RESUMO
BACKGROUND: Oral candidiasis is a common opportunistic infection in patients with human immunodeficiency virus (HIV). In addition, most of these patients suffer from vitamin D deficiency. This study aimed to investigate the association between vitamin D levels and oral candidiasis in patients with HIV infection. METHODS: This caseâcontrol study was conducted on HIV-infected patients. Cases were patients with oral candidiasis diagnosed based on physical examinations. Controls were age- and sex-matched individuals without oral candidiasis. The levels of 25-OH vitamin D and other laboratory markers (CD4 count and viral load) were compared between the case and control groups. RESULTS: A total of 104 cases and 102 controls were included in the study. The cases had significantly lower 25-OH vitamin D3 levels (MD = 33.86 ng/mL, 95% CI= (31.85, 35.87), P < 0.001) and CD4 counts (MD = 267.48 cells/mm3, 95% CI= (189.55, 345.41), P < 0.001) than the controls. In addition, viral load was significantly higher in cases than in controls (MD = 7.03 × 105 copies/mL, 95% CI= (4.46 × 105, 9.61 × 105), P < 0.001). The multivariate logistic regression analysis revealed that educational status (OR = 0.032, 95% CI= (0.002, 0.100), P < 0.001), current HAART (OR = 0.005, 95% CI= (0.001, 0.014), P < 0.001), history of oral candidiasis (OR = 20.114, 95% CI= (18.135, 21.957), P < 0.001), CD4 count (OR = 0.004, 95% CI= (0.001, 0.006), P < 0.001), viral load (OR = 12.181, 95% CI= (1.108, 133.392), P < 0.001), and vitamin D level (OR = 0.011, 95% CI= (0.008, 0.015), P < 0.001) were significantly associated with the risk of developing oral candidiasis. CONCLUSIONS: Based on the findings, most patients with HIV infection suffer from vitamin D deficiency, especially those with oral candidiasis. Hypovitaminosis D was significantly associated with an increased risk of oral candidiasis. Thus, vitamin D supplementation may assist HIV-positive patients in improving their oral health and preventing oral candidiasis.
Assuntos
Candidíase Bucal , Infecções por HIV , Deficiência de Vitamina D , Humanos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Candidíase Bucal/epidemiologia , Candidíase Bucal/complicações , Estudos de Casos e Controles , Deficiência de Vitamina D/complicações , Vitamina D , HIV , Vitaminas , Contagem de Linfócito CD4RESUMO
BACKGROUND: We investigated the association between oral candidiasis prevalence and cigarette, tobacco, alcohol, and opium consumption in Rafsanjan, a region in the southeast of Iran. METHODS: This cross-sectional study was conducted using the data of Oral Health Branch of Rafsanjan Cohort Study (OHBRCS) as a part of the Rafsanjan Cohort Study (RCS). RCS included in Prospective Epidemiological Research Studies in IrAN (PERSIAN) was begun in 2015 in the Rafsanjan. A full-mouth examination was done by trained dental specialists. Oral candidiasis was diagnosed based on clinical examination. Information about cigarette, tobacco, and opium smoking and alcohol consumption were collected based on data from self-reported questionaries. Univariate and multivariate dichotomous logistics regression were used to assess the association between oral candidiasis and cigarette, tobacco, alcohol, and opium consumption. RESULTS: Among 8682 participants with mean age of 49.94 years, the prevalence of oral candidiasis was 7.94%. There was a direct association between cigarette smoking in current and former cigarette smokers with an increased odds of oral candidiasis (OR: 3.26, 95% CI: 2.46-4.33 and OR: 1.63, 95% CI: 1.18-2.25 respectively) in fully adjusted models. There was a dose-response relationship between the odds of oral candidiasis and dose (OR: 3.31, 95% CI: 2.38-4.60), duration (OR: 2.48, 95% CI: 2.04-3.95) and number (OR: 3.01, 95% CI: 2.02-4.50) of cigarette smoking in the 4th quartile compared to reference group. CONCLUSIONS: A dose-response relationship was shown between cigarette smoking and increased odds of oral candidiasis.
