title: Activity of amphotericin B, anidulafungin, caspofungin, micafungin, posaconazole, and voriconazole against Candida albicans with decreased susceptibility to fluconazole from APECED patients on long-term azole treatment of chronic mucocutaneous candidiasis.
abstract: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, APS-I) is exceptionally common in Finland. Most patients have chronic oral candidiasis since childhood. Thus, most patients receive repeated courses of antifungals throughout their life. Eleven of our patients (31.4%) have become colonized with Candida albicans with decreased sensitivity to fluconazole. A total of 43 isolates of C. albicans from 23 APECED patients isolated during the years 1994 to 2004 were divided into 2 groups: fluconazole-susceptible dose-dependent (MIC, 16-32 microg/mL, 18 isolates) and fluconazole-susceptible (MIC <or=8 microg/mL, 25 isolates) groups. Antifungal activity of amphotericin B, echinocandins, and azoles was determined by the Clinical and Laboratory Standards Institute M27-A2 methodology. All isolates were highly susceptible to amphotericin B and echinocandins. Posaconazole and voriconazole were active against all isolates. Our data suggest that topical amphotericin B could continue to be a safe and active drug for daily administration for APECED patients. Posaconazole, voriconazole, and echinocandins may be useful in some complicated cases.
authors.affiliation: Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Helsinki FI-00014, Finland. riina.richardson@helsinki.fi
authors.forename: Riina
authors.initials: R
authors.lastname: Rautemaa
authors.forename: Malcolm
authors.initials: M
authors.lastname: Richardson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pfaller
authors.forename: Jaakko
authors.initials: J
authors.lastname: Perheentupa
authors.forename: Harri
authors.initials: H
authors.lastname: Saxén
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001393:Azoles / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D002176:Candida albicans / Q000187:drug effects*; D002178:Candidiasis, Chronic Mucocutaneous / Q000188:drug therapy* / Q000382:microbiology; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000494:pharmacology; D005387:Finland; D015725:Fluconazole / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000706:statistics & numerical data; D016884:Polyendocrinopathies, Autoimmune / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors
chemical_list: D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins; D000666:Amphotericin B; D015725:Fluconazole