Journal Article

Oropharyngeal Candidiasis in Patients with Human Immunodeficiency Virus: Correlation of Clinical Outcome with In Vitro Resistance, Serum Azole Levels, and Immunosuppression

Sharon Walmsley, Susan King, Allison McGeer, Yanna Ye and Susan Richardson

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 32, issue 11, pages 1554-1561
Published in print June 2001 | ISSN: 1058-4838
Published online June 2001 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/320517
Oropharyngeal Candidiasis in Patients with Human Immunodeficiency Virus: Correlation of Clinical Outcome with In Vitro Resistance, Serum Azole Levels, and Immunosuppression

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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 vitro correlations compare favorably to studies of susceptibility testing in bacteria.

Journal Article.  4201 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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