Assuntos
Candidíase Bucal , Produtos do Tabaco , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Ópio/efeitos adversos , Estudos de Coortes , Estudos Prospectivos , Estudos Transversais , Irã (Geográfico)/epidemiologia , Candidíase Bucal/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , EtanolRESUMO
Natural teeth are an integral part of the masticatory system. Absence of dentition subjects the individual to compromised oral function, facial appearance and phonetics. Rehabilitation with dental prosthesis is imperative to restore form and masticatory activity. Currently, fabrication of removable and fixed prosthesis has become most predictable. Nonetheless, there is an increased prevalence of oral stomatitis observed over the years in edentulous individuals wearing removable dentures. Amongst the many pathogens that cause denture infections, Candida albicans is assumed to be the most virulent opportunistic agent. Different methods, such as mechanical, chemical, chemicmechanical, and pharmacological are tried to fight such infections. Regardless of various management strategies developed to treat denture stomatitis, the research continues to evolve the most optimal one. Improper oral and or denture hygiene maintenance, surface irregularities on denture, persistence of xerostomia and associated systemic illness pose risk for exaggeration of the disease. In extreme conditions, the development of aspiration pneumonia in geriatric patients is considered a threat to both dental and medical specialists. Therapeutic administration of synthetic anti-microbial drugs, along with meticulous oral hygiene maintenance are recommended protocols till date. However, limitations such as antibiotic resistance, side effects, counter drug reactions, cost of the medicaments predispose to origin of natural herbal products to treat denture stomatitis. Vast array of plant products are studied in previous literature, yet no definitive edge of one over the other is proven. This article intends to provide a mini-review on the different organic plant materials, also called as phytomedicines used for the treatment of candida associated denture stomatitis (CADS).
Assuntos
Candidíase Bucal , Estomatite sob Prótese , Humanos , Idoso , Estomatite sob Prótese/tratamento farmacológico , Estomatite sob Prótese/complicações , Estomatite sob Prótese/epidemiologia , Candida , Candida albicans , Dentaduras/efeitos adversos , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/complicações , Candidíase Bucal/epidemiologiaRESUMO
Oropharyngeal candidiasis is the commonest mucocutaneous infection in HIV-positive individuals. Herein, samples were taken from oral cavities of 150 HIV-infected patients and cultured on Sabouraud-dextrose agar; 89 (59·3%) of 150 patients had positive culture for Candida and presented clinical sign of classical oral candidiasis. Totally, 102 morphologically distinct colonies were isolated from Candida positive cultures and subsequently identified by polymerase chain reaction and sequencing assay, presenting the following frequency: 54 C. albicans (52·9%), 16 C. dubliniensis (15·7%), 12 C. tropicalis (11·8%), 9 C. glabrata (8·8%), 7 C. kefyr (6·9%) and 4 C. africana (3·9%). Additionally, multiple Candida species were co-isolated from 13·5% (12/89) patients. Regarding the antifungal susceptibility test, which was performed by CLSI protocol (M27-A3/M27-S3), all Candida isolates were susceptible to amphotericin B and caspofungin, while some of them were resistant to fluconazole (17·6%; 16 C. albicans, 1 C. dubliniensis and 1 C. glabrata), itraconazole (16·7%; 15 C. albicans, 1 C. dubliniensis and 1 C. tropicalis) and voriconazole (5·9%; 5 C. albicans and 1 C. tropicalis). Collectively, our findings reinforce the urgent necessity to find new therapeutic agents to treat oral candidiasis in HIV-positive patients, especially due to the high incidence of azole-resistant Candida strains and the increased frequency of non-C. albicans species. SIGNIFICANCE AND IMPACT OF THE STUDY: The Candida species recovered from oral cavity of 150 Iranian HIV/AIDS patients and their antifungal susceptibility profiles were reported. Candida albicans was the commonest Candida species, followed by C. dubliniensis, C. tropicalis, C. glabrata, C. kefyr and C. africana. All Candida isolates were susceptible to amphotericin B and caspofungin, while resistance to azoles was detected. The growing drug-resistance profile reported in clinical isolates of C. albicans and non-C. albicans strains is a serious problem in hospitals worldwide. Consequently, the suitable antifungal choice to treat the HIV/AIDS population with oral candidiasis needs to be rethought and new therapeutic options must urgently arise.
Assuntos
Antifúngicos/uso terapêutico , Candida albicans , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/epidemiologia , Farmacorresistência Fúngica Múltipla/genética , Infecções por HIV/complicações , Boca/microbiologia , Adolescente , Adulto , Idoso , Anfotericina B/uso terapêutico , Candida albicans/classificação , Candida albicans/efeitos dos fármacos , Candida albicans/isolamento & purificação , Candidíase Bucal/microbiologia , Caspofungina , Equinocandinas/uso terapêutico , Feminino , Fluconazol/uso terapêutico , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Itraconazol/uso terapêutico , Lipopeptídeos/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
AIM: The potential role of superantigens derived from microbial agents could be considered in the pathogenesis of psoriasis, but the association between Candida albicans and psoriasis severity is still controversial. The present study was designed to compare the prevalence of oral candidiasis in a group of psoriatic patients and healthy patients, and its correlation with psoriasis severity. METHODS: Seventy psoriatic patients with no history of systemic treatment and 70 closely-matched control patients underwent oral examination. Scraping of oral mucosa to detect Candida species was done using a sterile cytobrush. RESULTS: Candida was detected in the oral cavity of 20% of patients with psoriasis and 2.8% of control cases (P = .002), but none had clinical features of oral candidiasis. Candida albicans was the only species isolated from the oral cavity of both groups. No correlation was found between sex, age, phototherapy, and presence of oral candidiasis. There was a positive correlation between psoriasis severity and colony count (P < .001). CONCLUSIONS: The prevalence of oral candidiasis is higher in psoriatic patients and is associated with disease severity. It is not exactly clear whether oral candidiasis can aggravate psoriasis or if psoriasis can predispose patients to oral candidiasis.
Assuntos
Candidíase Bucal/complicações , Psoríase/complicações , Adulto , Candida albicans/isolamento & purificação , Candidíase Bucal/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Prevalência , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: The purpose of this multicentre study was to determine the incidence of oral candidiasis in patients treated with topical steroids for oral lichen planus (OLP) and to determine whether the application of a concurrent antifungal therapy prevented the development of an oral candidiasis in these patients. MATERIALS AND METHODS: Records of 315 patients with OLP seen at four Oral Medicine practices treated for at least 2 weeks with steroids with and without the use of an antifungal regimen were retrospectively reviewed. RESULTS: The overall incidence of oral fungal infection in those treated with steroid therapy for OLP was 13.6%. There was no statistically significant difference in the rate of oral candidiasis development in those treated with an antifungal regimen vs those not treated prophylactically (14.3% vs 12.6%) (P = 0.68). CONCLUSIONS: Despite the use of various regimens, none of the preventive antifungal strategies used in this study resulted in a significant difference in the rate of development of an oral candidiasis in patients with OLP treated with steroids.
Assuntos
Antifúngicos/uso terapêutico , Candidíase Bucal/prevenção & controle , Glucocorticoides/administração & dosagem , Líquen Plano Bucal/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betametasona/administração & dosagem , Candidíase Bucal/diagnóstico , Candidíase Bucal/epidemiologia , Clotrimazol/administração & dosagem , Dexametasona/administração & dosagem , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Fluocinonida/administração & dosagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: Early infant HIV-1 diagnosis and treatment substantially improve survival. Where virologic HIV-1 testing is unavailable, integrated management of childhood illness (IMCI) clinical algorithms may be used for infant HIV-1 screening. We evaluated the performance of the 2008 WHO IMCI HIV algorithm in a cohort of HIV-exposed Kenyan infants. METHODS: From 1999 to 2003, 444 infants had monthly clinical assessments and quarterly virologic HIV-1 testing. Using archived clinical data, IMCI sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using virologic testing as a gold standard. Linear regression and survival analyses were used to determine the effect of age on IMCI performance and timing of diagnosis. RESULTS: Overall IMCI sensitivity, specificity, PPV, and NPV value were 58, 87, 52, and 90%, respectively. Sensitivity (1.4%) and PPV (14%) were lowest at 1 month of age, when 81% of HIV infections already had occurred. Sensitivity increased with age (P < 0.0001), but remained low throughout infancy (range 1.4-35%). Specificity (range 97-100%) was high at each time point and was not associated with age. Fifty-eight percent of HIV-1-infected infants (50 of 86) were eventually diagnosed by IMCI, and use of IMCI was estimated to delay diagnosis in HIV-infected infants by a median of 5.9 months (P < 0.0001). CONCLUSION: IMCI had low sensitivity during the first month of life, when the majority of HIV-1 infections had already occurred and initiation of treatment is most critical. Although sensitivity increased with age, the substantial delay in HIV-1 diagnosis using IMCI limits its utility in early infant HIV-1 diagnosis.