Oral Cavity Of HIV-infected Patients Research Articles

Frequency of Candida species isolated from the Oral Cavity of HIV-Infected Patients referring to Behavioral disease Counseling Center of Isfahan in 2017-2018

Frequency of Candida species isolated from the Oral Cavity of HIV-Infected Patients referring to Behavioral disease Counseling Center of Isfahan in 2017-2018

Oral Candida spp carriage and periodontal diseases in HIV-infected patients in Ribeirão Preto, Brazil.

ABSTRACTThe majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Human papillomavirus infection in the oral cavity of HIV patients is not reduced by initiating antiretroviral therapy.

Objective:The incidence of human papillomavirus (HPV)-related oral malignancies is increasing among HIV-infected populations, and the prevalence of oral warts has reportedly increased among HIV patients receiving antiretroviral therapy (ART). We explored whether ART initiation among treatment-naive HIV-positive adults is followed by a change in oral HPV infection or the occurrence of oral warts.Design:Prospective, observational study.Methods:HIV-1 infected, ART-naive adults initiating ART in a clinical trial were enrolled. End points included detection of HPV DNA in throat-washes, changes in CD4+ T-cell count and HIV RNA, and oral wart diagnosis.Results:Among 388 participants, 18% had at least one HPV genotype present before initiating ART, and 24% had at least one genotype present after 12–24 weeks of ART. Among those with undetectable oral HPV DNA before ART, median change in CD4+ count from study entry to 4 weeks after ART initiation was larger for those with detectable HPV DNA during follow-up than those without (P = 0.003). Both prevalence and incidence of oral warts were low (3% of participants having oral warts at study entry; 2.5% acquiring oral warts during 48 weeks of follow-up).Conclusion:These results suggest: effective immune control of HPV in the oral cavity of HIV-infected patients is not reconstituted by 24 weeks of ART; whereas ART initiation was not followed by an increase in oral warts, we observed an increase in oral HPV DNA detection after 12–24 weeks. The prevalence of HPV-associated oral malignancies may continue to increase in the modern ART era.

Plasmablastic lymphoma presenting as a large intracardiac mass and bilateral pleural effusions

Plasmablastic lymphoma (PBL) is a rare aggressive lymphoma arising most frequently in the oral cavity of HIV-infected patients. Rare cases of PBL have been reported in extra-oral sites, as well as in HIV-negative patients. Cardiac involvement by lymphoma is very rare. The most common primary cardiac lymphoma is diffuse large B-cell lymphoma. We report an unusual case of PBL in a 49-year-old, HIV-positive man presenting with a large intracardiac mass and bilateral pleural effusions. Histological examination of the cardiac mass biopsy and cytological evaluation of the pleural fluid demonstrated large lymphoma cells with plasmablastic differentiation. By immunohistochemistry, the large lymphoma cells expressed CD30, CD45, CD138, MUM1, and kappa light chain, were weakly positive for EMA, and were negative for T-cell and B-cell markers, lambda light chain, and human herpes virus 8 (HHV8). In situ hybridization for Epstein Barr Virus-encoded RNA (EBER) was negative in large lymphoma cells. To our knowledge, in the English literature, this is the second reported case of PBL with cardiac origin and the first reported case of PBL that presents as a combination of intracardiac mass and pleural effusions.

A Study on Exoenzyme Activities of Candida albicans Isolated from Oral Cavities of HIV-Infected Patients on HAART

The mortality and morbidity of HIV-infected patients have declined with the advent of highly active antiretroviral therapy (HAART), but its effect on Candida infections remains elusive. The aims of the present study were to determine the effect of HAART on the phosphor lipase, proteinase and haemoltyic activities of oral Candida albicans, and to investigate the correlation between these enzyme profiles and the patients’ demographic and clinical parameters. Isolates were obtained from 16 Chinese HIV-infected patients on HAART and 16 healthy controls using oral rinse technique. The isolates were tested in vitro for phospholipase, proteinase and haemolytic activities using three different plate assays. The phospholipase and haemolytic activities were found to be significantly higher (p <0.05) and the proteinase activities were lower in the test group (p< 0.05). The lower proteinase activities in HIV-infected group could be due to the direct effect of protease inhibitors in HAART while the higher phospholipase and haemolytic activity in the HIV-infected group remains elusive. These finding provide evidence of altered extracellular enzyme activities in the Candida isolates obtained from HIV patients on HAART, which may affect the infectivity of the Candida isolates.

