1
|
Owotade FJ, Gulube Z, Patel M. Oral Candida albicans strain diversity and maintenance in HIV positive women in South Africa. Arch Oral Biol 2024; 164:106007. [PMID: 38795522 DOI: 10.1016/j.archoralbio.2024.106007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE This study investigated C. albicans strain diversity and maintenance in the oral cavity of HIV positive women over a 6 month period. STUDY DESIGN C. albicans strains were isolated from 17 HIV positive women at Charlotte Maxeke Academic Hospital, Johannesburg at 3 intervals over a 6 month period. Strains were genotyped using ABC and Multilocus Sequence Typing (MLST) techniques. In the MLST technique, for each strain, a Diploid Sequence Type (DST) number was obtained. Using cluster analysis, an Unweighted Pair Group Method with Arithmetic Mean (UPGMA) dendrogram and a matrix of strain similarities were generated. Strains were also compared to the previous South African isolates documented in the MLST database. RESULTS Ninety four percent of women carried the same ABC genotype for 6 months. MLST technique, showed that ten women (58.8%) carried the same DST at 2 visits, while seven (41.2%) carried different DST at all visits. Further analysis showed that 64.7% of women were recolonised with different strains and 35.3% carried the same strains of C. albicans with heterozygosity. A total of 40 diploid sequence types were identified of which 27 DSTs were unique to this study group that were added to the MLST database. Most of the strains were closely related to previously isolated strains from South Africa. CONCLUSION Recolonization of the oral cavity with different strains and microevolution of the original strains of C. albicans can occur, which can be a potential problem for HIV patients, in whom highly virulent and drug resistant strains can emerge.
Collapse
Affiliation(s)
- F J Owotade
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, South Africa; Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Z Gulube
- Department of Oral Biological Sciences School of Oral Health Sciences, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - M Patel
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, South Africa.
| |
Collapse
|
2
|
Musinguzi B, Obuku EA, Kinengyere AA, Ndagire R, Baguma A, Mwesigwa A, Itabangi H, Mboowa G, Sande OJ, Achan B. Prevalence of Oropharyngeal Candidiasis and distribution of Candida species among People Living with Human Immunodeficiency Virus in Africa: a systematic review and meta-analysis. RESEARCH SQUARE 2024:rs.3.rs-4534730. [PMID: 38883750 PMCID: PMC11177986 DOI: 10.21203/rs.3.rs-4534730/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background The incidence of oropharyngeal candidiasis among people living with human immunodeficiency virus in Africa is on the rise. Oropharyngeal candidiasis is mainly caused by C.albicans; however, a shift in the etiology towards non-Candida albicans species is increasing. In addition, there are variations in the epidemiological distribution of Candida species causing oropharyngeal candidiasis among people living with human immunodeficiency virus in Africa. Objective This review aimed to determine the prevalence of oropharyngeal candidiasis and the distribution of Candida species among people living with human immunodeficiency virus in Africa. Materials and Methods This systematic review protocol was registered in the base PROSPERO database prior to its conduct (CRD42021254473). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines (PRISMA-P) were followed for this study. The PubMed, Scopus and EMBASE databases were searched to identify published studies published between 1st January 2000 and 8th October 2022. The eligible studies were included in the meta-analysis and analyzed using a random effects model. The risk of bias of the included studies was assessed using the Joanna Briggs Institute quality assessment tool for prevalence studies. Results The database search yielded 370 titles from PubMed (n=192), EMBASE (n=162) and SCOPUS (n=16). Fourteen studies with a total of 3,863 participants were included in the meta-analysis. The pooled prevalence of oropharyngeal candidiasis was 49.0% (95% CI: 37% - 62%). A total of 2,688 Candida isolates were reported; approximately 76.6% (n=2,060) were C. albicans, and 21.7% (n=582) were non-C. albicans. Among the non-Candida albicans species, C. glabrata was the most common isolate (29.6%), followed by C. tropicalis (27.7%), C. krusei (17.0%), C. parapsilosis (8.1%) and C. dubliniensis (5.2%). Out of 14 studies, 7 (50.0%) had a low risk of bias, 5 (35.7%) had a moderate risk of bias, and 2 (14.3%) had a high risk of bias. Conclusion Almost half of people living with HIV in Africa have oropharyngeal candidiasis, and C. albicans remains the most frequent cause of oropharyngeal candidiasis.
