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      Epidemiology of Oropharyngeal Candidiasis in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients and CD4+ Counts

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          Abstract

          Background:

          The present study was directed to evaluate the forms of oropharyngeal candidiasis (OPC) and their correlation with CD4+ cell counts in human immunodeficiency virus (HIV) patients.

          Materials and Methods:

          This was a descriptive and analytical cross-sectional study carried out for a 2-year period, in which quantitative data collection methods were used. 50 patients with HIV infection were evaluated. Relationship between OPC and CD4+ was investigated.

          Results:

          Five different clinical forms were noticed on examination: pseudomembranous candidiasis 20/38 (P) was the most common one (52.6%) followed by erythematous 5/38 (13.15%), angular cheilitis 5/38 (13.15%) (AC), a combination of AC and E 4/38 (10.52%) or AC, E and P 4/38 (10.52%). Candida albicans was the most frequent specie isolated in 35 cases of OPC (92%). Candida tropicalis was isolated in 2 cases (5.26%) and Candida glabrata in 1 case (2.64%). The majority of patients with OPC had cell counts 28/38 (73%) <200 cells/mm 3, followed by 9/38 (23%) at CD4+ cell counts of 201-499 cells/mm 3.

          Conclusion:

          Oral Candida colonization and invasive infection occur more frequently in HIV-positive patient and is significantly more common in patients with CD4+ cell counts <200 cell/mm 3.

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          Most cited references20

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          1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults.

          (1992)
          CDC has revised the classification system for HIV infection to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions. This classification system replaces the system published by CDC in 1986 (1) and is primarily intended for use in public health practice. Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have < 200 CD4+ T-lymphocytes/microL, or a CD4+ T-lymphocyte percentage of total lymphocytes of < 14. This expansion includes the addition of three clinical conditions--pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer--and retains the 23 clinical conditions in the AIDS surveillance case definition published in 1987 (2); it is to be used by all states for AIDS case reporting effective January 1, 1993.
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            Oropharyngeal candidiasis in the era of antiretroviral therapy.

            George Thompson, Payal K. Patel, William R. Kirkpatrick … (2010)
            Oropharyngeal candidiasis (OPC) remains a common problem in the HIV-infected population despite the availability of antiretroviral therapy (ART). Although Candida albicans is the most frequently implicated pathogen, other Candida species also may cause infection. The emergence of antifungal resistance within these causative yeasts, especially in patients with recurrent oropharyngeal infection or with long-term use of antifungal therapies, requires a working knowledge of alternative antifungal agents. Identification of the infecting organism and antifungal susceptibility testing enhances the ability of clinicians to prescribe appropriate antifungal therapy. Characterization of the responsible mechanisms has improved our understanding of the development of antifungal resistance and could enhance the management of these infections. Immune reconstitution has been shown to reduce rates of OPC, but few studies have evaluated the current impact of ART on the epidemiology of OPC and antifungal resistance in these patients. Preliminary results from an ongoing clinical study showed that in patients with advanced AIDS, oral yeast colonization was extensive, occurring in 81.1% of the 122 patients studied, and symptomatic infection occurred in one-third. In addition, resistant yeasts were still common, occurring in 25.3% of patients colonized with yeasts or with symptomatic infection. Thus, OPC remains a significant infection in advanced AIDS, even with ART. Current knowledge of the epidemiology, pathogenesis, clinical presentation, treatment, and mechanisms of antifungal resistance observed in OPC are important in managing patients with this infection and are the focus of this review. Published by Mosby, Inc.
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              1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescent and adults

              KG Castro, JW Ward, L Slutsker … (1993)
              Article 0 comments Cited 35 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Oral Health
                Journal ID (iso-abbrev): J Int Oral Health
                Journal ID (publisher-id): JIOH
                Title: Journal of International Oral Health : JIOH
                Publisher: Dentmedpub Research and Printing Co (India )
                ISSN (Print): 0976-7428
                ISSN (Electronic): 0976-1799
                Publication date (Print): March 2015
                Volume: 7
                Issue: 3
                Pages: 20-23
                Affiliations
                [1 ]Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon
                [2 ]Lecturer and Director Postgraduate Program of Oral Pathology, Departments of Oral and Maxillofacial Surgery and Pathology and Diagnosis Science, School of Dentistry, Lebanese University, Beirut, Lebanon
                [3 ]Assistant Professor, Department of Pathology and Diagnosis Science, School of Dentistry, Lebanese University, Beirut, Lebanon
                Author notes
                Correspondence: Dr. Berberi A. Department of Oral Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon. Tel: +961-3-731173, Fax: +961-4-533060. Email: anberberi@ 123456gmail.com
                Article
                Publisher ID: JIOH-7-20
                PMC ID: 4385720
                PubMed ID: 25878473
                SO-VID: a8d3afe9-e506-4929-8a91-ce12dea768ac
                Copyright © Copyright: © Journal of International Oral Health
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 September 2014
                Date accepted : 28 December 2014
                Categories
                Subject: Original Research

                Keywords: acquired immune deficiency syndrome,candidiasis,cd4+,human immunodeficiency virus,oral lesions
                Data availability:
                Keywords: acquired immune deficiency syndrome, candidiasis, cd4+, human immunodeficiency virus, oral lesions

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