Essential oils: new perspectives in human health and wellness.

Essential oils: new perspectives in human health and wellness.

Effect of Eugenol on Cell Surface Hydrophobicity, Adhesion, and Biofilm of Candida tropicalis and Candida dubliniensis Isolated from Oral Cavity of HIV-Infected Patients.

Most Candida spp. infections are associated with biofilm formation on host surfaces. Cells within these communities display a phenotype resistant to antimicrobials and host defenses, so biofilm-associated infections are difficult to treat, representing a source of reinfections. The present study evaluated the effect of eugenol on the adherence properties and biofilm formation capacity of Candida dubliniensis and Candida tropicalis isolated from the oral cavity of HIV-infected patients. All isolates were able to form biofilms on different substrate surfaces. Eugenol showed inhibitory activity against planktonic and sessile cells of Candida spp. No metabolic activity in biofilm was detected after 24 h of treatment. Scanning electron microscopy demonstrated that eugenol drastically reduced the number of sessile cells on denture material surfaces. Most Candida species showed hydrophobic behavior and a significant difference in cell surface hydrophobicity was observed after exposure of planktonic cells to eugenol for 1 h. Eugenol also caused a significant reduction in adhesion of most Candida spp. to HEp-2 cells and to polystyrene. These findings corroborate the effectiveness of eugenol against Candida species other than C. albicans, reinforcing its potential as an antifungal applied to limit both the growth of planktonic cells and biofilm formation on different surfaces.

IDENTIFICATION OF CANDIDA SPECIES ISOLATED FROM ORAL COLONIZATION IN IRANIAN HIV-POSITIVE PATIENTS, BY PCR-RFLP METHOD

: Background: The incidence of opportunistic infections due to Candida albicans and other Candida spp. has been increasing. Rapid identification of candidiasis is important for the clinical management of immunocompromised patients. Polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) is a rapid, sensitive, and specific method for detection of clinically important fungi.Objectives: The purpose of this study was to identify Candida spp. isolated from the oral cavities of HIV-infected patients in southeastern Iran (Kerman), by using PCR-based restriction enzyme digestion.Patients and Methods: We identified 96 Candida isolates obtained from 139 Iranian patients infected with the human immunodeficiency virus (HIV), between April 2009 and April 2010, by using PCR-RFLP assay. Universal primers for the internal transcribed spacer (ITS) region (ITS1–ITS4) of the fungal rRNA genes were used for this assay.Results: We successfully identified the different Candida spp. by using the restriction enzyme MspI. C. albicans was the most commonly identified species (82.2%), followed by C. glabrata (7.29%), C. parapsilosis and C. kefyr (both 4.1%), and C. tropicalis (2%).Conclusions: PCR-RFLP is a highly sensitive, specific, and direct method for fungal detection and can be used for fungal epidemiological studies in HIV-positive and other immunocompromised patients. Implication for health policy/practice/research/medical education:To have knowledge about the HIV positive patients and the role of Candida spp. and candidiasis in that group was so important forthe authors. Please cite this paper as:Ayatollahi Mousavi SA, Salari S, Rezaie S, Shahabi Nejad N, Hadizadeh S, Kamyabi H. et al. Identification of Candida Species Isolated From Oral Colonization in Iranian HIV-Positive Patients, by PCR-RFLP Method. Jundishapur J Microbiol. 2012;5(1):336-40. DOI:10.5812/kowsar.20083645.2429 © 2012, AJUMS. Published by Kowsar M.P.Co. All rights reserved.

Plasmablastic lymphoma may occur as a high-grade transformation from plasmacytoma

Plasmablastic lymphoma (PBL) is an uncommon aggressive lymphoma arising most frequently in the oral cavity of HIV-infected patients. Rare cases of PBL have been reported in extraoral sites, particularly extranodal sites, as well as in immunocompetent patients. We report an unusual case of PBL in a 69-year-old, HIV-negative non-immunocompromised man presenting with generalized lymphadenopathy. To our knowledge, this is the first case of PBL presented as primarily generalized lymphadenopathy in HIV-negative patients. Histologic examinations of cervical, inguinal and axillary lymph nodes demonstrated a neoplastic proliferation of large cells with extensive necrosis. The neoplastic cells formed sheets with a relatively cohesive growth pattern interspersed by small lymphocytes and plasma cells. The large tumor cells expressed MUM1, OCT-2 and BOB.1, and were negative for CD138, CD38, AE1/AE3, melan A, PLAP, S100, vimentin, CD117, CD30, ALK-1, leukocyte common antigen (CD45), T-cell, B-cell and histolytic markers, CD56, CD10 and BCL-6. The proliferation index by Ki-67 immunohistochemistry was approaching 100%. In situ hybridization for Epstein–Barr Virus-encoded RNA (EBER) was positive in large malignant cells. A diagnosis of PBL was made. These findings indicate that PBL should be included in the differential diagnosis of an HIV-negative, immunocompetent patient with generalized lymphadenopathy. The adjacent plasma cells were positive for CD138 and CD38 and show kappa-light chain restriction, but without EBER expression, raising the possibility of a preexisting or concurrent plasmacytoma and that the PBL may be a high-grade transformation from a preexisting plasma cell neoplasm following Epstein–Barr virus infection. Electron microscopy showed numerous circumferential long slender peripheral cytoplasmic projections in the large tumor cells, suggesting that some of the previously reported large B-cell lymphoma with cytoplasmic projections may actually be PBL.

Plasmablastic lymphoma: a review

Plasmablastic lymphoma (PBL) has been recently characterised as an aggressive subtype of non-Hodgkin's lymphoma, most frequently arising in the oral cavity of HIV-infected patients. To date, approximately 60 cases fulfilling the clinico-pathological characteristics of PBL have been reported. PBLs are composed of large cells with eccentrically located nuclei and deeply basophilic cytoplasm with a paranuclear hof. The tumour cells are invariably immunoreactive for the plasma cell marker CD138, and show monoclonal rearrangement of the immunoglobulin heavy chain gene (IgH) and/or clonal restriction of the Ig light chain (IgL) gene expression in most of the cases. Similar to other types of AIDS-related lymphomas, there is evidence that Epstein-Barr virus and Kaposi-sarcoma associated Human Herpes Virus 8 may play a relevant role in the pathogenesis of PBL. PBL patients have been treated heterogeneously, with a combination of chemotherapy, radiotherapy and/or surgery, and their prognosis is usually poor, with a death rate of approximately 60% at 1 year.

Isolation of Candida dubliniensis for the First Time in Cali, Colombia, and its Identification with Phenotyping Methods

Candida dubliniensis is an emerging pathogenic yeast isolated mainly from the oral cavity of HIV-infected patients. The close phenotypic and genotypic relationship between C. albicans and C. dubliniensis has led to incorrectly identifying isolates of C. dubliniensis as C. albicans. The oral cavities of 107 diabetic patients were studied in Cali, Colombia, and 72 colonies of Candida, with shades of green on CHROMagar Candida culture media, were obtained. Various phenotypic tests were carried out, which included germ tube formation and production of chlamydospores on corn meal Agar. Additionally, growth studies were carried out at 42 degrees C and 45 degrees C and on Sabouraud agar with 6.5%, sodium chloride. Identification of C. dubliniensis with these tests was confirmed with API 20C Aux. We identified 65 and 7 colonies of C. albicans and C. dubliniensis, respectively. This is the first time that C. dubliniensis is identified with phenotypic methods in Colombia.

In vitro activity of inexpensive topical alternatives against Candida spp. isolated from the oral cavity of HIV-infected patients

The use of inexpensive topical alternatives, e.g. oil of melaleuca (tea tree oil (TTO)), chlorhexidine (CHX), povidone iodine (PI) and gentian violet (GV), to treat oral candidiasis in human immunodeficiency virus (HIV)-infected patients has been proposed in resource-poor countries. However, pre-clinical studies comparing the antifungal activity of these agents are lacking. This study compared the minimal inhibitory concentrations (MICs) of TTO, GV, PI, CHX and fluconazole (FLZ) against 91 clinical Candida strains using Clinical and Laboratory Standard Institute (CLSI) methodology. Isolates were obtained from the oral cavity of acquired immune deficiency syndrome (AIDS) patients. Among the topical agents examined, GV showed the most potent activity against all Candida isolates tested (MIC range, MIC for 50% of the organisms (MIC 50) and MIC for 90% of the organisms (MIC 90) of 0.03–0.25 μg/mL, 0.06 μg/mL and 0.12 μg/mL, respectively). CHX was 64 times less active than GV (MIC range, MIC 50 and MIC 90 of 0.5–16 μg/mL, 4 μg/mL and 8 μg/mL, respectively). The lowest antifungal activity was seen for PI (MIC 90 = 0.25%). Moreover, GV, unlike the other topical agents tested, was fungicidal (minimum fungicidal concentration = 1 μg/mL) against Candida albicans isolates ( n = 83). In addition, GV showed activity against FLZ-resistant C. albicans ( n = 3). The combination of GV and FLZ was not antagonistic and there was no interaction between the two compounds. GV possesses potent antifungal activity against FLZ-susceptible and -resistant Candida strains and is not antagonistic when used in combination with FLZ. In vivo evaluation is warranted.

Oral Candida colonization of human immunodeficiency virus infected subjects in Turkey and its relation with viral load and CD4+ T‐lymphocyte count

The association of asymptomatic oral Candida colonization with the markers of immunodeficiency and HIV is not clear yet. In addition, the prevalence of different Candida species colonizing the oral cavity of HIV-infected patients in Turkey remains unknown. To evaluate these subjects, oral rinse samples were taken from 64 HIV-positive individuals who have come to the department of Microbiology and Clinical Microbiology, Istanbul Medical Faculty for viral load and CD4(+) T-lymphocyte count measurement. The specimens were plated quantitatively on CHROMagar Candida. Oral Candida colonization was detected in 53 (82.8%) patients. The species isolated most frequently from carriers was Candida albicans (83%), followed by Candida glabrata (22.6%) and Candida dubliniensis (11.3%). More than one Candida spp. was isolated from 16 (30%) colonized patients. The status of yeast carriage and Candida load was not associated with the number of CD4(+) cells or the viral load. Similarly, there was no statistical relation between the use of protease inhibitors, age, gender, smoking and the oral carriage of Candida. Other factors, which may be responsible for the high oral carriage of Candida spp. in this patient group, need to be researched.

Asymptomatic oral carriage of Candida species in HIV-infected patients in the highly active antiretroviral therapy era

Oropharyngeal candidiasis is the most common opportunistic fungal infection in individuals infected with human immunodeficiency virus. CD4+ lymphocytes count and the quantification of viral RNA in blood plasma have been found to be the main markers of HIV disease progression. The present study was conducted to evaluate Candida sp. diversity in the oral cavity of HIV-infected patients and to determine whether there was association of CD4+ cell count and viral load with asymptomatic oral Candida carriage. Out of 99 HIV-positive patients studied, 62 (62.6%) had positive culture for Candida (oral carriage) and 37 patients (37.4%) had Candida negative culture (no oral carriage). The etiologic agents most common were C. albicans and C. tropicalis. The range of CD4+ was 6-2305 cells/mm3 in colonized patients and 3-839 cells/mm3 for non-colonized patients, while the viral load was 60-90016 copies/mL for colonized patients and 75-110488 copies/mL for non colonized patients. The viral load was undetectable in 15 colonized patients and in 12 non colonized patients. Our results showed that there was no significant difference of the variables CD4+ cell count and viral load between oral candida carriage and no oral candida carriage patients.

Point prevalence, microbiology and fluconazole susceptibility patterns of yeast isolates colonizing the oral cavities of HIV-infected patients in the era of highly active antiretroviral therapy.

We conducted a prospective study to address the prevalence and microbiological characteristics of yeast isolates colonizing the oral cavities of HIV-infected patients undergoing highly active antiretroviral therapy. Sixty-eight patients (67%) from a total of 102 were found to be colonized with yeasts. Sixty-five patients carried a single species (60 Candida albicans, three Candida glabrata and two Candida krusei) and three patients had mixed colonization of C. albicans and C. krusei. The status of yeast carrier was not associated with the number of CD4 cells or the viral load. Similarly, the type of antiretroviral regimen was not associated with the carriage of Candida spp. The only predictor of Candida colonization was a previous history of oropharyngeal candidiasis (P = 0.009). Although many patients in this series had already been treated with repeated courses of fluconazole therapy for previous episodes of oropharyngeal candidiasis, fluconazole susceptibility patterns showed that 93% of yeasts were susceptible to this triazole in vitro (MIC < or = 8.0 mg/L).

Replacement of Candida albicans with C. dubliniensis in human immunodeficiency virus-infected patients with oropharyngeal candidiasis treated with fluconazole.

Candida dubliniensis is an opportunistic yeast that has been increasingly implicated in oropharyngeal candidiasis (OPC) in human immunodeficiency virus (HIV)-infected patients but may be underreported due to its similarity with Candida albicans. Although most C. dubliniensis isolates are susceptible to fluconazole, the inducibility of azole resistance in vitro has been reported. Thus, the use of fluconazole prophylaxis in the treatment of these patients may have contributed to the increasing rates of isolation of C. dubliniensis. In this study, yeast strains were collected from the oral cavities of HIV-infected patients enrolled in a longitudinal study of OPC. Patients received fluconazole for the suppression or treatment of OPC, and isolates collected at both study entry and end of study were chosen for analysis. Samples were plated on CHROMagar Candida medium for initial isolation and further identified by Southern blot analysis with the species-specific probes Ca3 (for C. albicans) and Cd25 (for C. dubliniensis). Fluconazole MICs were determined by using NCCLS methods. At study entry, susceptible C. albicans isolates were recovered from oral samples in 42 patients who were followed longitudinally (1 to 36 months). C. albicans strains from 12 of these patients developed fluconazole resistance (fluconazole MIC, >/=64 micro g/ml). C. dubliniensis was not detected at end of study in any of these patients. Of the remaining 30 patients, eight (27%) demonstrated a replacement of C. albicans by C. dubliniensis when a comparison of isolates obtained at baseline and those from the last culture was done. For the 22 of these 30 patients in whom no switch in species was detected, the fluconazole MICs for initial and end-of-study C. albicans isolates ranged from 0.125 to 2.0 micro g/ml. For the eight patients in whom a switch to C. dubliniensis was detected, the fluconazole MICs for C. dubliniensis isolates at end of study ranged from 0.25 to 64 micro g/ml: the fluconazole MICs for isolates from six patients were 0.25 to 2.0 micro g/ml and those for the other two were 32 and 64 micro g/ml, respectively. In conclusion, a considerable number of patients initially infected with C. albicans strains that failed to develop fluconazole resistance demonstrated a switch to C. dubliniensis. C. dubliniensis in this setting may be underestimated due to lack of identification and may occur due to the impact of fluconazole on the ecology of oral yeast species.

Diversity of naturally occurring Epstein-Barr virus revealed by nucleotide sequence polymorphism in hypervariable domains in the BamHI K and N subgenomic regions.

The extent of nucleotide sequence microheterogeneity varies among subgenomic regions of Epstein-Barr virus (EBV). We examined, in EBV-carrying lymphoid cell lines, the extent of polymorphism in EBV DNA fragments amplified from the BamHI E, K, N and Z regions, and then investigated the diversity of the more hypervariable regions in tissues and body fluids. In cell lines, sequence dissimilarities in a genotype-specifying fragment of the EBNA-3C gene varied from < 1-4% within each genotype; dissimilarities in the first intron of the BZLF- 1 gene were < 2% within each genotype. By contrast, dissimilarities in a C-terminal unique domain of the EBNA-1 gene, and in a fragment that encompasses and is upstream of the LMP-1 start codon, varied between 2 and 7% and were not genotype-specific. The sequence diversity in BamHI K and N regions was then examined in tissues and body fluids by single-strand conformation polymorphism (SSCP) analysis and cycle sequencing. Extensive inter-host diversity was observed, whether the host was co-infected by human immunodeficiency virus (HIV) or not. In the oral cavity of HIV-infected patients, inter-compartmental EBV diversity could be demonstrated, even between sites that were anatomically proximate. Studies of BamHI K clones derived from EBV in oral lesions revealed infection by multiple variants. Identification of hypermutable loci within the EBV genome such as those located in the BamHI K and N regions should permit fine discrimination of individual EBV variants.

A longitudinal study of the change in resistance patterns and genetic relationship of oralCandida albicansfrom HIV-infected patients

Candida albicans is an important opportunistic pathogen in the oral cavity of HIV-infected patients. C. albicans was isolated repeatedly over a period of 30 months from the mouth-swills of five males with category IV HIV infection who suffered from recurrent pseudomembranous oral candidosis and were being treated with fluconazole. C. albicans was identified by the germ tube test, carbon assimilation by the API 20C test (bioMerieux sa, Marcy, l'Etoile, France) and morphology on cornmeal Tween 20 agar. Sensitivity testing was performed with a disk diffusion method using neosensitabs (Rosco Diagnostica, Taasrup, Denmark) and the broth microdilution assay using RPMI 1640 medium. Isolates from the five patients taken between 14 and 30 months apart (mean = 23 months) showed the development of resistance to several antifungal agents, notably fluconazole, miconazole and itraconazole by the disc diffusion method and markedly higher minimum inhibitory concentrations (MICs) for fluconazole by the broth microdilution assay. Genetic relatedness of the C. albicans strains was assessed using the mixed-linker polymerase chain reaction method. Four patients had isolates which were genetically identical, while one patient had isolates of varying genetic type. This study has shown that in HIV-infected patients with recurrent oral pseudomembraneous candidosis, the development of drug resistance to antifungal agents may either be due to increased resistance of a single strain or replacement with a more resistant strain.

Increased expression of extracellular proteolytic activity in Candida albicans isolates from the oral cavities of HIV-infected patients

Increased expression of extracellular proteolytic activity in Candida albicans isolates from the oral cavities of HIV-infected patients

The lectin type of Candida albicans--an epidemiological marker relevant to pathogenesis.

Fifty Candida albicans strains isolated from the oral cavities of HIV-infected patients were typed with 14 different lectins by means of agglutination reactions. Sixteen different lectin types could be distinguished, the most frequent type representing 22% of strains. A change in the lectin type was found in about half of the Candida albicans strains representing control cultures from identical individuals. A simplified typing scheme based on three lectins seems to be almost as efficacious for epidemiological application.