1/10. Therapeutic experience with fluconazole in the treatment of fungal infections in diabetic patients.diabetes mellitus is associated with a higher incidence of certain infections, including fungal infections like rhinocerebral zygomycosis (RCZ) and cutaneous candidosis. As the pathophysiology of increased susceptibility to infection of diabetic patients is very complex, a general therapeutic approach is not existing yet. Appropriate diabetes control remains as the best preventive measure. Nevertheless, effective drug therapy is very often required. fluconazole has proven efficacy in prophylaxis, treatment and suppressive therapy of both systemic and superficial fungal infections, especially in candidosis and cryptococcosis. Therefore it is used routinely against fungal infections in diabetes (FID). Clinical efficacy of fluconazole against cutaneous candidosis, oropharyngeal candidosis (OPC) and vulvovaginal candidosis (VVC) has been confirmed in more than 100 studies, involving more than 10,000 patients (pts). The overall success rate is 90%, with a mean dosage of 100-200 mg/d. In severe cases, e.g. in OPC in late-stage AIDS pts or in recurrent VVC, higher dosages of up to 800 mg/d may be required. In the treatment of RCZ, therapeutic experience with fluconazole is limited. Four diabetic pts have been treated with dosages of 200-300 mg/d and all of them recovered. Nevertheless, treatment of RCZ should include surgical debridement combined with aggressive antifungal therapy. In conclusion, proven efficacy and the excellent safety profile justify the routine use of fluconazole in the treatment of FID.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
2/10. Development of simultaneous resistance to fluconazole in candida albicans and Candida dubliniensis in a patient with AIDS.In this report, we describe a patient with recurrent episodes of oral candidosis who finally suffered from fluconazole-refractory oral and oesophageal candidosis. The patient was monitored for 4 years until his death from AIDS. During the observation period, persistent colonization with both candida albicans and Candida dubliniensis was observed. From the appearance of the first episode of oral candidosis, the patient was treated with fluconazole for 18 months. The infection became unresponsive to fluconazole 400 mg/day. in vitro susceptibility testing revealed the development of resistance to fluconazole in C. albicans and C. dubliniensis. molecular typing confirmed the persistence of the same C. albicans and C. dubliniensis strains which developed resistance after up to 3 years of asymptomatic colonization. This observation demonstrates that Candida spp. other than C. albicans may develop resistance to fluconazole in a patient who is repeatedly exposed to the drug.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
3/10. Treatment of azole-resistant oropharyngeal candidiasis with topical amphotericin B.OBJECTIVE: To report a case of successful treatment of azole-refractory oropharyngeal candidiasis with topical amphotericin b. CASE SUMMARY: A 30-year-old white woman presented with recurrent oral thrush. The patient had been exposed to azole antifungals for >20 years, and in vitro susceptibility tests revealed class resistance. The patient started taking amphotericin b 100 mg oral suspension swish-and-spit 4 times daily. After 4 weeks of topical amphotericin b treatment, the patient reported significant symptomatic improvement. The oral candidiasis worsened following a course of oral antibiotics, but improved once the antibiotic was discontinued and after receiving amphotericin b swish-and-swallow for 4 additional weeks. DISCUSSION: Current Infectious Diseases Society of America guidelines include topical amphotericin b as a potentially effective option for the treatment of oropharyngeal candidiasis. There is limited evidence to support this recommendation. Besides lack of data, an appropriate dosing regimen and consistent means of product formulation need to be determined. CONCLUSIONS: This report demonstrates the potential role for topical amphotericin b in the treatment of azole-refractory oral candidiasis. Double-blind, randomized, controlled trials are needed to define dosing, efficacy, administration, and long-term safety of oral amphotericin b.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
4/10. Emergence of a Candida krusei isolate with reduced susceptibility to caspofungin during therapy.Clinical failure associated with reduced susceptibility to caspofungin has been described in candida albicans and C. parapsilosis. We report a case of Candida krusei infection that progressed despite caspofungin therapy. Reduced microbial susceptibility to all three echinocandins (caspofungin, anidulafungin, and micafungin) was noted but was not associated with mutations in FKS1.- - - - - - - - - - ranking = 6keywords = susceptibility (Clic here for more details about this article) |
5/10. Azole-resistant candida albicans: report of two cases of resistance to fluconazole and review.We report the course of oropharyngeal infection by candida albicans that was refractory to treatment with fluconazole in two patients infected by the human immunodeficiency virus (hiv). We also review the epidemiology of C. albicans with decreased in vitro and in vivo susceptibility to azole antifungal agents, the significance of such isolates, the known mechanisms by which C. albicans may become less susceptible to azole antifungal agents, and the efficacy of various treatments for mucosal candidiasis. The occurrence in hiv-infected patients of mucosal candidiasis that is refractory to therapy with fluconazole and is due to C. albicans that demonstrates decreased in vitro susceptibility to fluconazole has been reported since 1990. Following the release of miconazole and ketoconazole in the late 1970s, C. albicans with decreased in vitro susceptibility to these agents was isolated from patients with chronic mucocutaneous candidiasis who required repeated and prolonged courses of therapy. Subsequently, C. albicans with decreased in vitro-susceptibility to ketoconazole, clotrimazole, and itraconazole has been isolated from hiv-infected patients. Recent reports of the sexual and nosocomial transmission of wild-type C. albicans indicate the possibility of future person-to-person transmission of C. albicans with decreased in vitro susceptibility to azole antifungal agents.- - - - - - - - - - ranking = 5keywords = susceptibility (Clic here for more details about this article) |