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Candidíase Bucal/diagnóstico , Infecções por HIV/diagnóstico , HIV-1 , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Doenças Linfáticas/diagnóstico , Pneumonia/diagnóstico , Algoritmos , Aleitamento Materno/estatística & dados numéricos , Candidíase Bucal/epidemiologia , Serviços de Saúde da Criança , Prestação Integrada de Cuidados de Saúde , Feminino , Guias como Assunto , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Doenças Linfáticas/epidemiologia , Masculino , Programas de Rastreamento , Pneumonia/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , Organização Mundial da SaúdeRESUMO
UNLABELLED: Yeasts occur as part of the normal human microbiota. Nevertheless, some species are opportunistic, affecting immunocompromised patients such as those undergoing oncologic treatment. OBJECTIVE: To detect the presence of yeasts in patients suffering from head and neck cancer who are receiving radiation therapy and display lesions in the oral cavity, compatible with candidiasis; and to evaluate the antifungal susceptibility of the isolates recovered. METHODS: Sixty samples from patients were obtained by swabbing the oral mucosa. Identification of isolates were performed by classical taxonomic, morphological and biochemical methods as well as by using commercial identification kits. Susceptibility to antifungal drugs was determined by the agar diffusion method with Neosensitabs(®) disks. RESULTS: Forty-six samples (77%) yielded positive findings, and species recovered were: Candida albicans (22 isolates), Candida tropicalis (13 isolates), Candida parapsilosis (six strains), Candida krusei (three strains), Candida dubliniensis and Saccharomyces cerevisiae (one each). All strains were susceptible to itraconazole, clotrimazole, voriconazole, nystatin and amphotericin B. On the other hand, 65% of strains were miconazole-susceptible while 35%, showed intermediate susceptibility. With regard to ketoconazole, only three strains (7%) corresponding to C. albicans (one isolate) and C. krusei (two isolates) displayed intermediate susceptibility. Only C. krusei strains were resistant to fluconazole while all the other species were susceptible. Eventually, only six isolates (13%) were susceptible to terbinafine while the remaining strains were resistant in vitro. CONCLUSION: Early detection of etiological agents causing lesions, as well as the evaluation of their susceptibility to commonly used drugs, are crucial in order to choose the appropriate treatment that will minimize complications while improving the quality of patients' lives.
Assuntos
Antifúngicos/uso terapêutico , Candidíase Bucal/microbiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Micoses/microbiologia , Infecções Oportunistas/microbiologia , Anfotericina B/farmacologia , Anfotericina B/uso terapêutico , Antifúngicos/farmacologia , Candidíase Bucal/epidemiologia , Candidíase Bucal/etiologia , Farmacorresistência Fúngica , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Testes de Sensibilidade Microbiana , Micoses/epidemiologia , Micoses/etiologia , Naftalenos/farmacologia , Naftalenos/uso terapêutico , Nistatina/farmacologia , Nistatina/uso terapêutico , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/etiologia , Saccharomyces cerevisiae/isolamento & purificação , Especificidade da Espécie , Terbinafina , Triazóis/farmacologiaRESUMO
Vitamin D has a potential role in preventing HIV-related complications, based on its extensive involvement in immune and metabolic function, including preventing osteoporosis and premature cardiovascular disease. However, this association has not been examined in large studies or in resource-limited settings. Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation (excluding vitamin D) in Tanzania. Information on HIV related complications was recorded during follow-up (median, 70 months). Proportional hazards models and generalized estimating equations were used to assess the relationship of vitamin D status with these outcomes. Women with low vitamin D status (serum 25-hydroxyvitamin D<32 ng/mL) had 43% higher risk of reaching a body mass index (BMI) less than 18 kg/m(2) during the first 2 years of follow-up, compared to women with adequate vitamin D levels (hazard ratio [HR]: 1.43; 95% confidence intervals: [1.03-1.99]). The relationship between continuous vitamin D levels and risk of BMI less than 18 kg/m(2) during follow-up was inverse and linear (p=0.03). Women with low vitamin D levels had significantly higher incidence of acute upper respiratory infections (HR: 1.27 [1.04-1.54]) and thrush (HR: 2.74 [1.29-5.83]) diagnosed during the first 2 years of follow-up. Low vitamin D status was a significant risk factor for wasting and HIV-related complications such as thrush during follow-up in this prospective cohort in Tanzania. If these protective associations are confirmed in randomized trials, vitamin D supplementation could represent a simple and inexpensive method to improve health and quality of life of HIV-infected patients, particularly in resource-limited settings.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções por HIV/complicações , Síndrome de Emaciação por Infecção pelo HIV/sangue , Complicações Infecciosas na Gravidez/epidemiologia , Vitamina D/sangue , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/etiologia , Adulto , Candidíase Bucal/sangue , Candidíase Bucal/epidemiologia , Candidíase Bucal/etiologia , Suplementos Nutricionais , Progressão da Doença , Método Duplo-Cego , Feminino , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/fisiopatologia , Síndrome de Emaciação por Infecção pelo HIV/epidemiologia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/etiologia , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Modelos de Riscos Proporcionais , Infecções Respiratórias/sangue , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Tanzânia/epidemiologia , Resultado do Tratamento , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Adulto JovemRESUMO
Candida oral flora from 52 Brazilian HIV-infected children was characterized while they received antiviral monotherapy therapy and subsequently, HAART with the use of protease inhibitor. There was a significant increase in non-C. albicans Candida isolates from 9.6-28.8% (P=0.005) after the children were placed on protease inhibitor therapy. Although Candida albicans still remained the most commonly isolated species, relative presence of C. tropicalis (n=9) followed by C. parapsilosis (n=8) markedly increased in association with protease inhibitor therapy. Furthermore, rare Candida species including C. dubliniensis, C. norvegensis, C. humicula and C. rugosa also appeared after the onset of protease inhibitor therapy. Subsequent investigation of the antifungal sensitivity of these diverse isolates, derived during protease inhibitor therapy, demonstrated some variation in antifungal sensitivity. With notable exceptions, the majority were sensitive to amphotericin B while most C. albicans and non-C. albicans Candida isolates were also susceptible to fluconazole, itraconazole and ketoconazole. Amongst exceptions was a single C. tropicalis isolates which was resistant to fluconazole (MIC>64 microl/ml) and one C. albicans-B isolate which showed cross-resistance to all azoles and amphotericin.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Candida , Candidíase Bucal/epidemiologia , Candidíase Bucal/microbiologia , Infecções por HIV , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adolescente , Anfotericina B/administração & dosagem , Anfotericina B/farmacologia , Anfotericina B/uso terapêutico , Antifúngicos/farmacologia , Terapia Antirretroviral de Alta Atividade , Azóis/administração & dosagem , Azóis/farmacologia , Azóis/uso terapêutico , Brasil/epidemiologia , Candida/classificação , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase Bucal/complicações , Criança , Pré-Escolar , Esquema de Medicação , Quimioterapia Combinada , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , Inibidores da Protease de HIV/administração & dosagem , Inibidores da Protease de HIV/uso terapêutico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Especificidade da EspécieRESUMO
A prospective study to identify clinical and mycological aspects of oral candidiasis including a therapeutic trial for 4 drugs-2 topical (chlotrimazole and nistatine) and 2 systemic (itraconale and ketoconazole) was performed on 97 HIV adult patients from March 2003 to June 2004. Average age was 34.97 years, being males and heterosexual behaviour predominant. The pseudomembranous clinical form of presentation prevailed in 93.8% of cases, with accompanying symptoms like pain, burning sensation and difficult swallowing in addition to extensive lesions. Candida albicans was the most frequently isolated species both in swabs taken at the beginning (92%) and at the end of the treatment schedules applied to patients who did not succeed in mycological cure (89.4%). Treatment