Clinical and laboratorial features of oral candidiasis in HIV-positive patients

Polymerase chain reaction-based techniques were performed for differentiation of Candida spp. isolated from patients at a public teaching hospital in Midwest Brazil.

RESULTS:

Oral lesions, mainly pseudomembranous, were significantly related to higher levels of immunosuppression. Of 45 Candida isolates, 66.7% were C. albicans. Most of the isolates were susceptible to the antifungal drugs tested.

CONCLUSIONS:

Oral lesions were associated with higher immunosuppression levels. Lower susceptibility to antifungals by non-albicans isolates supports the importance of surveillance studies using susceptibility tests to aid in the treatment.

Keywords:
Candida spp; HIV; Antifungal susceptibility

Primer	Sequence (5’ → 3’)	Reference
CL	GTTAGGCGTTGCTCCGAAAT	Li et al.⁶6. Li YL, Leaw SN, Chen J, Chang HC, Chang TC. Rapid identification of yeasts commonly found in positive blood cultures by amplification of the internal transcribed spacer regions 1 and 2. Eur J Clin Microbiol Infect Dis. 2003;22(11):693-6.
CP	GGCGGAGTATAAAGTAATGGATAG
CT	AAGAATTTAACGTGGAAACTTA
CGU	GTATTG GCA TGG GTA GTA CTG
CA	TCAACTTGTCACACCAGATTATT3
CK	GAT TTAGTACTACACTGCGTG A
CGL	CACGACTCGACACTTTCTAATT
CALF	TGGTAAGGCGGGATCGCTT	Ahmad et al.⁷7. Ahmad S, Khan Z. Invasive candidiasis: a review of nonculture-based laboratory diagnostic methods. Indian J Med Microbiol. 2012;30(3):264-9.
CALR	GGTCAAAGTTTGAAGATATAC
CDUF	AAACTTGTCACGAGATTATTTTT
CDUR	AAAGTTTGAAGAATAAAATGGC
S1F	GTTGATGCTGTTGGATTGT	Tavanti et al.⁸8. Tavanti A, Davidson AD, Gow NAR, Maiden MCJ, Odds FC. Candida orthopsilosis and Candida metapsilosis spp. nov. to replace Candida parapsilosis groups II and III. J Clin Microbiol. 2005;43(1):284-92.
S1R	CAATGCCAAATCTCCCAA
UNI-5.8S	ACCAGAGGGCGCAATGTG	Romeo et al.⁹9. Romeo O, Scordino F, Pernice I, Lo Passo C, Criseo G. A multiplex PCR protocol for rapid identification of Candida glabrata and its phylogenetically related species Candida nivariensis and Candida bracarensis. J Microbiol Methods. 2009;79(1):117-20.
GLA-f	CGGTTGGTGGGTGTTCTGC
NIV-f	AGGGAGGAGTTTGTATCTTTCAAC
BRA-f	GGGACGGTAAGTCTCCCG

Variable	Number	Percentage	p value*
Gender			< 0.001
male (M)	50	75.8
female (F)	16	24.2
Age (years)			< 0.001
24 - 40	36	54.5
41 - 60	25	37.9
> 60	5	7.6
Attendance unit			<0.001
infectious and parasitic diseases/ward	47	71.2
day-care hospital	17	25.8
adult intensive care	2	3.0
Presence of oral lesions			< 0.001
yes	16	24.2
no	50	75.8
Type of oral lesions			0.14
pseudomembranous	8	50.0
erythematous	3	18.8
chronic multifocal	3	18.8
angular cheilitis	2	12.5
Correlation: species vs type of interaction			0.15
Infection
C. albicans	10	33.3
non-albicans Candida	3	20.0
Colonization
C. albicans	20	66.7
non-albicans Candida	12	80.0
Correlation: species vs lesion form			0.50
*C. albicans*
pseudomembranous	5	83.3
erythematous	2	66.7
*C. tropicalis*
pseudomembranous	1	16.7
erythematous	1	33.3
TCD4 ⁺ lymphocytes count (cells/µL)			0.03
≤200	42	63.6
>200	24	36.4

Candida species	Antifungal agent	MICs in μg/mL
		MIC range	MIC50/90*
C. albicans (n= 300)	Fluconazole	0.125 - 0.500	0,125/0,25
	Itraconazole	0.003 - 0.125	0,015/0,06
	Voriconazole	0.015 - 0.06	0,015/0,015
	Amphotericin B	0.06 - 0.5	0,5/0,5
C. tropicalis (n=6)	Fluconazole	0.125 - 0.500	0,5/0,5
	Itraconazole	0.015 - 0.06	0,06/0,060
	Voriconazole	0.015	0,015/0,015
	Amphotericin B	0.5 - 1	0,5/0,5
C. krusei (n=4)**	Fluconazole	-	-
	Itraconazole	0.015 - 0.125	0,03/0,03
	Voriconazole	0.015 - 0.06	0,03/0,03
	Amphotericin B	0.5 - 1.0	1/1
C. glabrata sensu stricto (n=2)	Fluconazole	4.0 - 8.0
	Itraconazole	0.03 - 0.250
	Voriconazole	0.06 - 0.125
	Amphotericin B	1
C. parapsilosis sensu stricto (n=2)	Fluconazole	0.125 - 0.5
	Itraconazole	0.015- 0.06
	Voriconazole	0.015
	Amphotericin B	0.06 - 0.5
C. dubliniensis (n=1)	Fluconazole	0.125
	Itraconazole	0.015
	Voriconazole	0.015
	Amphotericin B	0.06

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[1] Conflict of interest: The authors declare that there is no conflict of interest.