Oropharyngeal candidiasis in patients with human immunodeficiency virus: correlation of clinical outcome with in vitro resistance, serum azole levels, and immunosuppression.

Azole-resistant thrush has emerged as a problem in people who are infected with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), especially those who have low CD4 cell counts who have had a previous relapse of oral candidiasis, and in those who require long-term suppressive antifungal therapy. Because of the development of a standardized methodology for antifungal susceptibility testing and interpretive criteria for resistance testing, studies of the clinical predictive value of in vitro results are possible. In this study, 61% of organisms isolated from patients who were receiving azole therapy and who had clinically resistant thrush had minimal inhibitory concentration values that would classify the isolate as "resistant" or "susceptible dose dependent." In contrast, 86% of isolates from patients with thrush that was clinically responsive to an azole were classified in vitro as "susceptible" or "susceptible dose dependent." No resistant isolates were detected in samples obtained from asymptomatic control patients who were not exposed to azole drugs. Serum levels of azole and CD4 cell counts were also important parameters with regard to prediction of response. We conclude that in vivo and in vitro correlations compare favorably to studies of susceptibility testing in bacteria.

[Relationship between birch pollen allergy and oral and pharyngeal hypersensitivity to fruit].

We evaluated the relationship between birch pollen allergy and oral and pharyngeal hypersensitivities to certain fruits. 1. Of 171 birch pollen CAP positive (score > or = 2) patients, twenty two (13%) were revealed to be hypersensitive to apples, eleven (6%) to be hypersensitive to peaches, both rates being higher than those found in patients with other CAP positive reactions (orchard grass pollen CAP, mugwort pollen CAP or Dermatophagoides pteronyssius CAP positive). 2. Among the birch pollen CAP positive patients, the higher the CAP score for birch pollen, the higher the prevalences of hypersensitivity to apples and peaches were found to be. 3. Of 171 birch pollen CAP positive patients, six (3.5%) were revealed to be hypersensitive to kiwi fruit. Of 253 patients with other CAP positive reactions, three (1%) were revealed to be hypersensitive to kiwi fruit.