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Year : 2009  |  Volume : 27  |  Issue : 2  |  Page : 174--175

Immunosuppression level in HIV-positive patients with oropharyngeal candidiasis

Usha Arora, Maninder Jagdev, Neerja Jindal 
 Department of Microbiology, Government Medical College, Amritsar, Punjab - 143 001, India

Correspondence Address:
Usha Arora
Department of Microbiology, Government Medical College, Amritsar, Punjab - 143 001
India

How to cite this article:
Arora U, Jagdev M, Jindal N. Immunosuppression level in HIV-positive patients with oropharyngeal candidiasis.Indian J Med Microbiol 2009;27:174-175

How to cite this URL:
Arora U, Jagdev M, Jindal N. Immunosuppression level in HIV-positive patients with oropharyngeal candidiasis. Indian J Med Microbiol [serial online] 2009 [cited 2020 Feb 18 ];27:174-175
Available from: http://www.ijmm.org/text.asp?2009/27/2/174/49442

Full Text

Dear Editor,

Oropharyngeal candidiasis (OPC) is the most common opportunistic fungal infection in patients with HIV infection. Its incidence increases as the impairment of cellular immunity progresses. [1] A total of 60 isolates of Candida spp. obtained from HIV-positive patients having OPC were processed and their CD4 count was determined to find out the correlation of various isolates of Candida spp. and their antifungal susceptibility to the CD4 count of the patients. HIV seropositivity was confirmed by three E/R/S tests as per guidelines of NACO, Government of India. Antifungal susceptibility testing of various isolates was done for fluconazole, amphotericin B, and ketoconazole in accordance with standard procedures, [2] and CD4 count was measured by fluorescent activated cell sorter (FACS) counter (Becton Dickinson, Cockyesville, MD, USA).

Out of 60 Candida spp. isolates obtained, 45 (75%) were Candida albicans and 13 (22.67%) were nonalbicans Candida spp. Among the nonalbican species C. tropicalis was found to be the commonest. Other authors have also reported C. albicans to be the major isolate and C. tropicalis as the commonest nonalbicans species in HIV-positive patients having OPC. [1],[3] Of the 60 patients, 46 (76.66%) had CD4 count 3 [Table 1]. Singh et al , also reported that there is significantly increased risk of OPC in HIV-infected patients with progressive immunodeficiency (CD4 + 3 ). [4] Therefore, even when patient's CD4 cell count is not known, presence of oral lesions may be considered as an indirect marker of immunosuppression. In the current study, a close association was observed between prevalence of non albicans Candida spp. and fluconazole resistance with low CD4 count [Table 1], which goes well with the findings of other authors. [4],[5] The level of immunosuppression and prior fluconazole therapy, are important risk factors in the emergence of resistance in yeast isolates.

It is concluded that C. albicans is the major isolate causing OPC in HIV-seropositive patients and nonalbicans species are emerging as important pathogens with increased immunosuppression. Since OPC may be considered as indirect marker of immunosupression in HIV-positive patients, regular oral checkup of these patients could be an indicator of the level of immunosuppression.

References

1Darouiche RO. Oropharyngeal and esophageal candidiasis in immunocompromised patients: Treatment Issues. Clin Infect Dis 1998;26:259.
2Chander J. Candidiasis. In: Textbook of medical mycology.2 nd ED. New Delhi; Mehta Publishers; 2002. p. 212-30, 389-96.
3Revankar SG, Kirkpatrick WR, McAtee RK Dib OP, Fothergill AW, Redding SW et al . Detection and significance of fluconazole resistance in oropharyngeal candidiasis in human immunodeficiency virus infected patients. J Infect Dis 1996;174:821-7.
4Singh HR, Singh NG, Singh TB. Estimation of CD4+ and CD8 + T-lymphocytes in human immunodeficincy virus infection and acquired immunodeficiency syndrome patients in Manipur. Indian J Med Microbiol 2007;25:126-32.
5Fichtenbaum CJ, Koletar S, Yiannoutsos C, Holland F, Pottage J, Cohn E, et al . Refractory mucosal candidiasis in advanced human immunodeficiency virus infection. Clin Infect Dis 2000;30:749-56.