RESUMO
Fifty episodes of oropharyngeal candidiasis in HIV-infected patients were analyzed prospectively in order to evaluate the clinical response to fluconazole. The minimum inhibitory concentrations (MICs) of fluconazole for the Candida strains isolated from the pharynx were correlated with the clinical response. Treatment with fluconazole (100 mg/day) was successful in 86% of the cases. A good clinical outcome followed in 97% of the cases when a strain sensitive to fluconazole was isolated. This figure fell to 22% when the strain was resistant to fluconazole (p < 0.001). The rate of post-treatment colonization was high (87%), and selection of non-albicans Candida species occurred in 23% of the cases. In conclusion, fluconazole treatment for oropharyngeal candidiasis of HIV-infected patients was useful in most cases, but less sensitive non-albicans species can be selected. Most treatment failures were associated with increased MICs of fluconazole for the strains isolated before treatment; therefore, susceptibility testing is recommended as an aid in clinical decision-making for the use of the azole group of drugs.
Assuntos
Antifúngicos/uso terapêutico , Candidíase Bucal/tratamento farmacológico , Fluconazol/uso terapêutico , Infecções por HIV/complicações , Doenças Faríngeas/tratamento farmacológico , Candida albicans/efeitos dos fármacos , Candidíase Bucal/microbiologia , Resistência Microbiana a Medicamentos , Feminino , Fluconazol/farmacologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Doenças Faríngeas/microbiologiaRESUMO
The ability of the polymerase chain reaction (PCR) to detect pathogenic fungi in human blood was investigated. A DNA fragment of about 300 bp from the 18S rDNA, highly conserved in all fungi, was amplified with target DNA from 18 different species of fungi commonly isolated from clinical samples. The presence of PCR products was confirmed by hybridization with a fluorescein-labelled internal probe (21-mer). The PCR assay described is sensitive enough to detect 125 fg of purified Candida albicans DNA and 10 to 100 yeast cells per millilitre of blood.
Assuntos
Fungemia/diagnóstico , Fungos/isolamento & purificação , Reação em Cadeia da Polimerase , Sequência de Bases , Humanos , Dados de Sequência MolecularRESUMO
The MICs of fluconazole for four reference strains of Candida albicans were determined in one laboratory by the macrobroth dilution method recommended by the National Committee for Clinical Laboratory Standards (NCCLS) and by a modified version of the method which incorporated microbroth dilution, RPMI 1640 medium supplemented with glucose and the reading of MIC endpoints by spectrophotometry. The results obtained by the two methods were within one two-fold dilution. In addition, the susceptibilities of 58 clinical isolates of C. albicans to fluconazole were determined in two laboratories by the modified NCCLS method. Close interlaboratory agreement was observed, 98.2% of MICs varying by no more than one two-fold dilution.
