Fluconazole Resistance among Oral Candida Isolates from People Living with HIV/AIDS in a Nigerian Tertiary Hospital.

Iriagbonse Osaigbovo,Patrick Lofor,Rita Oladele

doi:10.3390/jof3040069

Abstract

Oropharyngeal candidiasis, a common fungal infection in people living with HIV/AIDS (PLWHA), arises from Candida species colonizing the oral cavity. Fluconazole is the preferred treatment and is often used empirically. Few studies have investigated the prevalence of fluconazole resistance in Nigeria. This study aimed at determining the burden of fluconazole resistance among Candida species in the oral cavities of PLWHA. We sampled the oral cavities of 350 HIV-infected adults and an equal number of HIV-negative controls. Candida isolates were identified using germ tube tests, CHROMagar Candida (CHROMagar, Paris, France), and API Candida yeast identification system (BioMérieux, Marcy-l’Étoile, France). Fluconazole susceptibility was determined using the Clinical and Laboratory Standards Institute disc diffusion method. Data were analysed using SPSS version 21 (IBM, New York, NY, USA). The significance level was set at p ≤ 0.05. The isolation rates for Candida amongst HIV-infected subjects and controls were 20.6% and 3.4%, respectively (p < 0.001). In PLWHA, Candida albicans was most frequently isolated (81.3%) and fluconazole resistance was present in 18 (24%) of the 75 Candida isolates. Resistance to fluconazole was present in half of the non-albicans Candida isolates. Fluconazole resistance is prevalent among oral Candida isolates in PLWHA in the study area with a significantly higher rate among non-albicans Candida spp.

Highlights

Oropharyngeal candidiasis (OPC) is the most prevalent opportunistic fungal infection in people living with HIV/AIDS (PLWHA) [1]
Few studies have elucidated the epidemiology of OPC in Nigeria; fewer still have documented the fluconazole sensitivity pattern of oral isolates of Candida species [14,15,16,17]
We observed resistance to fluconazole in 24.0% of oral Candida isolates from PLWHA

Summary

Introduction

Oropharyngeal candidiasis (OPC) is the most prevalent opportunistic fungal infection in people living with HIV/AIDS (PLWHA) [1]. The causative agent, Candida spp., is part of the oral mycobiome. Not a life-threatening condition in itself, OPC significantly lowers the quality of life of PLWHA. It manifests with local discomfort and altered taste sensation. OPC may be complicated by Candida oesophagitis which presents with dysphagia and retrosternal pain. Clinical variants of OPC include the pseudomembranous, erythematous, and hypertrophic types, as well as Candida-associated lesions, such as angular cheilitis, denture stomatitis, and median rhomboid glossitis [2]. OPC requires distinction from other oral mucous pathologies which may present in a similar fashion, including chemical and thermal burns, traumatic ulceration, mucous patches of syphilis, drug reactions, erosive lichen planus, pernicious anaemia, and burning mouth syndrome [3]

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