Collapse
Affiliation(s)
- Benson Musinguzi
- Department of Medical Laboratory Science, Faculty of Health Sciences, Muni University, Arua, Uganda
| | - Ekwaro A Obuku
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alison Annet Kinengyere
- Sir Albert Cook Medical Library, College of Health Sciences, Makerere University, Kampala Uganda
| | - Regina Ndagire
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Baguma
- Department of Microbiology, School of Medicine, Kabale University, Kabale, Uganda
| | - Alex Mwesigwa
- Department of Microbiology, School of Medicine, Kabale University, Kabale, Uganda
| | - Herbert Itabangi
- Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Gerald Mboowa
- African Centre of Excellence in Bioinformatics and Data Intensive, Sciences, the Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Obondo James Sande
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Beatrice Achan
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
3
|
Benson M, Turyamuhika L, Mwesigwa A, Nalumaga PP, Kabajulizi I, Njovu IK, Mwebesa E, Luggya T, Ocheng F, Kateete DP, Itabangi H, Mboowa G, Sande OJ, Achan B. Distribution and antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with HIV in the era of universal test and treat policy in Uganda. Ther Adv Infect Dis 2024; 11:20499361241255261. [PMID: 38812710 PMCID: PMC11135083 DOI: 10.1177/20499361241255261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Background Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts. Methods A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate Candida species which were identified using the matrix assisted laser desorption ionization time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of Candida isolates to six antifungal drugs was determined using VITEK® (Marcy-l'Étoile, France) compact system. Data on viral load were retrieved from records, and CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto. Results The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which Candida albicans comprised of 20 (57.1%) while C. tropicalis and C. glabrata comprised 4 (11.4%) each. C. parapsilosis, C. dubliniensis and C. krusei accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytocine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific specie isolates like C. albicans showed 20% (4/20), C. glabrata 50% (2/4) and C. krusei 50% (1/2) resistance to fluconazole. Additionally, C. krusei showed 50% resistance to flucytosine. Conclusion The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. C. albicans was the most frequently isolated oropharyngeal Candida species. C. glabrata and C. krusei exhibited the highest AFR among the non-albicans Candida species. The highest resistance was demonstrated to fluconazole.
Collapse
Affiliation(s)
- Musinguzi Benson
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Muni University, Arua, Uganda
| | - Laban Turyamuhika
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alex Mwesigwa
- Department of Microbiology and Immunology, School of Medicine, Kabale University Kabale, Uganda
| | - Pauline Petra Nalumaga
- Mycology Unit, Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Immaculate Kabajulizi
- Mycology Unit, Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Israel Kiiza Njovu
- Mycology Unit, Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edson Mwebesa
- Department of Mathematics, Faculty of Science, Muni University, Arua, Uganda
| | - Tonny Luggya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis Ocheng
- Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Herbert Itabangi
- Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Gerald Mboowa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- African Centre of Excellence in Bioinformatics and Data Intensive Sciences, The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Obondo James Sande
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Beatrice Achan
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| |
Collapse
|
4
|
Oral Cavity and Candida albicans: Colonisation to the Development of Infection. Pathogens 2022; 11:pathogens11030335. [PMID: 35335659 PMCID: PMC8953496 DOI: 10.3390/pathogens11030335] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
Candida colonisation of the oral cavity increases in immunocompromised individuals which leads to the development of oral candidiasis. In addition, host factors such as xerostomia, smoking, oral prostheses, dental caries, diabetes and cancer treatment accelerate the disease process. Candida albicans is the primary causative agent of this infection, owing to its ability to form biofilm and hyphae and to produce hydrolytic enzymes and candialysin. Although mucosal immunity is activated, from the time hyphae-associated toxin is formed by the colonising C. albicans cells, an increased number and virulence of this pathogenic organism collectively leads to infection. Prevention of the development of infection can be achieved by addressing the host physiological factors and habits. For maintenance of oral health, conventional oral hygiene products containing antimicrobial compounds, essential oils and phytochemicals can be considered, these products can maintain the low number of Candida in the oral cavity and reduce their virulence. Vulnerable patients should be educated in order to increase compliance.
Collapse
|
5
|
Moosazadeh M, Shafaroudi AM, Gorji NE, Barzegari S, Nasiri P. Prevalence of oral lesions in patients with AIDS: a systematic review and meta-analysis. Evid Based Dent 2021:10.1038/s41432-021-0209-8. [PMID: 34795396 DOI: 10.1038/s41432-021-0209-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022]
Abstract
Background Oral lesions are considered to be early clinical signs which may predict the progression of patients with acquired immune deficiency syndrome (AIDS). Due to the lack of a comprehensive study that includes oral lesions in people with AIDS, the global prevalence of oral lesions in people with AIDS was estimated by combining preliminary studies' results using meta-analysis.Material and methods Databases including PubMed, Science Direct and Scopus were searched using keywords as 'HIV', 'AIDS', 'oral candidiasis', 'Kaposi Sarcoma', 'LinearGingival Erythema' and OR operators, AND and NOT. After the elimination of duplicate documents, articles that met the inclusion criteria were selected. Quality assessment was performed based on the Newcastle-Ottawa Scale. After combining the results of preliminary studies, an overall estimate of each lesion was reported. Ninety-five studies met the criteria for inclusion in this meta-analysis.Results The global prevalence of 21 oral lesions in HIV-infected patients was estimated. The overall prevalence of oral candidiasis, pseudomembranous candidiasis, oral hairy leukoplakia, Kaposi sarcoma and erythematous candidiasis was as follows: 35% (95% CI: 28-42), 19% (95% CI: 15-22), 12% (95% CI: 11-14), 5% (95% CI: 4-6) and 18% (95% CI: 14-22).Conclusion The present meta-analysis showed that oral lesions have a high prevalence in patients with AIDS. Dentists should consider that the clinical appearance of the oral cavity reflects the overall systemic health of the patient. As such, oral lesions may be linked to underlying immunosuppression caused by AIDS.
Collapse
Affiliation(s)
- Mahmood Moosazadeh
- PhD in Epidemiology, Associate Professor, Gastrointestinal Cancer Research Centre, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Malekzadeh Shafaroudi
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nadia Elyassi Gorji
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Barzegari
- PhD in Health Information Management, Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Pegah Nasiri
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
| |
Collapse
|
6
|
Aboualigalehdari E, Tahmasebi Birgani M, Fatahinia M, Hosseinzadeh M. Oral colonization by Candida species and associated factors in HIV-infected patients in Ahvaz, southwest Iran. Epidemiol Health 2020; 42:e2020033. [PMID: 32512666 PMCID: PMC7644944 DOI: 10.4178/epih.e2020033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Oropharyngeal candidiasis is one of the most common opportunistic fungal infections among human immunodeficiency virus (HIV)-infected individuals. The most common cause is Candida albicans, followed by non-albicans Candida. This study aimed to identify colonized Candida species in HIV-infected patients from Ahvaz, Iran. Additionally, the relationships between immunity-related factors, lifestyle, and colonization of Candida spp. were studied. METHODS Oral swabs were taken from 201 HIV-positive patients referred for consultations at the Behavioral Modification Center. Oral Candida colonization was detected using culture-based and molecular assays. Data were assessed by descriptive statistics and analyzed to investigate the correlation between Candida colonization and various factors, including the CD4+ cell count and viral load. RESULTS It was found that 43.8% of patients were positive for Candida. The most common species was C. albicans (48.0%), followed by non-albicans Candida isolates, including C. dubliniensis, C. glabrata, C. tropicalis, C. parapsilosis, C. guilliermondii, C. kefyr, and C. krusei. Colonization of Candida spp. in patients was associated with a CD4 count ≤200 cells/mm3 (odds ratio [OR], 4.62; p<0.05), history of shared injections (OR, 6.96; p<0.001), and sex (OR, 3.59; p<0.05). CONCLUSIONS The results of this study showed that C. albicans was the dominant pathogen. The risk factors for colonization of Candida spp. were a CD4 count ≤ 200/mm3 , a history of shared injections, and sex. Other factors with potential relationships include viral load, age, and opportunistic infections, but further investigations are needed.
