Effect of Antifungal Agents on Candida spp. and Pichia anomala Isolated from Oropharyngeal Candidiasis of AIDS Patients in a University Hospital in Brazil.
In order to determine the clinical significance of oropharyngeal candidiasis in AIDS patients, 44 isolates collected from individual clinical episodes were evaluated. The isolates were identified by microbiologic standard methods and in vitro antifungal susceptibility testing was evaluated for amphotericin B, fluconazole, flucytosine, miconazole, itraconazole, and ketoconazole according to the National Committee for Clinical Laboratory Standards. Candida albicans ATCC90028 was used as control for the MICs. The microbiologic isolation revealed 2 strains of Pichia anomala, an uncommon pathogen in AIDS patients. C.albicans and Candida tropicalis comprised 35 and 6 isolates, respectively. The antifungal susceptibility testing for C.albicans isolates (35 isolates) revealed low sensitivity and 19 strains (54%) were resistant to at least 1 antifungal agent. 5 strains (14%) showed multi-drug resistance, including to fluconazole. The resistant profiles of these Candida spp. are of major concern since at present, fluconazole is not commonly prescribed for the treatment of oral candidiasis in our AIDS patients. All C.tropicalis isolates were resistant to fluconazole and miconazole. Both P.anomala strains were resistant to fluconazole. The local diversity of species and the variability of MICs and IC80s of antifungal agents seen in this study indicate that continuing evaluation of clinical and laboratory aspects of oral candidiasis in our HIV1-patients is needed, and that a new approach and therapy will be necessary to manage the increasing problem.
Branchini
ML
State University of Campinas, School of Medical Science-Infectious Diseases Division, São Paulo.
Aoki
FH
Colombo
AL
Taguchi
H
Yamamoto
K
Miyazi
M