6/10. Emergence of fluconazole-resistant strains of candida albicans in patients with recurrent oropharyngeal candidosis and human immunodeficiency virus infection.After repeated use of fluconazole for therapy of oropharyngeal candidosis, the emergence of in vitro fluconazole-resistant candida albicans isolates (MIC, > or = 25 micrograms/ml) together with oral candidosis unresponsive to oral dosages of up to 400 mg of fluconazole were observed in patients with human immunodeficiency virus (hiv) infection. Antifungal susceptibility testing was done by broth microdilution and agar dilution techniques on C. albicans isolates recovered from a cohort of patients with symptomatic hiv infection who were treated repeatedly with fluconazole for oropharyngeal candidosis. in vitro findings did show a gradual increase in the MICs for C. albicans isolates recovered from selected patients with repeated episodes of oropharyngeal candidosis. Primary resistance of C. albicans to fluconazole was not seen. Cross-resistance in vitro occurred between fluconazole and other azoles (ketoconazole, itraconazole), but to a lesser extent. The results of the study suggest that the development of clinical resistance to fluconazole could be clearly correlated to in vitro resistance to fluconazole. itraconazole may still serve as an effective antifungal agent in patients with hiv infection and oropharyngeal candidosis nonresponsive to fluconazole.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
7/10. fluconazole-resistant oral candidosis in a repeatedly treated female AIDS patient.A 29-year-old female suffering from full-blown AIDS received fluconazole 400 mg day-1 for a long period for treatment of oral candidosis, pseudomembranous type. She had previously received this drug repeatedly for the same reason, yet manifest disease persisted. She was therefore put on parenteral amphotericin b, which led to clinical, but not mycological, cure in the short term. IC30 testing revealed a minimum inhibitory concentration (MIC) > 128 micrograms ml-1 for fluconazole. The isolate, however, was susceptible in vitro to ketoconazole, itraconazole and amphotericin b. The same antimicrobial susceptibility pattern was found with a second isolate obtained later. Resistance to fluconazole might become a major problem in hiv-infected patients receiving this drug for long periods.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
8/10. Resistance of candida albicans to fluconazole during treatment of oropharyngeal candidiasis in a patient with AIDS: documentation by in vitro susceptibility testing and dna subtype analysis.We describe a patient with recurrent episodes of oropharyngeal candidiasis who required progressively higher doses of fluconazole to control and infection. The patient was treated for 14 infections over a 2-year period with doses of fluconazole that ranged from 100 to 800 mg per day. Clinical response, two methods of in vitro susceptibility testing, and molecular epidemiologic techniques were evaluated for 12 of the 14 episodes. Ultimately, the patient became unresponsive clinically to a dose of 800 mg of fluconazole per day. in vitro susceptibility testing of isolates obtained during these successive episodes of infection revealed the development of resistance to fluconazole, and molecular epidemiologic techniques confirmed the persistence of the same Candida albicans strain throughout all 12 episodes.- - - - - - - - - - ranking = 6keywords = susceptibility (Clic here for more details about this article) |
9/10. Transmission of fluconazole-resistant candida albicans between patients with AIDS and oropharyngeal candidiasis documented by pulsed-field gel electrophoresis.Electrophoretic karyotype and restriction endonuclease analysis of genomic dna were used for the typing of nine isolates of candida albicans from the oral cavities of two patients with AIDS--a husband and wife--whose infections became resistant to treatment with fluconazole (400 mg/d). The in vitro susceptibilities of sequential isolates to fluconazole and two other triazoles, itraconazole and the investigational drug D0870, were also evaluated. dna analysis showed that the isolates responsible for fluconazole-resistant episodes of oropharyngeal candidiasis in the two patients were genetically related. in vitro susceptibility to fluconazole correlated well with clinical outcome. Although the minimal inhibitory concentrations of itraconazole and D0870 for fluconazole-resistant isolates were higher than those for fluconazole-susceptible isolates, both of the former triazoles exhibited good in vitro activity against the isolates tested.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
10/10. Genetic dissimilarity of two fluconazole-resistant candida albicans strains causing meningitis and oral candidiasis in the same AIDS patient.We describe a patient with AIDS who simultaneously developed Candida meningitis with three positive cerebrospinal fluid cultures and oral candidiasis. This patient also had a history or recurrent episodes of oral candidiasis treated with fluconazole. The patient did not respond to this therapy but was cured with amphotericin b and flucytosine. in vitro susceptibility tests revealed that each infection was caused by fluconazole-resistant candida albicans isolates. Strain delineation by karyotyping, NotI restriction pattern analysis, hybridization with the specific probe 27A, and PCR fingerprinting with the phage M13 core sequence clearly demonstrated that meningitis and oral thrush were caused by two genetically different isolates.- - - - - - - - - - ranking = 1keywords = susceptibility (Clic here for more details about this article) |
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