Collapse
Affiliation(s)
- Elham Aboualigalehdari
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Tahmasebi Birgani
- Department of Medical Genetics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahnaz Fatahinia
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehran Hosseinzadeh
- Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
7
|
Lam-Ubol A, Rungsiyanont S, Vacharotayangul P, Sappayatosok K, Chankanka O. Oral manifestations, salivary flow rates and Candida species in Thai HIV-infected patients. J Clin Exp Dent 2019; 11:e138-e145. [PMID: 30805118 PMCID: PMC6383906 DOI: 10.4317/jced.55384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Effects of various Highly Active Antiretroviral Therapy (HAART) regimens on oral heath are unclear. Objectives: We aimed to evaluate effects of HAART on oral manifestations, salivary flow rates (SFR) and Candida species in HIV-infected patients who took mostly non-protease inhibitor-based HAART regimens. Material and Methods A cross-sectional study was performed on HIV-infected patients taking and never taken HAART who attended Thai Red Cross AIDS Research Centre (n = 48). Non-HIV subjects were recruited as control (n = 20). Oral conditions and salivary flow rates were evaluated using oral examination and measurement of unstimulated and stimulated saliva. In addition, Candida colonization counts (colony forming units; CFUs) and Candida species from the collected saliva were evaluated using CHROMagar. Results The most common oral manifestation in HIV-infected subjects taking HAART was hyperpigmentation. Unstimulated and stimulated SFR among the three groups were not statistically significant. Candida colonization was detected in 64%, 65% and 35% of HIV-infected subjects taking HAART, HAART-naïve, and non-HIV subjects, respectively. While 20% and 35% of HIV-infected subjects with and without HAART, respectively, had Candida CFUs higher than 500/ml, all non-HIV carriers had Candida CFUs lower than 500/ml. The most common Candida colonization species was C. albicans in HAART and non-HIV groups. Interestingly, HAART-naïve group was colonized more by non-albicans species. Conclusions HAART has minimal effects on oral health. While HAART may not prevent Candida colonization, it might lead to reduction of non-albicans species. Because maintaining low Candida counts is important, HAART administration and antifungal sensitivity test should be considered in HIV-infected patients. Key words:HIV, Candida, HAART, Oral manifestation, Salivary flow rates.
Collapse
Affiliation(s)
- Aroonwan Lam-Ubol
- Faculty of Dentistry, Srinakharinwirot University, 114 Sukhumvit 23, Wattana, Klongtoey Nua, Bangkok 10110, Thailand
| | - Sorasun Rungsiyanont
- Faculty of Dentistry, Srinakharinwirot University, 114 Sukhumvit 23, Wattana, Klongtoey Nua, Bangkok 10110, Thailand
| | - Piamkamon Vacharotayangul
- Faculty of Dentistry, Srinakharinwirot University, 114 Sukhumvit 23, Wattana, Klongtoey Nua, Bangkok 10110, Thailand
| | - Kraisorn Sappayatosok
- Faculty of Dentistry, Rangsit University, 52/347 Phaholyothin Road, Mueang Pathum Thani District, Pathum Thani 12000, Thailand
| | - Oitip Chankanka
- Faculty of Dentistry, Prince of Songkla University, 15 Karnjanavanich Raod, Hat Yai, Songkhla 90110, Thailand
| |
Collapse
|
8
|
