Maurya Vijeta, Srivastava Ashutosh, Mishra Jyoti, Gaind Rajni, Marak Rungmei S K, Tripathi Anil Kumar, Singh Mastan, Venkatesh Vimala
Chhatrapati Shahuji Maharaj Medical University, Lucknow, UP, India.
J Infect Dev Ctries. 2013 Aug 15;7(8):608-13. doi: 10.3855/jidc.2801.
Oropharyngeal candidiasis (OPC) is the most common opportunistic fungal infection reported in human immunodeficiency virus (HIV) positive patients worldwide. This prospective study was undertaken to investigate OPC and Candida colonization (CC) and their correlation with CD4+ cell counts and antiretroviral therapy (ART) in HIV-positive patients.
In total, 190 HIV-positive patients were enrolled for study in three groups as follows: Group A, 90 patients without ART; Group B, 100 patients undergoing treatment with ART; and Group C, 75 HIV-negative control patients. All HIV patients underwent clinical examination and were subjected to CD4+ cell counts. Swabs were collected from the oral cavity of all individuals and plated on Sabouraud's dextrose agar. Identification of Candida species was performed by conventional methods.
Candida species were isolated in 84/190 (44.2%) and 20/75 (26.6%) of the HIV-positive subjects and controls respectively (p<0.01). OPC was noted in 21/190 (11%) of the HIV-positive patients. Candida albicans was the most frequently isolated species. Patients with CD4+ cell counts ≤ 200 cells/mm3 were significantly (p<0.001) more frequently colonized (37/63; 58.7%) and infected (18/21; 85.7 %) with Candida species. Candida species was seen in patients with CC and OPC with CD4+cell counts between 201 and 500 (21/63; 33.4% vs 3/21; 14.3%) and > 500 cell/mm3 (5/63; 7.9% versus 0/21 0%) respectively.
OPC and Candida colonization occur more frequently in HIV-positive patients with CD4+ cell counts ≤ 200 cell/mm3. ART significantly reduces OPC. C. albicans is the most frequently isolated species in both OPC and colonization, suggesting endogenous infection.
口咽念珠菌病（OPC）是全球范围内人类免疫缺陷病毒（HIV）阳性患者中报告的最常见的机会性真菌感染。本前瞻性研究旨在调查HIV阳性患者中的OPC和念珠菌定植（CC）及其与CD4 +细胞计数和抗逆转录病毒疗法（ART）的相关性。
总共190名HIV阳性患者被纳入研究，分为以下三组：A组，90名未接受ART治疗的患者；B组，100名正在接受ART治疗的患者；C组，75名HIV阴性对照患者。所有HIV患者均接受临床检查并进行CD4 +细胞计数。从所有个体的口腔中采集拭子，并接种在沙氏葡萄糖琼脂上。通过常规方法进行念珠菌种类的鉴定。
HIV阳性受试者和对照组中分别有84/190（44.2%）和20/75（26.6%）分离出念珠菌（p<0.01）。190名HIV阳性患者中有21/190（11%）被诊断为OPC。白色念珠菌是最常分离出的菌种。CD4 +细胞计数≤200个细胞/mm3的患者念珠菌定植（37/63；58.7%）和感染（18/21；85.7%）的发生率明显更高（p<0.001）。在CC和OPC患者中，CD4 +细胞计数在201至500之间（21/63；33.4%对3/21；14.3%）和>500个细胞/mm3（5/63；7.9%对0/21；0%）时分别可见念珠菌。
CD4 +细胞计数≤200个细胞/mm3的HIV阳性患者中OPC和念珠菌定植更为常见。ART可显著降低OPC。白色念珠菌是OPC和定植中最常分离出的菌种，提示为内源性感染。
