Oral mycoses in HIV infection

Oral Biology Unit, Prince Philip Dental Hospital, University of Hong Kong, Sai Ying Pun.
Oral Surgery Oral Medicine Oral Pathology 03/1992; 73(2):171-80. DOI: 10.1016/0030-4220(92)90191-R
Source: PubMed


Oral mycoses in human immunodeficiency virus (HIV) infection are becoming increasingly common. Of these, oral candidiasis is by far the most prevalent; fewer than 10 cases of cryptococcosis, histoplasmosis, and geotrichosis have thus far been reported. Oral candidiasis is one of the earliest premonitory signs of HIV infection and may present as erythematous, pseudomembranous, hyperplastic, or papillary variants, or as angular cheilitis. Cumulative data from 23 surveys (incorporating 3387 adults) suggest that in general, oral candidiasis may develop in one third to half of HIV-seropositive persons. Almost equal numbers of cases manifest with either erythematous or pseudomembranous variants. These and related concepts pertaining to oral mycoses in HIV infection are reviewed.

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    • "In HIV-infected patients, there are many reports for a high incidence of asymptomatic oral yeast carriage [6-11]. In particular, oropharyngeal candidiasis (OPC) is the most frequent opportunistic infection, with a occurrence rate in 50% to 90% of patients during disease progression [12]. Presence of asymptomatic carriage of yeasts in the oral cavities of HIV-infected patients and lower CD4 cell count have been associated with subsequent development of OPC [6,13]. "
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    ABSTRACT: Background Oral Candida colonization and its relation with predisposing factors in HIV-infected patients have received wide concerns during recent decades. In this study, we investigated asymptomatic oral Candida carriage rate, species distribution and antifungal susceptibility of 604 HIV-infected patients and 851 healthy individuals in Kunming, Yunnan Province of China. Methods Mucosal swab sampling was taken from each subject and CHROMagar Candida agar medium and API 20C AUX system were used to identify yeast isolates. In vitro antifungal susceptibility was tested by the broth microdilution method according to the M27-A2 document of the Clinical and Laboratory Standard Institute (CLSI). Results The oral yeast colonization rate in HIV-infected patients (49.5%) was higher than that of healthy subjects (20.7%). Candida albicans constituted the most frequent species, accounting for 82.2% of yeast isolates. The remaining species were composed of C. glabrata, C. parapsilosis, C. krusei, C. tropicalis, C. rugosa, C. norvegensis, Pichia ohmeri and Saccharomyces cerevisiae. In HIV-infected patients, asymptomatic oral yeast colonization was associated with low CD4 cell count (<200 cells/mm3) and lack of highly active antiretroviral therapy (HAART). Different Candida species isolated from our samples presented different susceptibility to voriconazole, fluconazole and itraconazole. Amphotericin B had the best inhibiting effect for all isolates. Conclusion Oral yeast colonization in Han Chinese patients with HIV from Kunming had common and unique features and was associated with CD4 cell number and HARRT. Amphotericin B should be used with first priority in controlling Candida infection in Han Chinese patients from Kunming. Our results provide first hand information on monitoring oral yeasts colonization in HIV-infected patients from Kunming, China.
    BMC Infectious Diseases 01/2013; 13(1):46. DOI:10.1186/1471-2334-13-46 · 2.61 Impact Factor
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    • "Oral candidiasis is classically an acute infection seen in infants , in patients with diabetes mellitus, and in those receiving broad-spectrum antibiotics or corticosteroids (Akpan and Morgan 2002). Individuals infected with the human immunodeficiency virus commonly develop oral candidiasis as one of the early signs associated with AIDS (Samaranayake 1992). "
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    ABSTRACT: Bovine lactoferrin harbors 2 antimicrobial sequences (LFcin and LFampin), situated in close proximity in the N1-domain. To mimic their semi parallel configuration we have synthesized a chimeric peptide (LFchimera) in which these sequences are linked in a head-to-head fashion to the α- and ε-amino group, respectively, of a single lysine. In line with previously described bactericidal effects, this peptide was also a stronger candidacidal agent than the antimicrobial peptides LFcin17-30 and LFampin265-284, or a combination of these 2. Conditions that strongly reduced the candidacidal activities of LFcin17-30 and LFampin265-284, such as high ionic strength and energy depletion, had little influence on the activity of LFchimera. Freeze-fracture electron microscopy showed that LFchimera severely affected the membrane morphology, resulting in disintegration of the membrane bilayer and in an efflux of small and high molecular weight molecules such as ATP and proteins. The differential effects displayed by the chimeric peptide and a mixture of its constituent peptides clearly demonstrate the synergistic effect of linking these peptides in a fashion that allows a similar spatial arrangement as in the parent protein, suggesting that in bovine lactoferrrin the corresponding fragments act in concert in its candidacidal activity.
    Biochemistry and Cell Biology 02/2012; 90(3):378-88. DOI:10.1139/o11-085 · 2.15 Impact Factor
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    • "Early clinical reports implicated that mucosal candidiasis occurred predominantly in individuals with T cell immunodeficiency, and a strong role for CMI by Th1 cells against Candida was demonstrated by various experimental models [15] [16] [17] [18] [19] [20]. Based on these observations, the original consensus was that resistance to mucosal infections, including VVC, was mediated by Th1-type CMI, while susceptibility was associated with Th2-type humoral responses [21]. "
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    ABSTRACT: Vulvovaginal candidiasis (VVC), caused by Candida albicans, affects a significant number of women during their reproductive years. More than two decades of research have been focused on the mechanisms associated with susceptibility or resistance to symptomatic infection. Adaptive immunity by Th1-type CD4(+) T cells and downstream cytokine responses are considered the predominant host defense mechanisms against mucosal Candida infections. However, numerous clinical and animal studies have indicated no or limited protective role of cells and cytokines of the Th1 or Th2 lineage against vaginal infection. The role for Th17 is only now begun to be investigated in-depth for VVC with results already showing significant controversy. On the other hand, a clinical live-challenge study and an established animal model have shown that a symptomatic condition is intimately associated with the vaginal infiltration of polymorphonuclear leukocytes (PMNs) but with no effect on vaginal fungal burden. Subsequent studies identified S100A8 and S100A9 alarmins as key chemotactic mediators of the acute PMN response. These chemotactic danger signals appear to be secreted by vaginal epithelial cells upon interaction and early adherence of Candida. Thus, instead of a putative immunodeficiency against Candida involving classical immune cells and cytokines of the adaptive response, the pathological inflammation in VVC is now considered a consequence of a non-productive innate response initiated by non-classical immune mediators.
    Cytokine 12/2011; 58(1):118-28. DOI:10.1016/j.cyto.2011.11.021 · 2.66 Impact Factor
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