schemes had positive results from the clinical viewpoint in 91.8% of cases with improvement or total remission of symptoms and signs, and in 51.6% of mycological curing. There were no statistically significant differences of clinical and mycological responses between topical and systemic treatments. The above-mentioned allowed recommending a more extensive use of local treatment in the studied population because of their benefits for the patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Antifúngicos/uso terapêutico , Candidíase Bucal/epidemiologia , Clotrimazol/uso terapêutico , Soropositividade para HIV/epidemiologia , Itraconazol/uso terapêutico , Cetoconazol/uso terapêutico , Nistatina/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Administração Oral , Administração Tópica , Adulto , Candida/classificação , Candida/isolamento & purificação , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/microbiologia , Clotrimazol/administração & dosagem , Feminino , Humanos , Itraconazol/administração & dosagem , Cetoconazol/administração & dosagem , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Nistatina/administração & dosagem , Estudos Prospectivos , Fatores de Risco , Comportamento Sexual , Método Simples-Cego , Especificidade da Espécie , Resultado do Tratamento , Adulto JovemRESUMO
Multilocus enzyme electrophoresis (MEE) and in vitro antifungal susceptibility testing were used to investigate the Candida albicans strain diversity in twenty nine AIDS patients from Abidjan (Ivory Coast). All patients were monitored for a first episode of oropharyngeal candidiasis and were randomly clustered into three groups of therapy: ketoconazole, amphotericin B or nystatin. Oral swabs were collected before every treatment, 14 and 30 days after the initiation of the therapy; a total of 67 isolates were investigated. No resistant or less susceptible isolate to any antifungal agent was found despite the emergence of clinical relapses, mainly for patients treated with nystatin or amphotericin B. The MEE analysis revealed 27 different electrophoretic types (ETs). Genetic distances between ETs were statistically analyzed and represented on a dendrogram. The 27 ETs clustered into three groups; in each group, ETs represented variants of the same strain. A segregation of the C. albicans isolates seemed to be as a function of the serotype.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase Bucal/epidemiologia , Cetoconazol/uso terapêutico , Nistatina/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Anfotericina B/farmacologia , Antifúngicos/farmacologia , Candida albicans/classificação , Candida albicans/efeitos dos fármacos , Candida albicans/enzimologia , Candida albicans/genética , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/microbiologia , Côte d'Ivoire/epidemiologia , Resistência Microbiana a Medicamentos , Proteínas Fúngicas/análise , Proteínas Fúngicas/genética , Variação Genética , Humanos , Cetoconazol/farmacologia , Pessoa de Meia-Idade , Nistatina/farmacologia , Filogenia , Resultado do TratamentoRESUMO
A cross-sectional study was conducted to assess the prevalence and microbiology of oral infection due to fluconazole-resistant Candida in patients with AIDS. Oral swab specimens for fungal cultures were obtained from 100 consecutive outpatients with CD4 lymphocyte counts of < 200/mm3. At least one fungal organism demonstrating in vitro resistance to fluconazole (minimum inhibitory concentration, > or = 8 micrograms/mL) was isolated from 26 (41%) of 64 patients for whom cultures were positive. When fluconazole-resistant C. albicans was isolated, in vitro resistance correlated with clinical thrush. None of 10 patients from whom only non-albicans species of Candida were isolated had active thrush. The patients from whom fluconazole-resistant Candida albicans was isolated had lower CD4 cell counts (median, 9/mm3), a greater number of treated episodes of thrush (median, 4.5), and a greater median duration of prior fluconazole treatment (231 days) than did patients from whom fluconazole-susceptible C. albicans was isolated (median CD4 cell count, 58/mm3 [P = .004]; median number of treated episodes of thrush, 2.0 [P = .001]; and median duration of prior fluconazole treatment, 10 days [P = .01]; respectively). In a multivariate analysis, the number of episodes and duration of fluconazole therapy were independent predictors of resistance.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/microbiologia , Antifúngicos/uso terapêutico , Candidíase Bucal/tratamento farmacológico , Candidíase Bucal/epidemiologia , Fluconazol/uso terapêutico , Antifúngicos/administração & dosagem , Contagem de Linfócito CD4 , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Estudos Transversais , Resistência Microbiana a Medicamentos , Feminino , Fluconazol/administração & dosagem , Humanos , Masculino , Testes de Sensibilidade Microbiana , Análise Multivariada , Prevalência , Recidiva , Fatores de TempoRESUMO
Se expone la situación bucal de un grupo de menores internados, su ambiente familiar, antecedentes personales, sociales y delictivos. Se anuncian consideraciones a partir de los hallazgos expuestos; se delinea el papel positivo de la internación, y sus limitaciones ante la escasez de cambios familiares y la rigidez del medio social. Se explica el papel de distintos aspectos de tiempo, en los hechos descriptos. Finalmente, se exponen conclusiones y formulan proposiciones a partir de observaciones efectuadas (AU)
Assuntos
Humanos , Masculino , Adolescente , Adolescente Institucionalizado/psicologia , Assistência Odontológica Integral/métodos , Doenças da Boca/epidemiologia , Doenças da Boca/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Perda de Dente/epidemiologia , Doenças da Gengiva/epidemiologia , Candidíase Bucal/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Relações Pais-Filho , Alcoolismo/complicações , Alcoolismo/epidemiologia , Grupos de RiscoRESUMO
Se expone la situación bucal de un grupo de menores internados, su ambiente familiar, antecedentes personales, sociales y delictivos. Se anuncian consideraciones a partir de los hallazgos expuestos; se delinea el papel positivo de la internación, y sus limitaciones ante la escasez de cambios familiares y la rigidez del medio social. Se explica el papel de distintos aspectos de tiempo, en los hechos descriptos. Finalmente, se exponen conclusiones y formulan proposiciones a partir de observaciones efectuadas
Assuntos
Humanos , Masculino , Adolescente , Adolescente Institucionalizado/psicologia , Assistência Odontológica Integral/métodos , Doenças da Boca/epidemiologia , Doenças da Boca/terapia , Alcoolismo/complicações , Alcoolismo/epidemiologia , Candidíase Bucal/epidemiologia , Doenças da Gengiva/epidemiologia , Relações Pais-Filho , Perda de Dente/epidemiologia , Grupos de Risco , Síndrome da Imunodeficiência Adquirida/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
The aim of this study was to investigate the epidemiology of oral mucosal lesions in a selected Cambodian population to obtain pilot data useful in planning an oral health data base for the country. Due to unstable conditions in Cambodia, the validity of population data related to present census information is highly questionable. Therefore, prior to this investigation a census registration was carried out using local health workers as registrars in nine villages of a commune. In the period July 4-31, 1991, a total of 1319 individuals (953 women, 366 men, 15-99 yr) were examined by one oral surgeon in the nine villages of Kok Trop Commune, Kandal Stung District, southwest of the capital Phnom Penh. Clinical diagnoses were based on WHO criteria. Information on smoking habits, betel nut chewing habits, and alcohol use was collected by 4 Khmer dental personnel. In total, 71 lesions were recorded in 64 (4.9%) individuals. Leukoplakia was found in 1.1%, lichen lesions in 1.8%, candidosis in 1.4%, submucous fibrosis in 0.2%, cancer in 0.1% and other diagnoses in 0.8%. The prevalence of leukoplakia was 2.2% and 0.6% among men and women respectively, a statistically significant difference (P < 0.05). There were significantly more smokers (P < 0.01) among subjects with leukoplakia (64.3%) than among those without this lesion (28.6%). All subjects with lichen lesions were women. The age-adjusted relative risk for developing lichen among betel nut chewers as compared to non-chewers was 3.3.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Doenças da Boca/epidemiologia , Neoplasias Bucais/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Areca , Camboja/epidemiologia , Candidíase Bucal/epidemiologia , Demografia , Feminino , Humanos , Leucoplasia Oral/epidemiologia , Líquen Plano Bucal/epidemiologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Projetos Piloto , Plantas Medicinais , Prevalência , Fumar/epidemiologiaRESUMO
A prospective randomized study was conducted to assess the effectiveness of clotrimazole troches and nystatin suspension to prevent oral candidiasis in immunosuppressed orthotopic liver transplant patients. Thirty-four patients received either clotrimazole troches, 10 mg, five times daily, or nystatin suspension, 500,000 units, four times daily. Prophylaxis was initiated after extubation after transplantation and continued throughout the hospitalization. One of 17 patients in each treatment group developed clinical and microscopic evidence of an oropharyngeal Candida infection. This gave an intragroup and an overall infection rate of 5.9%. It appears that either nystatin or clotrimazole may be used for candidiasis prophylaxis in orthotopic liver transplant patients.