title: Oral thrush to candidemia: a morbid outcome.
abstract: A 35-year-old female living with AIDS presented with oral thrush 3 months after the initiation of antiretroviral therapy (ART). On investigation, it was found to be due to Candida albicans. She was started on fluconazole. After 4 months on ART, she presented with fever. Blood culture was performed. After 4 days, she expired due to septic shock. Two days after her death, C albicans strain was isolated from the blood culture which was similar to the C albicans strain (by DNA fingerprinting) isolated from oral thrush. Both strains of C albicans were found to be resistant to fluconazole by broth microdilution method. A high index of suspicion in high-risk patients along with early and aggressive management of the patient with antigen detection would go a long way in the management of these patients. Guidelines for treatment of candidiasis need to be re-evaluated, keeping in mind the increasing emergence of resistance to azoles and its effect on morbidity outcome.
authors.affiliation: Department of Microbiology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India. drhitender@gmail.com
authors.forename: Hitender
authors.initials: H
authors.lastname: Gautam
authors.forename: Ravinder
authors.initials: R
authors.lastname: Kaur
authors.forename: Ritu
authors.initials: R
authors.lastname: Goyal
authors.forename: Preena
authors.initials: P
authors.lastname: Bhalla
authors.forename: Richa
authors.initials: R
authors.lastname: Dewan
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology*; D058387:Candidemia; D002180:Candidiasis, Oral / Q000188:drug therapy*; D025141:Drug Resistance, Fungal; D017809:Fatal Outcome; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D015497:HIV-1; D006801:Humans; D012772:Shock, Septic / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole