title: Variations in fluconazole susceptibility and electrophoretic karyotype among oral isolates of Candida albicans from patients with AIDS and oral candidiasis.
abstract: DNA subtyping by pulsed-field gel electrophoresis and in vitro susceptibility testing were used to study strain variation and fluconazole resistance in Candida albicans isolates from patients with AIDS undergoing azole (fluconazole and clotrimazole) therapy for oropharyngeal candidiasis. A total of 29 patients suffered 71 episodes of oropharyngeal candidiasis. Overall, 121 isolates of C. albicans recovered throughout the course of treatment of each infection were available for further characterization. DNA subtyping revealed a total of 61 different DNA subtypes. In vitro susceptibility testing of the 121 isolates by using proposed standard methods of the National Committee for Clinical Laboratory Standards revealed MICs of fluconazole ranging from < or = 0.125 to > 64 micrograms/ml. The MIC for 50% of isolates tested was 0.25 microgram/ml, and the MIC for 90% of isolates tested was 8.0 micrograms/ml. MICs were > or = 64 micrograms/ml for only 7.4% of the isolates tested. The majority (62%) of the patients with oropharyngeal candidiasis and undergoing azole therapy were infected or colonized with more than one DNA subtype, and the introduction or selection of strains with a more resistant DNA subtype during the course of fluconazole therapy was not uncommon. With one exception, this did not appear to have an adverse effect on clinical outcome. In contrast, for patients with AIDS and oropharyngeal candidiasis infected with a single DNA subtype of C. albicans, an increase in fluconazole MICs for the infecting strain was rarely demonstrated over the course of therapy.
authors.affiliation: Department of Pathology, Oregon Health Sciences University, Portland 97201.
authors.forename: M A
authors.initials: MA
authors.lastname: Pfaller
authors.forename: J
authors.initials: J
authors.lastname: Rhine-Chalberg
authors.forename: S W
authors.initials: SW
authors.lastname: Redding
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: G
authors.initials: G
authors.lastname: Farinacci
authors.forename: A W
authors.initials: AW
authors.lastname: Fothergill
authors.forename: M G
authors.initials: MG
authors.lastname: Rinaldi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000382:microbiology*; D002176:Candida albicans / Q000235:genetics*; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000235:genetics; D004271:DNA, Fungal / Q000145:classification*; D004352:Drug Resistance, Microbial / Q000235:genetics*; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D015725:Fluconazole / Q000494:pharmacology* / Q000627:therapeutic use; D014644:Genetic Variation; D006801:Humans; D007621:Karyotyping; D008297:Male; D012150:Polymorphism, Restriction Fragment Length; D016896:Treatment Outcome
chemical_list: D004271:DNA, Fungal; D015725:Fluconazole