Oral Candida dubliniensis as a clinically important species in HIV-seropositive patients in the United States.
OBJECTIVE
Interest in Candida dubliniensis has led to renewed clinical investigations regarding incidence, drug resistance, pathogenesis, and epidemiology of fungal infections in patients with HIV. C dubliniensis phenotypically resembles Candida albicans in many respects, yet it can be identified and differentiated as a unique Candida species by its phenotypic and genetic profiles. The purpose of this study was to prospectively evaluate the prevalence of C dubliniensis in clinical isolates and determine the clinical and demographic characteristics of patients harboring C dubliniensis.


METHODS
Over a 6-week period, 24 yeast-positive isolates from HIV-positive dental patients were screened for C dubliniensis through use of phenotypic criteria. HIV viral load, CD4 count, and complete oral health evaluations were performed on each patient at the same visit during which the oral fungal surveillance culture was taken.


RESULTS
Six isolates from 24 HIV-seropositive and yeast-positive patients were shown to be consistent phenotypically and by electrophoretic karyotyping with the European reference strain of C dubliniensis. Dose-dependent susceptibility to fluconazole was shown in one of the C dubliniensis isolates. Five of the 6 patients demonstrated moderate to high viral loads. General oral health, as evidenced by the presence of advanced periodontal lesions and a high decayed, missing, and filled teeth index (>20), was poor in 3 of the 6 patients with C dubliniensis and 7 of the 18 patients with C albicans. A history of intravenous drug abuse was present in 50% of the C dubliniensis -positive patients, which is representative of the HIV-positive population at the hospital.


CONCLUSIONS
In this small sample, C dubliniensis represented 25% of the yeast-positive cultures. The clinical significance of this interesting species in the United States may be related to high viral load, rapid AIDS progression, and/or concomitant oral disease, such as a high caries index or periodontal disease.
Meiller
T F
TF
Department of Oral Medicine and Diagnostic Sciences, Dental School, University of Maryland, Baltimore 21201, USA.
Jabra-Rizk
M A
MA
Baqui
A a
Aa
Kelley
J I
JI
Meeks
V I
VI
Merz
W G
WG
Falkler
W A
WA
D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D002180:Candidiasis, Oral / Q000209:etiology / Q000382:microbiology*; D004245:DMF Index; D004271:DNA, Fungal / Q000032:analysis; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D007621:Karyotyping; D008297:Male; D008826:Microbial Sensitivity Tests; D010510:Periodontal Diseases / Q000150:complications; D011446:Prospective Studies; D019562:Viral Load
D000935:Antifungal Agents; D004271:DNA, Fungal; D015725:Fluconazole