Goulart LS, Souza WWRD, Vieira CA, Lima JSD, Olinda RAD, Araújo CD. Oral colonization by Candida species in HIV-positive patients: association and antifungal susceptibility study. ACTA ACUST UNITED AC 2018; 16:eAO4224. [PMID: 30088546 PMCID: PMC6080703 DOI: 10.1590/s1679-45082018ao4224] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/25/2018] [Indexed: 01/12/2023]
Abstract
Objective To investigate antifungal susceptibility and factors associated with oral colonization by Candida species in HIV-positive patients. Methods A prospective study based on convenience sampling of subjects recruited from a pool of confirmed HIV-positive individuals seen at a specialty outpatient service in Rondonópolis, Mato Grosso, Brazil). Oral swabs were collected from 197 patients. Candida species were identified by standard microbiological techniques (phenotypic and molecular methods). Antifungal susceptibility was investigated using the broth microdilution method. Results A total of 101 (51.3%) patients were Candida spp carriers. Candida albicans was the most prevalent species (80%). Patients aged 45 to 59 years (Prevalence ratios: 1.90; 95%CI: 1.57-6.31) and 60 years or older (Prevalence ratios: 4.43; 95%CI: 1.57-34.18) were at higher risk of oral colonization by Candida species. Resistance to fluconazole and ketoconazole, or to itraconazole, corresponded to 1% and 4%, respectively. Conclusion Age (45 years or older) was the only factor associated with oral colonization by Candida . Low rates of antifungal resistance to azoles were detected in yeast isolates obtained from HIV-positive patients. Findings of this study may contribute to proper therapeutic selection for oral candidiasis in HIV-positive patients.
Collapse
|
9
|
Vidya KM, Rao UK, Nittayananta W, Liu H, Owotade FJ. Oral mycoses and other opportunistic infections in HIV: therapy and emerging problems - a workshop report. Oral Dis 2017; 22 Suppl 1:158-65. [PMID: 27109283 DOI: 10.1111/odi.12437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Oral mycoses and other opportunistic infections are recognized features of HIV infection even after four decades of the epidemic. The therapeutic options, challenges of therapy, and evolving patterns of opportunistic infections were evaluated by the workshop. It was observed that high Candida counts and infection are still more prevalent in HIV-positive individuals even in the era of antiretroviral therapy. Furthermore, one or more non-Candida albicans are present in some HIV-positive individuals. While Candida species are more virulent in HIV infection, similar virulence may be present in other states of immunosuppression. Consequently, the interplay between host factors and virulence ultimately determines the clinical outcomes. Adverse clinical outcomes such as candidemia and other deep fungal infections are on the increase in HIV infection. Disseminated histoplasmosis and penicilliosis have been reported, especially with low CD4 counts. Even with advances in antifungal therapy, mortality and morbidity from deep fungal infections have not changed significantly. In addition, long-term exposure to common antifungal drugs such as fluconazole has led to the development of antifungal resistance in 6% to 36%. Development of new antifungal therapeutic agents and the use of alternative therapies may offer breakthrough. In addition, effective strategies to enhance the host immune status are being explored.
