title: Oral Candida colonization in HIV-infected patients in Londrina-PR, Brazil: antifungal susceptibility and virulence factors.
abstract: BACKGROUND
  Host colonization by Candida species is an important predisposing factor to candidiasis, which seems to be more frequent in human immunodeficiency virus (HIV)-infected patients. Knowledge about the distribution, antifungal susceptibility, and virulence of oral Candida isolates is important for effective management of candidiasis.
  
  
  METHODS
  Oral rinses were collected from 242 HIV-infected patients without clinical evidence of candidiasis seen at the AIDS referral center in Londrina, Brazil. Species were identified by standard phenotypic and molecular methods, and characterized in vitro according to antifungal susceptibility, cell surface hydrophobicity, biofilm formation, and enzyme activities.
  
  
  RESULTS
  Oral Candida colonization was detected in 50.4% of patients and combined use of antiretroviral therapy and protease inhibitor had a protective effect against colonization. Candida albicans (75.2%) was the most prevalent species. A high proportion of Candida spp. (39.9%) showed decreased susceptibility to fluconazole. Five isolates were resistant to nystatin. Protease and phospholipase activities were detected in 100% and 36.8% of isolates, respectively. Most isolates displayed a hydrophobic property that was associated with biofilm formation ability.
  
  
  CONCLUSIONS
  A significant number of oral Candida species exhibiting decreased susceptibility to fluconazole were isolated from colonized HIV-infected individuals. Furthermore, all isolates expressed potential virulence attributes in vitro. Given the high incidence and severity of fungal infections in HIV-infected individuals, the results of this study reinforce the importance of antifungal susceptibility testing, which contributes to therapeutic strategies and highlights the need for continuous surveillance of Candida colonization in this population.
authors.affiliation: Universidade Estadual de Londrina, Londrina, Paraná (PR), Brasil. d_suelen@hotmail.com.
authors.forename: Suelen Balero de
authors.initials: SB
authors.lastname: Paula
authors.forename: Alexandre Tadachi
authors.initials: AT
authors.lastname: Morey
authors.forename: Jussevania Pereira
authors.initials: JP
authors.lastname: Santos
authors.forename: Pollyanna M C dos
authors.initials: PM
authors.lastname: Santos
authors.forename: Danielle G
authors.initials: DG
authors.lastname: Gameiro
authors.forename: Gilselena
authors.initials: G
authors.lastname: Kerbauy
authors.forename: Ester M
authors.initials: EM
authors.lastname: Sena
authors.forename: Luiz T
authors.initials: LT
authors.lastname: Ueda
authors.forename: Marcelo
authors.initials: M
authors.lastname: Carneiro
authors.forename: Phileno
authors.initials: P
authors.lastname: Pinge-Filho
authors.forename: Lucy Megumi
authors.initials: LM
authors.lastname: Yamauchi
authors.forename: Sueli Fumie
authors.initials: SF
authors.lastname: Yamada-Ogatta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D058070:Asymptomatic Diseases; D018441:Biofilms / Q000254:growth & development; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D002180:Candidiasis, Oral / Q000453:epidemiology* / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D004798:Enzymes / Q000032:analysis; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D057927:Hydrophobic and Hydrophilic Interactions; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013499:Surface Properties; D037521:Virulence Factors / Q000032:analysis*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D004798:Enzymes; D037521:Virulence Factors