Dronda F, Alonso-Sanz M, Laguna F, Chaves F, Martínez-Suárez J V, Rodríguez-Tudela J L, González-López A, Valencia E
Unidad de Enfermedades Infecciosas-Microbiología, Hospital General Penitenciario, Madrid, Spain.
Eur J Clin Microbiol Infect Dis. 1996 Jun;15(6):446-52. doi: 10.1007/BF01691310.
In order to determine the clinical significance of mixed oropharyngeal candidiasis (Candida albicans plus a non-albicans strain of Candida) in patients infected with HIV-1, a retrospective chart review was done in 12 HIV-1-infected patients with a clinical episode of oropharyngeal candidiasis, in whom a mixed culture of Candida albicans (found to be fluconazole-sensitive) plus a non-albicans species of Candida was obtained from their oral cavities. This group was compared with 26 HIV-positive patients (control group) with oropharyngeal candidiasis due to Candida albicans (found to be fluconazole-sensitive). Antifungal susceptibility testing was performed by a broth microdilution test with RPMI-2% glucose. A fungal strain was considered fluconazole-sensitive if its MIC was < 0.5 micrograms/ml. Both the study and control groups had similar clinical and demographic characteristics. All the patients were severely immunocompromised, with a mean CD4+ lymphocyte count of 63/mm3 (95% CI 41-84) and 80/mm3 (95% CI 25-135) in the study and control groups, respectively. In the study group, seven patients had Candida albicans and Candida krusei in their oral cavity, four had Candida albicans and Candida glabrata, and one had Candida albicans and Candida tropicalis. Antifungal therapy consisted of ketoconazole (5 patients in the study group, 14 in the control group) or fluconazole (7 patients in the study group, 12 in the control group); no statistically significant difference in clinical outcome was observed. Fungal strain persistence after therapy was frequently observed in both groups. It is concluded that non-albicans strains of Candida, less sensitive to azole drugs than their Candida albicans counterparts, are not clinically relevant in episodes of mixed oropharyngeal candidiasis in HIV-1-infected patients.
为了确定混合性口咽念珠菌病（白色念珠菌加非白色念珠菌菌株）在感染HIV-1患者中的临床意义，对12例有口咽念珠菌病临床发作的HIV-1感染患者进行了回顾性病历审查，这些患者口腔中获得了白色念珠菌（对氟康唑敏感）加非白色念珠菌的混合培养物。将该组与26例因白色念珠菌（对氟康唑敏感）导致口咽念珠菌病的HIV阳性患者（对照组）进行比较。通过含RPMI-2%葡萄糖的肉汤微量稀释试验进行抗真菌药敏试验。如果真菌菌株的最低抑菌浓度（MIC）<0.5微克/毫升，则认为其对氟康唑敏感。研究组和对照组具有相似的临床和人口统计学特征。所有患者均严重免疫受损，研究组和对照组的平均CD4+淋巴细胞计数分别为63/mm³（95%置信区间41-84）和80/mm³（95%置信区间25-135）。在研究组中，7例患者口腔中有白色念珠菌和克鲁斯念珠菌，4例有白色念珠菌和光滑念珠菌，1例有白色念珠菌和热带念珠菌。抗真菌治疗包括酮康唑（研究组5例，对照组14例）或氟康唑（研究组7例，对照组12例）；未观察到临床结局有统计学显著差异。两组在治疗后均经常观察到真菌菌株持续存在。得出的结论是，对唑类药物敏感性低于白色念珠菌的非白色念珠菌菌株，在HIV-1感染患者的混合性口咽念珠菌病发作中无临床相关性。
