Oral Candida carriage and immune status in Thai human immunodeficiency virus-infected individuals.

Oral candidiasis is a common opportunistic infection among human immunodeficiency virus (HIV)-infected individuals, with growing concerns about the emergence of non-albicans species with resistance to antifungal agents. This cross-sectional study determined the prevalence of oral Candida species in Thai HIV-infected adults and factors affecting their colonization. Candida species were identified from oral rinse samples of 60 HIV-infected participants of the MTCT-Plus initiative and 49 healthy controls by culture-based and molecular assays. The prevalence of oral Candida carriage was similar in HIV-infected patients (56.6 %) and in controls (55.1 %, P = 0.87). Candida albicans was the most predominant species in both groups (94.1 % of Candida carriers in HIV, 88.9 % in control). Interestingly, Candida dubliniensis was the second most common species in controls (29.6 %) and the third in HIV-infected patients (11.8 %, P = 0.08). Multivariate analysis showed that, amongst HIV-infected individuals, CD4 count <200 cells mm(-3) was associated with increased prevalence of oral carriage of both C. albicans (P = 0.03) and non-albicans species (P = 0.03). Moreover, patients with tuberculosis infection had a higher prevalence of the non-albicans species than those without (P = 0.03). Intriguingly, contraceptive use was also associated positively with non-albicans and multi-species carriage (P = 0.04 for both). However, use of antiretroviral drugs protected the patients from Candida carriage (P = 0.03), especially from C. albicans (P = 0.02). In conclusion, while HIV-infected individuals had a similar prevalence of oral Candida carriage to that of the control group, host immune status, tuberculosis infection, and contraceptive use may influence oral colonization of Candida, especially of the non-albicans species.

Candida in oral lichen planus patients undergoing topical steroid therapy.

OBJECTIVES: To determine the incidence, intensity, and species of Candida in the oral cavity of oral lichen planus (OLP) patients who were being treated with a topical steroid. STUDY DESIGN: The incidence and intensity of oral Candida carriage were assessed by salivary and imprint cultures. Cytological smears were used to investigate the presence of Candida spores and hyphae in the OLP lesions. Candida species were identified by a chlamydospore formation test and the API 20C system. RESULTS: The salivary cultures were positive in 76.7% of the OLP patients and 43.3% of the controls (P = .008), whereas the imprint cultures were positive in 76.7% of the OLP patients and 40% of the controls (P = .004). A high-level Candida count in saliva was more frequently found in the OLP patients than in the controls (73.9% vs. 38.5%; P = .004). The mean scores of Candida growth from imprint cultures were higher in OLP patients than in the controls (P = .002). The mean scores of Candida growth were also higher in OLP patients who were taking xerogenic or immunosuppressive drugs (P = .038) and in OLP denture wearers (P = .022). Spores and hyphae were detected in 83.3% of the OLP lesions. Candida albicans, the most frequently isolated yeast, was found in 76.7% OLP patients and 40% of the controls. CONCLUSIONS: The results of this study indicate that topical steroids induce Candida growth and the associated risk factors are age, medication use, and the wearing of dentures.