Detection of fungal organisms in saliva from HIV-infected children: a preliminary cytologic analysis.
OBJECTIVE
Fungal infections in HIV-infected individuals are associated with advancement of disease. In pediatric HIV infection, symptomatic children have a significantly higher incidence of clinical candidiasis and persistent drug-resistant candidiasis than do asymptomatic HIV-infected children. The purpose of this preliminary cytologic study was to determine the prevalence of fungal organisms in whole unstimulated saliva from children with vertically acquired HIV infection.


METHODS
The subjects included 27 HIV-infected and 11 HIV-exposed, but uninfected, children. Whole unstimulated saliva was obtained for cytologic evaluation (hematoxylin and eosin, silver stains) with selected samples evaluated by electron microscopy.


RESULTS
Yeast and hyphae were identified cytologically in 19% of HIV-infected (22% symptomatic HIV-infected, 11% asymptomatic HIV-infected) and 9% of HIV-exposed, but uninfected, children. Fungal organisms were found more frequently in HIV-infected with moderate (18%) and severe (27%) suppression. Fungi were more frequent with antiretroviral therapy (22%) vs no antiretroviral therapy (0%) and no antifungal therapy (20%) vs. antifungal therapy (7%). Yeast and hyphal fungal forms are more prevalent in symptomatic HIV-infection with moderate and severe suppression, and those receiving antiretroviral agents, but no antifungal medications.


CONCLUSIONS
Fungal organisms in the saliva may reflect oral carriage or mucosal colonization, which may influence the development of clinically significant candidiasis in these immunocompromised children.
Hicks
M J
MJ
Department of Pathology, Baylor College of Medicine, Houston, Texas, USA.
Carter
A B
AB
Rossmann
S N
SN
Demmler
G J
GJ
Simon
C L
CL
Cron
S G
SG
Flaitz
C M
CM
Shearer
W T
WT
Kline
M W
MW
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification*; D002180:Candidiasis, Oral / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D015169:Colony Count, Microbial; D004396:Coloring Agents; D004352:Drug Resistance, Microbial; D004801:Eosine Yellowish-(YS); D005456:Fluorescent Dyes; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission; D018023:HIV Seronegativity; D006416:Hematoxylin; D006801:Humans; D016867:Immunocompromised Host; D018445:Infectious Disease Transmission, Vertical; D008709:Methenamine; D008854:Microscopy, Electron; D008855:Microscopy, Electron, Scanning; D015995:Prevalence; D012463:Saliva / Q000166:cytology / Q000382:microbiology*
D019380:Anti-HIV Agents; D000935:Antifungal Agents; D004396:Coloring Agents; D005456:Fluorescent Dyes; D008709:Methenamine; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin