Background: Oro-pharyngeal candidiasis (OPC) is one of the most common conditions seen in HIV-infected individuals. Over the last decade, there have been different reports describing an increase in the proportion of cases with refractory disease, associated to non-albicans species of Candida or to antifungal resistance. The significance of these problems is unknown in Peru. Methods: Fifty-six patients with a clinical diagnosis of OPC were studied. Swab samples were obtained from the oral cavity of these patients and were cultured. Species identification was made with germ tube test, ChromAgar and API 20C. Antifungal susceptibility was tested according to NCCLS guidelines. Epidemiological and statistical analysis was performed to identify factors associated to antifungal resistance and non-albicans candidiasis. Results: Diagnosis was confirmed microbiologically in 44 patients. A total of 59 strains were recovered, from which 18 (30.5%) corresponded to non-albicans organisms. The most common species in this group were C. guillermondii, C. glabrata and C. krusei. Six patients grew more than one Candida species. Sixteen isolates showed decreased susceptibility (tolerance or resistance) to fluconazole and 8 to ketaconazole. In the C. albicans group we found 6 strains with decreased susceptibility to fluconazole and 6 to itraconazole. Resistance to amphotericin B was rare amongst all strains. The main factor associated to 1 species infection, non-albicans candidiasis and decreased susceptibility to fluconazole, was history of prior fluconazole use. Refractory disease was strongly associated to severe immunedeficiency. Conclusion: The microbiological and clinical characteristics of OPC in the studied population were similar to previous reports in terms of prevalence of antifungal resistance. We found a high frequency of non-albicans disease. The use of fluconazole should be restricted to selected indications in order to prevent the development of resistance.
Full conference title:
41st Annual Meeting Infectious Diseases Society of America
- Infectious Diseases Society of America 41st