Collapse
Affiliation(s)
- K M Vidya
- Department of Oral and Maxillofacial Pathology and Microbiology, Sathyabama University Dental College, Sathyabama University, Chennai, India
| | - U K Rao
- Ragas Dental College and Hospital, Chennai, India
| | - W Nittayananta
- Excellent Research Laboratory, Phytomedicine and Pharmaceutical Biotechnology Excellence Center, Hat Yai, Songkhla, Thailand.,Natural Products Research Center of Excellence, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, Thailand.,Graduate School, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - H Liu
- Department of Oral Medicine and Traditional Chinese Medicine, Peking University School of Stomatology, Haidian District, Beijing, China
| | - F J Owotade
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
10
|
Mushi MF, Bader O, Taverne-Ghadwal L, Bii C, Groß U, Mshana SE. Oral candidiasis among African human immunodeficiency virus-infected individuals: 10 years of systematic review and meta-analysis from sub-Saharan Africa. J Oral Microbiol 2017; 9:1317579. [PMID: 28748027 PMCID: PMC5508360 DOI: 10.1080/20002297.2017.1317579] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/04/2017] [Indexed: 11/18/2022] Open
Abstract
Oral candidiasis (OC) is the most common opportunistic fungal infection among immunocompromised individuals. This systematic review and meta-analysis reports on the contribution of non-albicans Candida species in causing OC among human immunodeficiency virus (HIV)-infected individuals in sub-Saharan Africa between 2005 and 2015. Thirteen original research articles on oral Candida infection/colonization among HIV-infected African populations were reviewed. The prevalence of OC ranged from 7.6% to 75.3%. Pseudomembranous candidiasis was found to range from 12.1% to 66.7%. The prevalence of non-albicans Candida species causing OC was 33.5% [95% confidence interval (CI) 30.9–36.39%]. Of 458 non-albicans Candida species detected, C. glabrata (23.8%; 109/458) was the most common, followed by C. tropicalis (22%; 101/458) and C. krusei (10.7%; 49/458). The overall fluconazole resistance was 39.3% (95% CI 34.4–44.1%). Candida albicans was significantly more resistant than non-albicans Candida species to fluconazole (44.7% vs 21.9%; p < 0.001). One-quarter of the cases of OC among HIV-infected individuals in sub-Saharan Africa were due to non-albicans Candida species. Candida albicans isolates were more resistant than the non-albicans Candida species to fluconazole and voriconazole. Strengthening the capacity for fungal diagnosis and antifungal susceptibility testing in sub-Saharan Africa is mandatory in order to track the azole resistance trend.
Collapse
Affiliation(s)
- Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences, Mwanza, Tanzania
| | - Oliver Bader
- Institute of Medical Microbiology, University Medical Center, Göttingen, Germany
| | | | - Christine Bii
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi, Kenya
| | - Uwe Groß
- Institute of Medical Microbiology, University Medical Center, Göttingen, Germany
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences, Mwanza, Tanzania
| |
Collapse
|
11
|
Patil S, Rao RS, Majumdar B, Anil S. Clinical Appearance of Oral Candida Infection and Therapeutic Strategies. Front Microbiol 2015; 6:1391. [PMID: 26733948 PMCID: PMC4681845 DOI: 10.3389/fmicb.2015.01391] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023] Open
Abstract
Candida species present both as commensals and opportunistic pathogens of the oral cavity. For decades, it has enthralled the clinicians to investigate its pathogenicity and to improvise newer therapeutic regimens based on the updated molecular research. Candida is readily isolated from the oral cavity, but simple carriage does not predictably result in development of an infection. Whether it remains as a commensal, or transmutes into a pathogen, is usually determined by pre-existing or associated variations in the host immune system. The candida infections may range from non-life threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. In fact, with the increase in number of AIDS cases, there is a resurgence of less common forms of oral candida infections. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes such as ill-fitting oral appliances, history of medications (antibiotics, corticosteroids, etc.), immunological and endocrine disorders, nutritional deficiency states and prolonged hospitalization. Treatment with appropriate topical antifungal agents such as amphotericin, nystatin, or miconazole usually resolves the symptoms of superficial infection. Occasionally, administration of systemic antifungal agents may be necessary in immunocompromised patients, the selection of which should be based upon history of recent azole exposure, a history of intolerance to an antifungal agent, the dominant Candida species and current susceptibility data.
Collapse
Affiliation(s)
- Shankargouda Patil
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Roopa S Rao
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Barnali Majumdar
- Department of Oral Pathology and Microbiology, Faculty of Dental Sciences, M. S. Ramaiah University of Applied Sciences Bangalore, India
| | - Sukumaran Anil
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Influence of cancer treatment on the Candida albicans isolated from the oral cavities of cancer patients. Support Care Cancer 2015; 24:2429-36. [PMID: 26638003 DOI: 10.1007/s00520-015-3035-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/15/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE Cancer treatment causes mucositis and the manifestation of oral candidiasis. This study investigated the virulence properties and antifungal susceptibilities of Candida albicans isolated from cancer patients undergoing therapy. METHODS C. albicans were isolated from 49 patients on cancer treatment and 21 healthy individuals and their virulence attributes measured. A correlation was determined between the length of treatment and the fungal counts and their virulence factors. RESULTS Although Candida carriage was similar in all the study groups, high quantities of C. albicans and variety of Candida were found in cancer patients. Germ tubes were produced by all the strains. Significantly high number of yeast isolated from radiotherapy and chemotherapy produced large quantities of phospholipase compared to healthy individuals (p < 0.01). The length of chemotherapy was associated with an increase in the phospholipase production (p = 0.03) by the C. albicans. Proteinase production was seen in a significant number of isolates from the radiotherapy group (p < 0.01). Type of cancer treatment had no effect. Resistance to antifungal agents was low. CONCLUSIONS High quantities of phospholipase were produced by C. albicans in cancer patients on therapy which also increased with the length of chemotherapy suggesting enhanced risk of oral and systemic infection. Therefore, during treatment, prophylactic topical antifungal therapy may be considered.
