Takasuka T, Baily G G, Birch M, Anderson M J, Law D, Denning D W
Department of Medicine, University of Manchester School of Medicine, UK.
J Infect. 1998 Jan;36(1):57-62. doi: 10.1016/s0163-4453(98)93162-0.
Azole-resistant oropharyngeal and oesophageal candidiasis is a recent phenomenon observed in patients with AIDS usually previously treated with fluconazole. Some variation has been observed in antifungal susceptibility testing among separate colonies of Candida albicans from the same patient. This raises the question of whether there are multiple clones present or simply phenotypic variation in expression of azole resistance. To address this question we took 18 isolates grown from multiple swabs taken before and after experimental azole therapy from a single HIV-positive individual with fluconazole-resistant oral candidiasis and compared morphotype, karyotype, PCR-based DNA typing and azole susceptibility. Ten of the isolates were from a single 2-day period. Amongst these 10 there were seven morphotypes, five karyotypes and four polymerase chain reaction (PCR) types. Three further morphotypes, one karyotype and two PCR types were found amongst the eight isolates obtained during the subsequent 4 months. Limited variation in susceptibility to two azoles--fluconazole and D0870--was also seen. This work emphasizes both the large genotype and phenotypic variability of C. albicans isolates in the mouth of AIDS patients with fluconazole resistance, and the difficulties in interpretation of present typing methods.
耐唑类的口咽和食管念珠菌病是一种最近在通常先前接受过氟康唑治疗的艾滋病患者中观察到的现象。在来自同一患者的白色念珠菌不同菌落之间的抗真菌药敏试验中观察到了一些差异。这就提出了一个问题，即是否存在多个克隆，还是仅仅是唑类耐药性表达的表型变异。为了解决这个问题，我们从一名患有耐氟康唑口腔念珠菌病的HIV阳性个体身上，获取了在实验性唑类治疗前后多次擦拭样本培养出的18株分离株，并比较了其形态型、核型、基于聚合酶链反应（PCR）的DNA分型和唑类药敏性。其中10株分离株来自单一的2天时间段。在这10株中，有7种形态型、5种核型和4种聚合酶链反应（PCR）类型。在随后4个月内获得的8株分离株中又发现了另外3种形态型、1种核型和2种PCR类型。对氟康唑和D0870这两种唑类的药敏性也存在有限的差异。这项工作强调了在耐氟康唑的艾滋病患者口腔中白色念珠菌分离株的基因型和表型变异性都很大，以及目前分型方法在解释上的困难。
