Assessment of therapeutic response of oropharyngeal and esophageal candidiasis in AIDS with use of a new clinical scoring system: studies with D0870.
We developed and compared five scoring systems designed to quantitate therapeutic response in cases of oropharyngeal candidiasis. We utilized prospectively collected data on 114 patients treated with several doses of the azole D0870. Patients were infected with fluconazole-susceptible (n = 49) or -resistant organisms (MIC, > or = 16 mg/mL; n = 61). Patients with fluconazole resistance had lower CD4+ cell counts at baseline; more symptoms (P = .0006); a higher frequency of dysgeusia (P = .004), dysphagia (P = .006), and throat pain (P = .0034); and greater oral coverage by plaques of Candida. There was no difference between the two groups in terms of colony-forming units, and any change did not correlate with response to therapy. Resolution of dysphagia (P < .01) and oral pain (P < .01) correlated well with response to therapy, unlike retrosternal pain and throat pain, which were also less frequent. Xerostomia, a "furry" taste, and dysgeusia were frequent nonspecific symptoms. Scoring system C, weighting resolution of a symptom higher than absence of a symptom at baseline, yielded the best correlation with global outcome (r = 0.86) and allows the quantitation of incomplete but clinically beneficial responses to therapy.
Hood
S V
SV
Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, University of Manchester, United Kingdom.
Hollis
S
S
Percy
M
M
Atkinson
G
G
Williams
K
K
Denning
D W
DW
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000382:microbiology; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015169:Colony Count, Microbial; D004352:Drug Resistance, Microbial; D004935:Esophageal Diseases / Q000188:drug therapy* / Q000382:microbiology; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D014230:Triazoles / Q000494:pharmacology / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C058219:ICI 195739; D015725:Fluconazole