Fluconazole susceptibility and strain variation of Candida albicans isolates from HIV-infected patients with oropharyngeal candidosis
Fluconazole susceptibility and strain variation of Candida albicans isolates from HIV-infected patients with oropharyngeal candidosis
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DOI：
10.1093/jac/41.5.541
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发表时间：
1998-05-01
影响因子：
5.2
通讯作者：
Scalise, G
中科院分区：
文献类型：
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作者：
Barchiesi, F;Arzeni, D;Scalise, G
我们在 16 个月的时间里对 45 名 HIV 阳性患者进行了一项前瞻性研究，以检测氟康唑耐药性的发展并分析口咽念珠菌病 (OPC) 的流行病学。每次发作均用氟康唑 100 mg/天口服治疗 10 天。测试了所有酵母分离株对氟康唑的体外敏感性。通过电泳核型分析同时从给定患者中分离出多种白色念珠菌菌株。总体而言，45 名患者中诊断出 106 次 OPC 发作：18/45 患者 (40%) 仅发作一次，11/45 (24%) 发作两次，其余 16/45 (36%) 发作 3 次或以上（范围 3-7）。在 OPC 发作中分别观察到治愈（体征和症状完全消退，治疗后培养呈阴性）和改善（体征和症状完全消退，但治疗后培养呈阳性）。分别为 30/106 (28%) 和 69/106 (65%)。在 4 名患者的 7 次发作 (7%) 中观察到失败（体征和症状没有改善或恶化）。在这 4 名患者中，有两名患者的氟康唑 MIC 显着且逐渐增加：一名患者从 0.25 mg/L 增加至 16 mg/L，另一名患者从小于或等于 0.125 mg/L 增加至 32 mg/L。对单个分离平板的多个菌落进行测试表明，获得不同氟康唑 MIC 的情况并不罕见，这表明，为了避免误导性结果，应使用多菌落接种物而不是由单个菌落制成的接种物进行体外药敏试验。通过电泳核型分析，从 7 名患有 4 次或以上 OPC 发作的患者身上分离出总共 213 株白色念珠菌。五名患者 (71%) 感染了仅一种 DNA 类型的酵母菌，而另外两名患者则显示出两种或三种不同 DNA 类型的存在。仅在七个受试者之一中发现同时存在多种类型。我们的数据证实了氟康唑 100 毫克/天治疗 HIV 患者 OPC 的疗效。用这种方案分离出耐氟康唑的白色念珠菌菌株的情况很少见。绝大多数艾滋病毒患者在每次感染期间都会感染一种独特的白色念珠菌菌株。然而，少数患者可能同时携带具有不同氟康唑敏感性模式的白色念珠菌菌株。
Over a 16 month period we conducted a prospective a prospective study in a cohort of 45 HIV-positive patients to detect the development of resistance to fluconazole and to analyze the epidemiology of oropharyngeal candidosis (OPC). Each episode was treated with fluconazole 100 mg/day po for 10 days. All yeast isolates were tested for their in-vitro susceptibility to fluconazole. Multiple strains of Candida albicans simultaneously isolated from a given patient were typed by electrophoretic karyotyping. Overall, 106 episodes of OPC were diagnosed among the 45 patients: 18/45 patients (40%) had only one episode, 11/45 (24%) had two episodes, and the remaining 16/45 (36%) had three or more episodes (range 3-7). Cure (complete resolution of signs and symptoms and negative post-treatment cultures) and improvement (complete resolution of signs and symptoms but positive post-treatment cultures.) were observed in 30/106 (28%) and 69/106 (65%) episodes of OPC, respectively. Failure (absence of improvement or exacerbation of signs and symptoms) was observed in seven episodes (7%) from four patients. In two of these four patients a significant and progressive increase in fluconazole MICs was observed: from 0.25 to 16 mg/L in one patient, and from less than or equal to 0.125 to 32 mg/L in the second one. Tests on multiple colonies from individual isolation plates showed that it was not unusual to obtain different fluconazole MICs, indicating that, in order to avoid misleading results, one should perform in-vitro susceptibility testing by using a multiple colony inoculum rather than an inoculum made from a single colony. A total of 213 strains of C. albicans isolated from seven patients who suffered fro four or more episodes of OPC through the course of the study were typed by electrophoretic karyotyping. Five individuals (71%) were infected with yeasts with only one DNA type, while the other two patients showed the presence of two or three different DNA types. The simultaneous presence of multiple types was found only in one of the seven subjects. Our data confirm the efficacy of fluconazole 100 mg/day for the treatment of OPC in HIV patients. Isolation of fluconazole-resistant strains of C. albicans with this regimen is rare. The vast majority of HIV patients are infected with a unique strain of C. albicans throughout each episode of infection. A minority of patients, however, can harbour strains of C. albicans with variable patterns of fluconazole susceptibility simultaneously.