Clinical and Mycological Responses to Fluconazole and Fluconazole MIC in Oropharyngeal Candidiasis in HIV Infected Patients
VA LAI BUSSARA TID, M.D.*, BENJALUCK PHONRAT, M.Sc.*, SOMSIT TANSUPASA W ASDIKUL, M.D.**, PAUL HOWE, M.Sc.***, ANDREW SIMPSON, M.D.***, NICHOLAS J WHITE, M.D.*** PUNNEE PITISUTTITHUM, M.D.*,
Affiliation : * Clinical Infectious Disease Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, ** Department oflntemal Medicine, Bamrasnaradura Hospital, Department of Communicable Diseases Control, MOPH, Nonthaburi 11000, *** Wellcome Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
Objectives : This study aimed to test the MICs (minimal inhibitory concentrations) to fluconazole of Candida species isolated from mouthwash specimens of 54 HIV positive patients with oral candidiasis. Clinical and mycological responses to fluconazole were also assessed in 16 patients.
Materials and Methods : This was a prospective study. Mouthwash specimens were cultured on sabouraud dextrose agar twice. Candida species identification was performed and MICs for fluco nazole were obtained using NCCLS guidelines. Clinical and mycological responses were assessed on day 14 and 42 in 16 patients who received a 14-day course of fluconazole.
Results : 48/54 patients (88.89%) were found to carry pure C. albicans. The other 6 patients ( 11.11%) had mixed Candida species on cultures. Among these 6 patients, 5 patients had mixed C. albicans and C. glabrata, and 1 patient had C. albicans and C. krusei. Fluconazole MICs of C. albicans, C. glabrata, and C. krusei ranged from 0.125-32 (median=0.250), 4-64 (median=2), and 8 giL respectively. This study showed that the MICs to fluconazole of oropharyngeal Candida was a good predictor of the therapeutic responses.
Keywords : Oropharyngeal Candidiasis, HIV Infection
