Presence of various fungi in the oral smears of HIV / AIDS patients

ABSTRACT

This study was designed to observe the various fungi present in the oral buccal smears of HIV/ AIDS patients and their relation to CD4+lymphocyte count. Oral smears from n=35 patients taking antiretroviral therapy [ART] and twenty five [n=25] patients not taking ART were taken. These smears were stained with routine [H and E, Pap] and special stains recommended for fungi i.e. Grocott-Gomori's Methenamine Silver [GMS] and Periodic Acid Schiff [PAS]. The CD4+ lymphocyte count was determined using flow cytometry. Candida albicans was the most common being present in 26% patients on ART and 44% in Non-ART patients. Cryptococcus neoformans was seen in 11.4% ART patients and 4% in Non-ART patients. Coccidioides immitis was observed in 2.9% ART patients and 4% of Non-ART patients. Aspergillus was seen in 1.6% Non-ART patients only. Mean CD4+ count at which various fungi were seen was <300 cells/mm3 in all types. The CD4+ lymphocyte count was quantitatively grouped as Group 1 with CD4 + lymphocyte count <350 cells/mm3 and Group 2 having CD4+ lymphocyte count >350 cells/mm3. Fungi was found to have significant [p=0.001] association with Group1 having CD4+ count less than 350 cells/mm3 which shows their association with immunosuppression. Determination of increased colonization of Candidal and Non-Candidal fungi in oral cavity by means of simple non-invasive methods like oral smears may be helpful in indirectly predicting the immune suffered status and such patients should be given early medical treatment to prevent from disseminated fungal infections