Collapse
|
13
|
Nouaman MN, Meless DG, Coffie PA, Arrivé E, Tchounga BK, Ekouévi DK, Anoma C, Eholié SP, Dabis F, Jaquet A. Oral health and HIV infection among female sex workers in Abidjan, Côte d'Ivoire. BMC Oral Health 2015; 15:154. [PMID: 26631015 PMCID: PMC4668627 DOI: 10.1186/s12903-015-0129-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/29/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW. METHODS A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d'Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases. RESULTS A total of 249 FSW with a median age of 29 years, [Inter Quartile Range (IQR) = 23-36] and a median duration of sex work of 24 months [IQR 9-60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 - 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 - 67.5], 14.5 % [95 % CI 10.2 - 18.9] and 8.2 % [95 % CI 4.8 - 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2-5.8]) and 50.0 [95 % CI; 6.4-384.6]. CONCLUSIONS This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.
Collapse
Affiliation(s)
- Marcellin N Nouaman
- Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire.
| | - David G Meless
- UFR Odonto-Stomatologie, Université Félix Houphouët Boigny, 18 BP 1954, Abidjan 18, Côte d'Ivoire.
| | - Patrick A Coffie
- Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. .,Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.
| | - Elise Arrivé
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.
| | - Boris K Tchounga
- Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. .,Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.
| | - Didier K Ekouévi
- Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. .,Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,Département de santé publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo.
| | | | - Serge P Eholié
- Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.
| | - François Dabis
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.
| | - Antoine Jaquet
- Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. .,INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France.
| | | |
Collapse
|
14
|
Ribeiro Ribeiro AL, de Alencar Menezes TO, de Melo Alves-Junior S, de Menezes SAF, Marques-da-Silva SH, Rosário Vallinoto AC. Oral carriage of Candida species in HIV-infected patients during highly active antiretroviral therapy (HAART) in Belém, Brazil. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:29-33. [PMID: 25921710 DOI: 10.1016/j.oooo.2015.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/14/2015] [Accepted: 03/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify the oral carriage of Candida spp in patients infected by human immunodeficiency virus (HIV) and the possible correlation with clinical characteristics. STUDY DESIGN Mucosal swab samples collected from 246 patients who were infected by HIV, did not have oral candidiasis, and were being treated with highly active antiretroviral therapy were analyzed. Yeast colonies that developed were identified by using the VITEK 2 automated system. RESULTS Candida yeasts were present in 41.87% of the samples, and Candida albicans was the most prevalent (32.52%). Other identified Candida species were C tropicalis (4.88%), C parapsilosis (2.85%), C dubliniensis (0.81%), and C famata (0.81%). CONCLUSIONS There was low rate of oral Candida carriage in patients infected by HIV who were on highly active antiretroviral therapy. A greater prevalence of C albicans than non-albicans Candida species was found at the species level. Prior candidiasis predicted the oral carriage of C albicans; however, it did not influence the carriage of non-albicans species. This is the first report of oral carriage of C famata in patients with HIV infection.
Collapse
Affiliation(s)
- André Luis Ribeiro Ribeiro
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University Center of Pará-CESUPA, Belém, Brazil.
| | | | | | | | | | | |
Collapse
|