungaemia. Lancet. 1991 Mar 30;337(8744):790–790. doi: 10.1016/0140-6736(91)91406-k. [DOI] [PubMed] [Google Scholar]
  4. Dupouy-Camet J., Paugam A., Di Donato C., Viguié C., Vicens I., Volle P. J., Tourte-Schaefer C. Résistance au fluconazole en milieu hospitalier. Concordance entre la résistance de Candida albicans in vitro et l'échec thérapeutique. Presse Med. 1991 Sep 14;20(28):1341–1341. [PubMed] [Google Scholar]
  5. Espinel-Ingroff A., Kish C. W., Jr, Kerkering T. M., Fromtling R. A., Bartizal K., Galgiani J. N., Villareal K., Pfaller M. A., Gerarden T., Rinaldi M. G. Collaborative comparison of broth macrodilution and microdilution antifungal susceptibility tests. J Clin Microbiol. 1992 Dec;30(12):3138–3145. doi: 10.1128/jcm.30.12.3138-3145.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fan-Havard P., Capano D., Smith S. M., Mangia A., Eng R. H. Development of resistance in candida isolates from patients receiving prolonged antifungal therapy. Antimicrob Agents Chemother. 1991 Nov;35(11):2302–2305. doi: 10.1128/aac.35.11.2302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fox R., Neal K. R., Leen C. L., Ellis M. E., Mandal B. K. Fluconazole resistant candida in AIDS. J Infect. 1991 Mar;22(2):201–204. doi: 10.1016/0163-4453(91)91767-r. [DOI] [PubMed] [Google Scholar]
  8. Franker C. K., Lucartorto F. M., Johnson B. S., Jacobson J. J. Characterization of the mycoflora from oral mucosal surfaces of some HIV-infected patients. Oral Surg Oral Med Oral Pathol. 1990 Jun;69(6):683–687. doi: 10.1016/0030-4220(90)90348-v. [DOI] [PubMed] [Google Scholar]
  9. Gallagher P. J., Bennett D. E., Henman M. C., Russell R. J., Flint S. R., Shanley D. B., Coleman D. C. Reduced azole susceptibility of oral isolates of Candida albicans from HIV-positive patients and a derivative exhibiting colony morphology variation. J Gen Microbiol. 1992 Sep;138(9):1901–1911. doi: 10.1099/00221287-138-9-1901. [DOI] [PubMed] [Google Scholar]
  10. Goodman J. L., Winston D. J., Greenfield R. A., Chandrasekar P. H., Fox B., Kaizer H., Shadduck R. K., Shea T. C., Stiff P., Friedman D. J. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med. 1992 Mar 26;326(13):845–851. doi: 10.1056/NEJM199203263261301. [DOI] [PubMed] [Google Scholar]
  11. Horsburgh C. R., Jr, Kirkpatrick C. H. Long-term therapy of chronic mucocutaneous candidiasis with ketoconazole: experience with twenty-one patients. Am J Med. 1983 Jan 24;74(1B):23–29. doi: 10.1016/0002-9343(83)90511-9. [DOI] [PubMed] [Google Scholar]
  12. Just-Nübling G., Gentschew G., Meissner K., Odewald J., Staszewski S., Helm E. B., Stille W. Fluconazole prophylaxis of recurrent oral candidiasis in HIV-positive patients. Eur J Clin Microbiol Infect Dis. 1991 Nov;10(11):917–921. doi: 10.1007/BF02005444. [DOI] [PubMed] [Google Scholar]
  13. Kitchen V. S., Savage M., Harris J. R. Candida albicans resistance in AIDS. J Infect. 1991 Mar;22(2):204–205. doi: 10.1016/0163-4453(91)91789-z. [DOI] [PubMed] [Google Scholar]
  14. Korting H. C., Ollert M., Georgii A., Fröschl M. In vitro susceptibilities and biotypes of Candida albicans isolates from the oral cavities of patients infected with human immunodeficiency virus. J Clin Microbiol. 1988 Dec;26(12):2626–2631. doi: 10.1128/jcm.26.12.2626-2631.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Miyasaki S. H., Hicks J. B., Greenspan D., Polacheck I., MacPhail L. A., White T. C., Agabian N., Greenspan J. S. The identification and tracking of Candida albicans isolates from oral lesions in HIV-seropositive individuals. J Acquir Immune Defic Syndr. 1992 Oct;5(10):1039–1046. [PubMed] [Google Scholar]
  16. Perfect J. R., Savani D. V., Durack D. T. Comparison of itraconazole and fluconazole in treatment of cryptococcal meningitis and candida pyelonephritis in rabbits. Antimicrob Agents Chemother. 1986 Apr;29(4):579–583. doi: 10.1128/aac.29.4.579. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Persons D. A., Laughlin M., Tanner D., Perfect J., Gockerman J. P., Hathorn J. W. Fluconazole and Candida krusei fungemia. N Engl J Med. 1991 Oct 31;325(18):1315–1315. [PubMed] [Google Scholar]
  18. Pfaller M. A., Rinaldi M. G., Galgiani J. N., Bartlett M. S., Body B. A., Espinel-Ingroff A., Fromtling R. A., Hall G. S., Hughes C. E., Odds F. C. Collaborative investigation of variables in susceptibility testing of yeasts. Antimicrob Agents Chemother. 1990 Sep;34(9):1648–1654. doi: 10.1128/aac.34.9.1648. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Powderly W. G. Mucosal candidiasis caused by non-albicans species of Candida in HIV-positive patients. AIDS. 1992 Jun;6(6):604–605. [PubMed] [Google Scholar]
  20. Ryley J. F., Wilson R. G., Barrett-Bee K. J. Azole resistance in Candida albicans. Sabouraudia. 1984;22(1):53–63. [PubMed] [Google Scholar]
  21. Smith D., Boag F., Midgley J., Gazzard B. Fluconazole resistant candida in AIDS. J Infect. 1991 Nov;23(3):345–346. doi: 10.1016/0163-4453(91)93584-y. [DOI] [PubMed] [Google Scholar]
  22. Stiller R. L., Bennett J. E., Scholer H. J., Wall M., Polak A., Stevens D. A. Correlation of in vitro susceptibility test results with in vivo response: flucytosine therapy in a systemic candidiasis model. J Infect Dis. 1983 Jun;147(6):1070–1077. doi: 10.1093/infdis/147.6.1070. [DOI] [PubMed] [Google Scholar]
  23. Tam J. Y., Blume K. G., Prober C. G. Prophylactic fluconazole and Candida krusei infections. N Engl J Med. 1992 Mar 26;326(13):891–893. doi: 10.1056/NEJM199203263261312. [DOI] [PubMed] [Google Scholar]
  24. Wingard J. R., Merz W. G., Rinaldi M. G., Johnson T. R., Karp J. E., Saral R. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med. 1991 Oct 31;325(18):1274–1277. doi: 10.1056/NEJM199110313251803. [DOI] [PubMed] [Google Scholar]

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