title: Clinical evaluation and microbiology of oropharyngeal infection due to fluconazole-resistant Candida in human immunodeficiency virus-infected patients.
abstract: Signs and symptoms of oropharyngeal candidiasis (OPC) were correlated with microbiology and clinical response to fluconazole in a cohort of patients with advanced human immunodeficiency virus (HIV) infection and recurrent OPC. Sixty-four HIV-infected patients with a median CD4 cell count of < 50/mm3 (range, 3-318/mm3) who presented with OPC were enrolled in a longitudinal study. Specimens for cultures were taken weekly until clinical resolution. Therapy with fluconazole was increased weekly as required to a maximum daily dose of 800 mg until resolution of symptoms and oral lesions. Resistant or dose-dependent susceptible yeasts, defined as a minimum inhibitory concentration of > or = 16 micrograms/mL, were detected in 48 (31%) of 155 episodes. Clinical resolution with fluconazole therapy occurred in 107 (100%) of 107 episodes with susceptible yeasts vs. 44 (92%) of 48 episodes with resistant or dose-dependent susceptible strains (P = .008). Patients from whom fluconazole-resistant yeasts were isolated required longer courses of therapy and higher doses of fluconazole for response, but overall, excellent responses to fluconazole were seen in patients with advanced HIV infection.
authors.affiliation: University of Texas Health Science Center at San Antonio 78284-7881, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Revankar
authors.forename: O P
authors.initials: OP
authors.lastname: Dib
authors.forename: W R
authors.initials: WR
authors.lastname: Kirkpatrick
authors.forename: R K
authors.initials: RK
authors.lastname: McAtee
authors.forename: A W
authors.initials: AW
authors.lastname: Fothergill
authors.forename: M G
authors.initials: MG
authors.lastname: Rinaldi
authors.forename: S W
authors.initials: SW
authors.lastname: Redding
authors.forename: T F
authors.initials: TF
authors.lastname: Patterson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D004352:Drug Resistance, Microbial; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008826:Microbial Sensitivity Tests; D009960:Oropharynx; D010608:Pharyngeal Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole