amphotericin-b and Candidiasis--Oral

Candidiasis is one of the most common opportunistic oral infections that presents different acute and chronic clinical presentations with diverse diagnostic and therapeutic approaches. The present study carries out a bibliographic review on the therapeutic tools available against oral candidiasis and their usefulness in each clinical situation.. Recent studies on treatment of oral candidiasis were retrieved from PubMed and Cochrane Library.. Nystatin and miconazole are the most commonly used topical antifungal drugs. Both antifungal drugs are very effective but need a long time of use to eradicate the infection. The pharmacological presentations of miconazole are more comfortable for patients but this drug may interact with other drugs and this fact should be assessed before use. Other topical alternatives for oral candidiasis, such as amphotericin B or clotrimazole, are not available in many countries. Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment. Other systemic treatment alternatives, oral or intravenous, less used are itraconazole, voriconazole or posaconazole. Available novelties include echinocandins (anidulafungin, caspofungin) and isavuconazole. Echinocandins can only be used intravenously. Isavuconazole is available for oral and intravenous use. Other hopeful alternatives are new drugs, such as ibrexafungerp, or the use of antibodies, cytokines and antimicrobial peptides.. Nystatin, miconazole, and fluconazole are very effective for treating oral candidiasis. There are systemic alternatives for treating recalcitrant infections, such as the new triazoles, echinocandins, or lipidic presentations of amphotericin B.

Topics: Administration, Intravenous; Administration, Oral; Administration, Topical; Amphotericin B; Anidulafungin; Antifungal Agents; Azoles; Candidiasis, Oral; Caspofungin; Clotrimazole; Databases, Factual; Drug Interactions; Echinocandins; Fluconazole; Humans; Miconazole; Nitriles; Nystatin; Pyridines; Triazoles

Dysphagia following cardiac surgery is a frequently encountered problem, being most commonly due to the sternotomy incision and/or prolonged intubation. Oesophageal candidiasis is an increasing problem that is usually associated with immunosuppression or immunodeficiency. We report a 59 years age, immunocompetent lady whom had developed dysphagia and odynophagia following open cardiac surgery and long term course of antibiotics. Diagnosis of Candida oesophagitis was established after radiological, endoscopic and microbiological evidence, and successful treatment with combined topical and systemic antifungal therapy was achieved. Possibility of immunodeficiency was excluded. We believe that this lady developed oesophageal candidiasis due to a long-term course of broad spectrum antibiotics. We discuss the various diagnostic modalities and treatment options.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candidiasis, Oral; Deglutition Disorders; Dilatation; Drug Therapy, Combination; Esophagitis; Female; Humans; Immunocompetence; Middle Aged; Nystatin; Thoracic Surgery; Treatment Outcome

Not only have the systemic mycoses clearly increased in number but also mycoses of the skin are more common than presumed in the past. Today onychomycosis is found in up to 10% of human beings. Onychomycosis can compromise quality of life markedly. Common tinea pedis is one of the most important risk factors for erysipelas of the lower legs. The clinical presentation of oral candidosis in HIV-infected patients is changing; Candida dubliniensis has been identified as another important causative microorganism. Onychomycosis today in most cases can be cured using terbinafine or itraconazole. When choosing the ideal drug in a given case, both the benefit risk ratio and the benefit cost ratio have to be taken into account. Liposomally encapsulated amphotericin B represents a major breakthrough in the treatment of systemic mycoses or fever of unknown origin. The same applies to liposomally encapsulated econazole with respect to tinea pedis. In regard to the pathogenesis of Candida infections the family of secreted aspartic proteinases plays a major role as a virulence factor and possible future target for antimycotic treatment.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspartic Acid Endopeptidases; Axilla; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Case-Control Studies; Child; Clinical Trials as Topic; Dermatomycoses; Female; Humans; Liposomes; Microscopy, Immunoelectron; Multicenter Studies as Topic; Multivariate Analysis; Naphthalenes; Onychomycosis; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Terbinafine; Tinea; Tinea Pedis; Trichophyton

A systematic review of randomized clinical trials published between 1966 and April 2000 was undertaken to determine the strength of evidence for the effectiveness of antifungal drugs (nystatin, clotrimazole, amphotericin B, fluconazole, ketoconazole, and itraconazole) to prevent and treat oral candidiasis in human immunodeficiency virus-positive patients.. An automated database search identified 366 articles. Six met inclusion and exclusion criteria with respect to prophylaxis; 12 met criteria for treatment of oral candidiasis.. The evidence for the prophylactic efficacy of fluconazole is good, although insufficient to draw conclusions about the other antifungals. Evidence for treatment effectiveness is insufficient for amphotericin B but good for nystatin, clotrimazole, fluconazole, ketoconazole, and itraconazole.. Suggestions for strengthening the evidence base include the following: use of larger, more well-defined groups; control for immunologic status, viral load, history of oral candidiasis, past exposure to antifungals, baseline oral Candida carriage, drug interactions, and antiretroviral therapy; and consistent use of compliance monitors, fungal speciation, and susceptibility testing.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candidiasis; Candidiasis, Oral; Clotrimazole; Databases as Topic; Fluconazole; HIV Seropositivity; Humans; Itraconazole; Ketoconazole; Nystatin; Oropharynx; Pharyngeal Diseases; Randomized Controlled Trials as Topic; Research Design; Statistics as Topic; Treatment Outcome

As both humans and fungi are eukaryotic organisms, antifungal agents affect their cellular metabolism. Thus, a relatively few antifungals with minimal toxicity and side-effects are available compared with a plethora of antibacterials. These agents currently prescribed in dentistry belong to two major groups, the polyenes (nystatin and amphotericin B) and the azoles (imidazoles and triazoles). A newly recognized phenomenon known as the post-antifungal effect implies that antifungals, even at sub-therapeutic concentrations, may suppress the virulent attributes of yeasts, especially intra-orally where topical drug levels fluctuate dramatically during dosing intervals.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Clotrimazole; Drug Interactions; Drug Resistance, Microbial; Fluconazole; Humans; Itraconazole; Ketoconazole; Miconazole; Nystatin; Virulence

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Infective Agents, Local; Antifungal Agents; Candida; Candidiasis, Oral; Chlorhexidine; Clotrimazole; Drug Resistance, Fungal; Fluconazole; Flucytosine; Humans; Immunocompromised Host; Itraconazole; Ketoconazole; Miconazole; Mouth; Nystatin; Opportunistic Infections; Saliva; Treatment Failure; Triazoles

The high frequency of oropharyngeal candidiasis in immunocompromised patients has led many institutions to develop protocols to guide the use of antifungal agents in the treatment of this opportunistic infection. However, few specific recommendations have been made for directing the management of oropharyngeal candidiasis in patients infected with HIV. To meet this need, a panel of experts representing a variety of disciplines met to formulate a consensus and devise a treatment strategy for clinical application. Among other recommendations, the algorithm calls for use of a topical agent for the treatment of initial and recurring oropharyngeal candidiasis in HIV-infected patients, provided there is no esophageal involvement, patients' CD4+ lymphocyte cell count is >50 cells/mm3, and they are currently receiving or expected to receive effective antiretroviral treatment. For episodes of oropharyngeal candidiasis with concurrent esophageal involvement or where patients have a CD4+ cell count of <50 cells/mm3, are not receiving or anticipating highly active antiretroviral therapy (HAART), and have a high viral load, the algorithm suggests a systemic oral azole as the more appropriate treatment choice. Acute treatment of all oropharyngeal candidiasis episodes is preferred. Chronic suppressive antifungal treatment is to be avoided in recognition of the potential for the development of drug-resistant infection.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; AIDS-Related Opportunistic Infections; Algorithms; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Candidiasis; Candidiasis, Oral; Clotrimazole; Dosage Forms; Esophagitis; Humans; Imidazoles; Viral Load

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Clinical Trials as Topic; Cryptococcosis; Drug Resistance, Microbial; Esophageal Diseases; Female; Fluconazole; Fungi; Humans; Ketoconazole; Male; Retrospective Studies

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Candidiasis, Oral; Clinical Trials as Topic; Dermatomycoses; Esophageal Diseases; Humans; Itraconazole; Meningitis, Cryptococcal; Mycoses; Pharyngeal Diseases; Tropical Medicine

Mucormycosis (phycomycosis, zygomycosis) is an acute opportunistic infection caused by a saprophytic fungus found in soil, bread molds, and decaying fruits and vegetables. Numerous predisposing risk factors are associated with mucormycosis, although most cases have been reported in poorly controlled diabetics or in patients with hematologic malignant conditions. This report presents two cases of oral mucormycosis. One case occurred in the maxilla in a patient with well-controlled diabetes. The other involved the mandible and overlying gingiva in a patient with acute myelogenous leukemia. A review of the literature concerning oral mucormycosis is also presented.

Topics: Adult; Aged; Amphotericin B; Candidiasis, Oral; Diabetes Complications; Gingival Diseases; Humans; Leukemia, Myeloid, Acute; Male; Mandibular Diseases; Maxillary Diseases; Mouth Diseases; Mucormycosis

Topics: Amphotericin B; Candidiasis, Oral; Denture, Complete; Denture, Partial; Disease Susceptibility; Humans; Miconazole; Nystatin; Stomatitis, Denture

Topics: Acetylglucosamine; Adult; Aged; Amphotericin B; Candida albicans; Candidiasis, Oral; Humans; Nystatin

Topics: Amphotericin B; Candida; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Cheilitis; Female; Folliculitis; Gastrointestinal Diseases; Humans; Immunologic Deficiency Syndromes; Intertrigo; Leukoplakia, Oral; Male; Nystatin; Paronychia

Candida albicans causes debilitating, often azole-resistant, infections in patients with chronic mucocutaneous candidiasis (CMC). Amphotericin B (AMB) resistance is rare, but AMB use is limited by parenteral administration and nephrotoxicity. In this study, we evaluated cochleated AMB (CAMB), a new oral AMB formulation, in mouse models of oropharyngeal candidiasis (OPC) and vulvovaginal candidiasis (VVC) and in patients with azole-resistant CMC. OPC and VVC were modeled in

Topics: Amphotericin B; Animals; Antifungal Agents; Azoles; Candida albicans; Candidiasis; Candidiasis, Chronic Mucocutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Female; Humans; Mice

The effectiveness of amphotericin B oral suspension versus nystatin oral suspension for the prevention of oral colonization by Candida in hematopoietic cell transplant (HCT) patients was examined.. Prior to hematopoietic cell infusion, 40 patients receiving systemic fluconazole for prophylaxis were randomized to receive either amphotericin B oral suspension or nystatin oral suspension, q.i.d. The study continued to day 21 or until the patient was discharge from the hospital or withdrawn from the study. Oral examinations were conducted twice weekly, and adverse events and compliance were recorded. Cultures were taken for quantitative counts and species identification. Candida isolates were assessed for resistance to the oral antifungal agents. Blood was collected for assessment of amphotericin B levels.. Ulcerative mucositis occurred in 84.6% of patients undergoing HCT, and no correlation was observed between the severity of mucositis and the presence of oral Candida and the severity of mucositis. Systemic and topical antifungal treatment resulted in a decrease in the number of colonized patients (54.8% before treatment; 23.1% during treatment); however, oral colonization was not eliminated. Tolerability of the oral rinse products was limited, with greater noncompliance in the amphotericin B than the nystatin group. Reports of altered taste appeared to be greater in the amphotericin B group. Minimal absorption of amphotericin B was seen following oral rinsing (serum levels 0.12-0.50 microg/ml), and no consistent changes in organism susceptibility to polyenes were seen. The results suggest that topical antifungal rinses may further control oropharyngeal colonization by Candida in patients on systemic antifungals receiving HCT, but the effect is limited by tolerability and reformulation and should be considered in order to increase compliance.

Topics: Administration, Oral; Adolescent; Adult; Aged; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Candidiasis, Oral; Female; Fluconazole; Gingivitis, Necrotizing Ulcerative; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Mouth; Mouthwashes; Nystatin; Polyenes; Severity of Illness Index; Time Factors; Treatment Outcome

Inhaled steroids such as fluticasone propionate and beclomethasone dipropionate play a central role in the treatment of bronchial asthma. Fluticasone exhibits excellent clinical effectiveness; however, oral adverse effects can occur.. To compare the frequency of oral candidiasis in asthmatic patients treated with fluticasone and beclomethasone, to evaluate the effect of gargling with amphotericin B, and to measure the inhalation flow rate on candidiasis.. The study consisted of 143 asthmatic patients who were treated with inhaled steroids, 11 asthmatic patients not treated with inhaled steroids, and 86 healthy volunteers. Quantitative fungal culture was performed by aseptically obtaining a retropharyngeal wall swab from these patients. Patients with positive results were treated with gargling using a 1:50 dilution amphotericin B solution. In asthmatic patients treated with fluticasone, the inhalation flow rate was measured using an inspiratory flow meter.. The amount of Candida spp. was significantly greater in asthmatic patients taking inhaled steroids compared with those who were not. It was also significantly greater in patients with oral symptoms than asymptomatic patients and significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Although the presence of Candida did not correlate with the inhaled dose of beclomethasone, it did increase with the dose of fluticasone. Gargling with amphotericin B was effective in most asthmatic patients with candidiasis. Candidiasis was not due to inappropriate flow rates during inhalation of steroids.. Fungal culture of a retropharyngeal wall swab may be useful for predicting the risk of developing oral candidiasis in asthmatic patients treated with inhaled steroids. The amount of isolated Candida was significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Attention to dosage is required as the amount of Candida increased with dose of fluticasone. Gargling with a 1:50 dilution of amphotericin B is effective in treating oral candidiasis of asthmatic patients treated with inhaled steroids.

Topics: Administration, Inhalation; Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Androstadienes; Anti-Inflammatory Agents; Antifungal Agents; Asthma; Beclomethasone; Candidiasis, Oral; Dose-Response Relationship, Drug; Drug Hypersensitivity; Female; Fluticasone; Glucocorticoids; Humans; Japan; Male; Middle Aged; Regression Analysis; Statistics as Topic; Treatment Failure

This randomized study compared the efficacy and safety of fluconazole suspension with that of amphotericin B suspension in patients with head and neck cancer who were suffering from candidiasis during cancer treatment with radiotherapy and/or chemotherapy. A total of 123 evaluable patients received 50 mg fluconazole once daily and 120 evaluable patients received 0.5 g amphotericin B thrice daily for 7-14 days depending on clinical response. A positive culture result was obtained in 121 of 264 (46%) patients; Candida albicans was most common. At the end of treatment, fluconazole and amphotericin B were equivalent (CI(90) of -10.7 to +14.9) in terms of clinical cure and improvement, but the rate of mycologic cure was higher for fluconazole (48%) than amphotericin B (35%). The incidence of adverse events was 39% for fluconazole and 44% for amphotericin B. Fluconazole suspension appeared effective and safe.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Female; Fluconazole; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth Mucosa; Stomatitis; Treatment Outcome

the optimum treatment for oropharyngeal candidosis, particularly in older patients, has not been established. Local treatment with nystatin and amphotericin B can be problematic. The oral suspension formulation of fluconazole may offer a good alternative to these conventional agents.. to compare the safety and efficacy of fluconazole oral suspension with amphotericin B oral suspension in the treatment of older patients with oropharyngeal candidosis.. randomized open-label study.. three hundred and five patients, aged 62 or older, with at least one sign or symptom of oropharyngeal candidosis.. we evaluated patients for the signs and symptoms of candidosis before receiving the study drug and on days 4, 7 and 14. We assessed patients who were cured or improved after 7-14 days of treatment 2 weeks after the end of treatment (follow-up). We obtained specimens from buccal lesions for microscopic examination (baseline only) and culture at baseline and on days 7 and 14. Patients were evaluated for adverse events on days 4, 7 and 14.. one hundred and fifty patients received fluconazole and 155 received amphotericin B. There were no statistically significant differences in clinical or mycological response between fluconazole and amphotericin B at the end of treatment or at follow-up. At the end of treatment, 122 (81%) of 150 fluconazole-treated and 135 (87%) of 155 amphotericin B-treated patients were clinically cured or improved. Mycological cure rates were 35% and 46% for fluconazole and amphotericin B, respectively. The symptoms of burning sensation and buccal pain resolved significantly sooner (P < 0.05) in fluconazole-treated patients. The presence of dentures did not affect the response to antifungal therapy. The incidence of adverse events was 46% in the fluconazole group and 50% in the amphotericin B group (not statistically significant).. fluconazole oral suspension is a good therapeutic alternative to amphotericin B oral suspension in the treatment of older patients with oropharyngeal candidosis.

Topics: Administration, Oral; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Consumer Product Safety; Female; Fluconazole; Humans; Male; Middle Aged; Risk Factors; Treatment Outcome

To determine the efficacy and safety of amphotericin B oral suspension (ABOS) for the treatment of fluconazole refractory oral candidiasis in persons with HIV infection.. A prospective, multicenter, open label trial at 25 study centers within the AIDS Clinical Trials Group.. Individuals with diffuse oral candidiasis after 14 days of treatment with 200 mg of fluconazole daily (more than five plaques or a single plaque > 3 cm largest length) were treated with ABOS, 100 mg/ml, 5 ml swish and swallow, four times daily for 14 days. Thereafter incomplete or non-responders received an additional 14 days of therapy and responders received maintenance ABOS twice daily for up to 6 months. Relapses during maintenance ABOS were treated by increasing the dose to four times daily.. To demonstrate an ABOS clinical response rate > 33% and a treatment-limiting toxicity rate < 50%. Clinical response was defined as the absence of mouth pain and the presence of less than five oral plaques, the largest being < 3 cm largest dimension.. Fifty-eight subjects with a median age of 39 years and a median CD4 count of 10 x 10(6) cells/l were enrolled. Four subjects were excluded from the analysis because of inadequate follow-up after randomization (n = 3) or the presence of active esophageal disease (n = 1). Of the remaining 54 subjects, 23 (42.6%; 95% lower confidence interval, 31.1%) were classified as responders after 28 days. Five subjects (9%) stopped treatment due to toxicity. Relapse occurred in 16 responders (70%).. Amphotericin B oral suspension is well tolerated but has limited efficacy for the treatment of fluconazole refractory oral candidiasis.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Drug Resistance, Microbial; Female; Fluconazole; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Treatment Outcome

Multilocus enzyme electrophoresis (MEE) and in vitro antifungal susceptibility testing were used to investigate the Candida albicans strain diversity in twenty nine AIDS patients from Abidjan (Ivory Coast). All patients were monitored for a first episode of oropharyngeal candidiasis and were randomly clustered into three groups of therapy: ketoconazole, amphotericin B or nystatin. Oral swabs were collected before every treatment, 14 and 30 days after the initiation of the therapy; a total of 67 isolates were investigated. No resistant or less susceptible isolate to any antifungal agent was found despite the emergence of clinical relapses, mainly for patients treated with nystatin or amphotericin B. The MEE analysis revealed 27 different electrophoretic types (ETs). Genetic distances between ETs were statistically analyzed and represented on a dendrogram. The 27 ETs clustered into three groups; in each group, ETs represented variants of the same strain. A segregation of the C. albicans isolates seemed to be as a function of the serotype.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Oral; Cote d'Ivoire; Drug Resistance, Microbial; Fungal Proteins; Genetic Variation; Humans; Ketoconazole; Middle Aged; Nystatin; Phylogeny; Treatment Outcome

Radiotherapy given during treatment of oral and pharyngeal malignancy is frequently associated with colonization of the oral mucosa by Candida species. Treatment of these infections has included topical and systemic agents. In the present study 73 patients with oropharyngeal candidosis were treated with either amphotericin B (10 mg lozenges, four times daily for 14 days, 36 patients) or fluconazole (50 mg daily for 7 days, 37 patients). The yeasts most frequently isolated were C albicans and C glabrata. Clinical signs and symptoms showed improvement at end of treatment in 72% of patients who received amphotericin B compared with 92% of patients who received fluconazole. Mycological cure at end of treatment was achieved in 31% of the amphotericin B group and 46% of patients who received fluconazole. For both treatments the cure rate was less in denture wearers than in non denture wearers.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Colony Count, Microbial; Cranial Irradiation; Dentures; Female; Fluconazole; Head and Neck Neoplasms; Humans; Middle Aged; Pharyngeal Diseases; Treatment Outcome

Fungal infections are a major problem in patients with hematologic malignancy. Attempts to reduce their frequency with antifungal agents have not been successful. A double-blind, controlled, single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy. Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions. End points were amphotericin B use, fungal infection, stable neutrophil count > 0.5 x 10(9)/L, toxicity precluding further fluconazole use, and death. By Kaplan-Meier estimation, the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole (P = .003). Also, fluconazole reduced the number of febrile days by 20% (P = .002) and prevented oropharyngeal candidiasis (1/75 vs. 9/76, P = .018). The frequency of deep mycoses (8/76 vs. 8/75) and outcome were unaffected. Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia (P = .01).

Topics: Adult; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Aspergillosis; Bacteremia; Candidiasis, Oral; Double-Blind Method; Drug Therapy, Combination; Fever; Fluconazole; Humans; Incidence; Infusions, Intravenous; Leukemia; Lymphoma; Middle Aged; Mycoses; Neutropenia; Treatment Outcome

Oral candidal infection is a common problem in bone marrow transplantation. This prospective study compared the effectiveness of antifungal prophylaxis with topical antifungals (nystatin and amphotericin B suspensions) versus oral fluconazole in 196 patients undergoing bone marrow transplantation. Oral candidosis occurred frequently in the group receiving topical antifungals (61/113, 54%), but was rare in the group receiving fluconazole (6/83, 7%). The difference in efficacy between the two groups was highly significant (p < 0.00001). There was no difference in the incidence of suspected systemic fungal infection between the two groups. While nausea was a problem with antifungal suspensions, no significant adverse reactions to fluconazole occurred. Because of greater efficacy in preventing oral candidosis and better patient tolerance, oral fluconazole is preferred to antifungal suspensions for prophylactic use in patients undergoing bone marrow transplantation.

Topics: Administration, Oral; Adolescent; Adult; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Bone Marrow Transplantation; Candidiasis, Oral; Child; Drug Combinations; Fellowships and Scholarships; Female; Fluconazole; Humans; Male; Middle Aged; Mouthwashes; Nystatin; Prospective Studies; Retrospective Studies

The efficacy of fluconazole and amphotericin in the management of denture stomatitis was investigated in a comparative trial. Patients were assessed clinically, hematologically, and mycologically at the time of entry into the study and at 1, 4, and 12 weeks thereafter. A total of 29 patients were selected at random to receive 50 mg of fluconazole daily for 14 days; 30 patients were selected to receive amphotericin lozenges and cream for 28 days. Clinical response rates were similar in both treatment groups throughout the study. The best mycologic response was noted after 1 week whereas the best clinical response was observed after 4 weeks. Clinical evidence of relapse and recurrence at 12 weeks was a common finding irrespective of treatment. Side effects were uncommon in both groups.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis, Oral; Erythema; Female; Fluconazole; Humans; Male; Middle Aged; Random Allocation; Stomatitis, Denture

To compare the tolerance, efficacy, and pharmacokinetics of amphotericin deoxycholate (Fungizone) prepared in a parenteral fat emulsion (Intralipid 20%) or glucose in HIV patients with candidiasis.. Non-blind randomised controlled trial.. University hospital; tertiary clinical care.. 22 HIV positive patients with oral candidiasis.. Amphotericin 1 mg/kg/day given on four consecutive days as a one hour infusion dissolved in either 5% glucose (amphotericin-glucose) or parenteral fat emulsion at a final concentration of 2 g/l fat emulsion (amphotericin-fat emulsion).. Clinical tolerance (fever, chills, sweats, nausea, arterial pressure, and pulse rate); biological tolerance (serum creatinine, electrolyte, and magnesium values); clinical score of candidiasis; and serum concentrations of amphotericin.. 11 patients were enrolled in each group. All the amphotericin-fat emulsion infusions were given without serious problem whereas four amphotericin-glucose infusions were stopped because of renal impairment (n = 3) or severe chills (n = 2), or both. For patients completing the amphotericin-glucose treatment creatine concentration increased by 42 mumol/l; four of seven patients had at least one creatinine value > or = 133 mumol/l versus one of 11 receiving amphotericin-fat emulsion. Magnesium concentration fell significantly with amphotericin-glucose but not with amphotericin-fat emulsion. Clinical side effects were noted in 36/38 infusions with amphotericin-glucose but 10/44 with amphotericin-fat emulsion. Oral candidiasis score was reduced similarly in both groups. Serum amphotericin concentrations were significantly lower and the volume of distribution of the drug higher after infusion of amphotericin-fat emulsion than after amphotericin-glucose.. Clinical and renal toxicity of amphotericin are reduced when the drug is prepared in fat emulsion. Preparation is simple and cost effective. Its efficacy is similar to that of conventional amphotericin.

Topics: Adolescent; Adult; Aged; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Deoxycholic Acid; Drug Combinations; Excipients; Fat Emulsions, Intravenous; Glucose; HIV Infections; Humans; Infusions, Intravenous; Middle Aged

This study assessed the efficacy, toxicity, and pharmacology of low-dose amphotericin B given prophylactically to patients (serum concentrations of 0.2-0.4 microgram/ml) undergoing bone marrow transplantation. Yeast isolates from patients' oropharyngeal areas had MICs of 0.1-0.2 microgram/ml, and none were amphotericin B resistant. The effect of low-dose amphotericin B on reducing the numbers of yeast colonizing the oropharyngeal area was significant (P less than .01). The average delay in switching to high-dose prophylactic amphotericin B was only 1 day; the decision to do so because of a perceived fungal infection occurred more frequently for the placebo group (P = .06). Fewer patients from the low-dose amphotericin B group (8.8%) than from the placebo group (14.3%) had fungi isolated from normally sterile body sites (P = .35). Infusion-related side effects but not systemic toxicities were significantly greater (P less than .001) in the amphotericin B group. The 6-week survival was greater in those receiving amphotericin B (P less than .03), but the improved survival could not be attributed to the prevention of fungal infections.

Topics: Adult; Amphotericin B; Bone Marrow Transplantation; Candidiasis, Oral; Female; Humans; Infusions, Intravenous; Male; Mycoses; Neutropenia; Oropharynx

Mucositis induced by irradiation is the reactive inflammatory-like process of the oropharyngeal mucous membranes following irradiation. Bacteria colonizing the oral tissues are thought to contribute to this inflammatory process. The eradication of Gram-negative bacilli (selective elimination of oral flora) in fifteen comparably irradiated head and neck cancer patients was found to be associated with a significant reduction in mucositis compared with two groups of 15 patients receiving either placebo or chlorhexidine rinsing. Criteria used were the extent of local mucositis signs (mucositis score), as well as generalized side-effects such as the need of nasogastric tube feedings following severe feeding problems. Mucositis signs were confined to erythema only in all selectively decontaminated patients. No pseudomembranes were observed and artificial feeding was completely prevented. These promising results need further confirmation in larger (multicenter) studies.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis, Oral; Colistin; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Head and Neck Neoplasms; Humans; Male; Middle Aged; Mouth; Prospective Studies; Radiotherapy; Radiotherapy Dosage; Stomatitis; Tobramycin

This report is a survey of epidemiological facts about oro-gastro-intestinal tract mycoses. It is documented that children and older people suffer more often from oro-gastro-intestinal tract mycoses than the rest of the average population. In addition older patients with oro-gastro-intestinal tract mycoses show predisposing factors more frequently than younger people.

Topics: Adolescent; Adult; Aged; Amphotericin B; Candidiasis, Oral; Child; Child, Preschool; Clinical Trials as Topic; Gastrointestinal Diseases; Humans; Infant; Middle Aged; Mycoses; Opportunistic Infections

Forty-eight neutropenic patients with acute leukaemia were randomly allocated to receive, as antifungal prophylaxis, either ketoconazole, 400 mg once daily (K), or amphotericin B tablets and lozenges (A), or both ketoconazole and amphotericin B together (K + A). Antifungal prophylaxis was considered to have failed if (1) there was evidence of increasing colonization of the oropharynx or faeces with Candida spp. or other yeasts, or (2) if systemic antifungal therapy was begun empirically. Prophylaxis failed in nine of 17 patients given K, in four of 19 given A, and in four of 12 given K + A. The differences between the three regimens were not statistically significant, neither was there any significant difference in the mean duration of neutropenia before prophylaxis failed. The absorption of ketoconazole was impaired when patients were neutropenic. We conclude that ketoconazole was neither more nor less effective than amphotericin B in the prevention of yeast colonization in neutropenic patients.

Topics: Adolescent; Adult; Amphotericin B; Antineoplastic Agents; Candidiasis, Oral; Candidiasis, Vulvovaginal; Drug Therapy, Combination; Female; Humans; Ketoconazole; Leukemia, Myeloid; Male; Middle Aged; Neutropenia; Random Allocation

To determine the incidence of hematogenous candida endophthalmitis in seriously ill patients given parenteral hyperalimentation fluids, 131 hyperalimented postoperative patients were prospectively evaluated. All patients were screened weekly for the development of chorioretinal lesions, blood cultures positive for Candida albicans, and signs and symptoms of candida infection. Thirteen (9.9%) of 131 patients developed chorioretinal lesions compatible with hematogenous candida endophthalmitis. Seven of the 13 patients with eye lesions had blood cultures positive for yeast, whereas only two of 118 without eye lesions had blood cultures positive for yeast (P less than 0.0005). Thus, the occurrence of eye lesions consistent with hematogenous candida endophthalmitis correlated with positive blood cultures for yeast and strongly suggested invasive candidiasis.

Topics: Amphotericin B; Candidiasis; Candidiasis, Oral; Chorioretinitis; Culture Media; Endophthalmitis; Gastrointestinal Hemorrhage; Humans; Intertrigo; Parenteral Nutrition; Parenteral Nutrition, Total; Urinary Tract Infections; Wound Infection

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Oral; Clinical Trials as Topic; Dental Plaque; Denture Cleansers; Humans; Placebos; Stomatitis; Stomatitis, Denture

A double-blind trial of nystatin, amphotericin B, and a placebo was carried out in fifty-two cases of denture-related candidiasis and/or angular cheilitis. The drugs effected a significant clinical cure, but recurrence of the signs was common after withdrawal of the drugs. Concurrent bacteriologic examination showed few cures and continued presence of Candida albicans during the trial. A specimen from a red palate was examined histologically.

Topics: Amphotericin B; Blood Vessels; Candida albicans; Candidiasis, Oral; Cheilitis; Denture, Complete, Upper; Epithelium; Humans; Nystatin; Palate; Placebos; Stomatitis; Stomatitis, Denture

Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity.. An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014-2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied.. Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2-3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin.. C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer.. The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.

Topics: Amphotericin B; Anidulafungin; Antifungal Agents; Candida; Candida albicans; Candidiasis, Oral; Drug Resistance, Fungal; Fluconazole; Humans; Microbial Sensitivity Tests; Neoplasms

Oropharyngeal candidiasis (OPC) is an oral infection mainly caused by Candida albicans, a dimorphic human opportunistic pathogen that can proliferate and invade the superficial oral epithelium using its hyphae. The filamentation of C. albicans is a hallmark of biofilm formation, accompanied by the occurrence of a hypoxic microenvironment. Paeonol (PAE) is a traditional medicine with multiple properties. In a previous study, we demonstrated the synergism of PAE plus Fluconazole (FLU) or Amphotericin B (AmB) against C. albicans in vitro and in vivo. This study aimed to explore the therapeutic mechanisms of drug combinations on OPC. In an established OPC mouse model, the culture of hypoxia was observed by calcofluor white and hypoxyprobe staining. The expression and levels of IL-17 signaling-associated genes and proteins (IL-17A and IL-23) were evaluated in tissue homogenates and EC109 cells. The results show that compared with the single therapy, PAE plus FLU or AmB can decrease fungal burden, restore mucosal integrity, and reduce the hypoxic microenvironment and inflammation in the OPC mice. Relative to infected mice, the drug combinations can also rectify the abnormal expression of hypoxia inducible factor (hif)-1α, il-17a, and il-23 mRNA. Meanwhile, compared with the infected EC109 cells treated with a single drug, PAE plus FLU or AmB significantly inhibited the mRNA and protein expression of HIF-1α, IL-17A, and IL-23. Taken together, the possible mechanism of PAE plus FLU or AmB can be attributed to the regulation of hypoxia-associated IL-17 signaling in OPC treatment.

Topics: Acetophenones; Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis, Oral; Fluconazole; Interleukin-17; Mice; Microbial Sensitivity Tests

Oral candidiasis is a fungal infection caused mainly by Candida albicans and it is a major problem among hematologic malignancy patients. Biofilm formation is an attributable factor to both virulence and drug resistance of Candida species. The aim of the study was to evaluate the biofilm-producing ability of oral C. albicans isolates and to evaluate the inhibitory activity of eucalyptol on Candida biofilm, alone and in combination with antifungal agents. Samples were collected from the oral cavity of 106 patients with hematologic malignancy. The isolated yeasts were identified by PCR-sequencing. Then C. albicans isolates were analyzed for their biofilm-producing ability by crystal violet staining and MTT assay. The minimum biofilm inhibition concentrations (MBIC) of eucalyptol, amphotericin B, itraconazole, and nystatin and the in vitro interaction of eucalyptol with these drugs were tested according to CLSI-M-27-A3 protocol and checkerboard methods, respectively. From 106 patients, 50 (47.2%) were confirmed for oral candidiasis [mean ± SD age 39 ± 14 years; female 31 (62%) and male 19 (38%)]. C. albicans was isolated from 40 of 50 (80%) patients. From 40 C. albicans isolates, 24 (60%) and 16 (40%) were moderate and weak biofilm producer, respectively. The geometric mean MBIC of amphotericin B, itraconazole, nystatin and eucalyptol were 3.93 µg/mL, 12.55 µg/mL, 0.75 µg/mL and 798 µg/mL, respectively. Eucalyptol interacted synergistically with amphotericin B, itraconazole and nystatin against 12.5, 10, and 22.5% of isolates, respectively. Eucalyptol demonstrated promising activity against biofilm of C. albicans when tested alone or combined with antifungal drugs.

Topics: Adult; Amphotericin B; Antifungal Agents; Biofilms; Candida; Candida albicans; Candidiasis, Oral; Eucalyptol; Female; Hematologic Neoplasms; Humans; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged; Nystatin

Oral candidiasis, especially caused by Candida albicans, is the most common fungal infection of the oral cavity. The increase in drug resistance and lack of new antifungal agents call for new strategies of antifungal treatment. This study repurposed artemisinin (Art) as a potentiator to the polyene amphotericin B (AmB) and characterised their synergistic mechanism against C. albicans and oral candidiasis. The synergistic antifungal activity between Art and AmB was identified by the checkerboard and recovery plate assays according to the fractional inhibitory concentration index (FICI). Art showed no antifungal activity even at >200 mg/L. However, it significantly reduced AmB dosages against the wild-type strain and 75 clinical isolates of C. albicans (FICI ≤ 0.5). Art significantly upregulated expression of genes from the ergosterol biosynthesis pathway (ERG1, ERG3, ERG9 and ERG11), as shown by RT-qPCR, and elevated the ergosterol content of Candida cells. Increased ergosterol content significantly enhanced binding between fungal cells and the polyene agent, resulting in sensitisation of C. albicans to AmB. Drug combinations of Art and AmB showed synergistic activity against oral mucosal infection in vivo by reducing the epithelial infection area, fungal burden and inflammatory infiltrates in murine oropharyngeal candidiasis. These findings indicate a novel synergistic antifungal drug combination and a new Art mechanism of action, suggesting that drug repurposing is a clinically practical means of antifungal drug development and treatment of oral candidiasis.

Topics: Amphotericin B; Antifungal Agents; Artemisinins; Candida albicans; Candidiasis, Oral; Drug Repositioning; Drug Synergism; Ergosterol; Genetic Variation; Genotype; Humans; Microbial Sensitivity Tests

Topics: Alginates; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Oral; Drug Delivery Systems; Emulsions; Fluconazole; Hydrophobic and Hydrophilic Interactions; Liquid Crystals; Mouth Mucosa; Nanotechnology; Resveratrol; Surface-Active Agents

Pemphigus vulgaris is an autoimmune disease that mostly affects the mucosa and oral cavity. Candida species can invade the mucosal lesions of these patients and cause diseases. The aim of this study was to identify the fungal agents isolated from mucosal lesions and evaluate antifungal activity profile against the isolates. A total of 25 patients with pemphigus vulgaris with active oral lesions and 25 healthy people serving as a control group were included in this study. Identification of the fungal isolates was performed based on conventional methods and DNA sequence analysis of the internal transcribed spacer (ITS) rDNA gene region. The sequence results were deposited in the NCBI database using the Basic Local Alignment Search Tool. Antifungal activity of fluconazole, itraconazole, ketoconazole, posaconazole, econazole, and amphotericin B against the isolates were evaluated based on the CLSI M-44 A protocol. Oral candidiasis was detected in 20% of the patients. Candida species isolated from oral lesions of patients with pemphigus were identified as Candida albicans 22/25, Candida glabrata 2/25, and Candida dubliniensis 1/25. All of the isolates were sensitive to amphotericin and econazole, 96% to fluconazole and posaconazole, and 92% to ketoconazole and itraconazole. One patient showed a profile resistant to fluconazole, posaconazole, and ketoconazole, simultaneously. Ninety six percent of control group isolates were sensitive to six antifungals. Candida albicans was the most prevalent species isolated from oral lesions of patients with pemphigus vulgaris and the control group. Amphotericin B and econazole were the most effective antifungals against the isolates.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Disk Diffusion Antimicrobial Tests; Econazole; Female; Fluconazole; Humans; Itraconazole; Ketoconazole; Male; Pemphigus; Triazoles

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Oral; Diagnosis, Differential; Fatal Outcome; Female; HIV Infections; Humans; Infant; Palate, Hard

Oral infections caused by Candida species, the most commonly isolated human fungal pathogen, are frequently associated with biofilms. Although Candida albicans is the predominant organism found in patients with oral thrush, a biofilm infection, there is an increasing incidence of oral colonization and infections caused by non- albicans Candida species, including C. glabrata, C. dubliniensis, and C. tropicalis, which are frequently more resistant to antifungal treatment. While single-species Candida biofilms have been well studied, considerably less is known about the dynamics of mixed- Candida species biofilms and how these dynamics are altered by antifungal treatment. To address these questions, we developed a quantitative polymerase chain reaction-based approach to determine the precise species composition of mixed- Candida species biofilms formed by clinical isolates and laboratory strains in the presence and absence of clinically relevant concentrations of 3 commonly used antifungals: fluconazole, caspofungin, and amphotericin B. In monospecies biofilms, fluconazole exposure favored growth of C. glabrata and C. tropicalis, while caspofungin generally favored significant growth of all species to a varying degree. Fluconazole was not effective against preformed mixed- Candida species biofilms while amphotericin B was potent. As a general trend, in mixed- Candida species biofilms, C. albicans lost dominance in the presence of antifungals. Interestingly, presence in mixed versus monospecies biofilms reduced susceptibility to amphotericin B for C. tropicalis and C. glabrata. Overall, our data suggest that antifungal treatment favors the growth of specific non- albicans Candida species in mixed- Candida species biofilms.

Topics: Amphotericin B; Antifungal Agents; Biofilms; Candida; Candida glabrata; Candida tropicalis; Candidiasis, Oral; Coinfection; Fluconazole; Humans; Polymerase Chain Reaction

Oropharyngeal candidiasis is the commonest mucocutaneous infection in HIV-positive individuals. Herein, samples were taken from oral cavities of 150 HIV-infected patients and cultured on Sabouraud-dextrose agar; 89 (59·3%) of 150 patients had positive culture for Candida and presented clinical sign of classical oral candidiasis. Totally, 102 morphologically distinct colonies were isolated from Candida positive cultures and subsequently identified by polymerase chain reaction and sequencing assay, presenting the following frequency: 54 C. albicans (52·9%), 16 C. dubliniensis (15·7%), 12 C. tropicalis (11·8%), 9 C. glabrata (8·8%), 7 C. kefyr (6·9%) and 4 C. africana (3·9%). Additionally, multiple Candida species were co-isolated from 13·5% (12/89) patients. Regarding the antifungal susceptibility test, which was performed by CLSI protocol (M27-A3/M27-S3), all Candida isolates were susceptible to amphotericin B and caspofungin, while some of them were resistant to fluconazole (17·6%; 16 C. albicans, 1 C. dubliniensis and 1 C. glabrata), itraconazole (16·7%; 15 C. albicans, 1 C. dubliniensis and 1 C. tropicalis) and voriconazole (5·9%; 5 C. albicans and 1 C. tropicalis). Collectively, our findings reinforce the urgent necessity to find new therapeutic agents to treat oral candidiasis in HIV-positive patients, especially due to the high incidence of azole-resistant Candida strains and the increased frequency of non-C. albicans species.. The Candida species recovered from oral cavity of 150 Iranian HIV/AIDS patients and their antifungal susceptibility profiles were reported. Candida albicans was the commonest Candida species, followed by C. dubliniensis, C. tropicalis, C. glabrata, C. kefyr and C. africana. All Candida isolates were susceptible to amphotericin B and caspofungin, while resistance to azoles was detected. The growing drug-resistance profile reported in clinical isolates of C. albicans and non-C. albicans strains is a serious problem in hospitals worldwide. Consequently, the suitable antifungal choice to treat the HIV/AIDS population with oral candidiasis needs to be rethought and new therapeutic options must urgently arise.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Oral; Caspofungin; Drug Resistance, Multiple, Fungal; Echinocandins; Female; Fluconazole; HIV Infections; Humans; Incidence; Iran; Itraconazole; Lipopeptides; Male; Microbial Sensitivity Tests; Middle Aged; Mouth; Prevalence; Young Adult

In recent years, the infection Candida albicans infection worldwide has risen, and the incidence of resistance to traditional antifungal therapies is also increasing. The aim of this study was to evaluate in vitro susceptibility of C. albicans clinical isolates to eight antifungal agents in Ouagadougou.. A cross-sectional study was conducted from January 2013 to December 2015 at Yalgado Ouédraogo University Teaching Hospital. Two hundred seven strains have been isolated from 347 symptomatic patients received in different clinical services. Samples were cultured on Sabouraud Dextrose Agar supplemented with Cloramphenicol. Isolates were diagnosed as C. albicans using germ tube test, chlamydospore formation on Corn Meal Agar, and Api-Candida test (Biomérieux). Antifungal susceptibility testing was performed by disk diffusion method and isolates classified as susceptible, susceptible dose-dependent and resistant.. Three hundred forty-seven (347) patients are included in this study. Two hundred and six (206) out of 347 collected samples (59.36%) were found positive for C. albicans. The strains were mostly isolated from vulvovaginal (49%) and oral infections (40.3%). The highest resistance rates of azoles were obtained with fluconazole (66.5%), itraconazole (52.3%) and ketoconazole (22.9%) when all clinical isolates were included. The resistance rates of fluconazole, itraconazole and ketoconazole remain highest for vulvovaginal and oral isolates. The rate of resistance to the polyene amphotericin B was 32.0% for all clinical isolates and was 56.4% for vulvovaginal strains. Resistance rate to nystatin was 6.3% for all clinical isolates. Cross-resistance analysis with data of all clinical strains revealed that the incidence of resistance to ketoconazole and itraconazole in fluconazole-resistant isolates was significantly higher than recorded for fluconazole-susceptible isolates.. In vitro C. albicans antifungal susceptibility test in this study showed relatively high resistance to commonly and widely used azoles (fluconazole, ketoconazole). Most C. albicans clinical isolates were susceptible to nystatin.

Topics: Adult; Amphotericin B; Antifungal Agents; Burkina Faso; Candida albicans; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Cross-Sectional Studies; Drug Resistance, Fungal; Female; Fluconazole; Humans; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged

The incidence of oral candidosis has increased in recent years due to the escalation in HIV-infection, cancer treatments, organ transplantation, and diabetes. In addition, corticosteroid use, dentures, and broad-spectrum antibiotic use have also contributed to the problem. Treatment of oral candidosis has continued to be problematic because of the potential toxicity of antifungals in clinical use, and, above all, development of drug resistance among patients. In this study, the antifungal effect of magnolol was investigated against 64 strains of Candida spp. (four standard and 60 oral isolates) through minimum inhibitory concentration (MIC) and growth curve assays. Insight into the mechanisms of the antifungal action has been gained through ultrastructural studies using confocal scanning laser microscopy (CSLM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Molecular docking was done for predicting the interactions of magnolol with ergosterol at supramolecular level. The toxicity of magnolol on human erythrocytes was measured by in vitro hemolytic assay. MIC values of magnolol ranged from 16-64 μg/ml, respectively. All tested isolates showed a marked sensitivity towards magnolol in growth curve assays. Biofilm results suggested that magnolol showed strong anti-biofilm activity. The results obtained for four different Candida spp. demonstrated that MBIC values of magnolol showed the average biofilm inhibition by 69.5%, respectively. CLSM experiments showed that cells exposed to magnolol (MIC) exhibited cell membrane disruption. SEM analysis of magnolol treated cells resulted in deformed cells. TEM micrographs showed rupturing of the cell wall and plasma membrane, releasing the intracellular content, and swelling of the cell wall. Hemolytic activity of magnolol is 11.9% at its highest MIC compared to an activity level of 25.4% shown by amphotericin B (Amp B) at 1 μg/ml. Lipinski's parameters calculated for magnolol suggested its good oral bioavailability. Docking studies indicated that magnolol might be interacting with ergosterol in the fungal cell membranes. Together, the present study provides enough evidence for further work on magnolol so that better strategies could be employed to treat oral candidosis.

Topics: Amphotericin B; Antifungal Agents; Biofilms; Biphenyl Compounds; Candida; Candidiasis, Oral; Cell Membrane; Ergosterol; Erythrocytes; Humans; Lignans; Microbial Sensitivity Tests; Microscopy; Molecular Docking Simulation

Ability to produce hemolysin by Candida species is an important determinant of its pathogenicity. Candida dubliniensis is implicated in the causation of oral candidosis, which can be treated with polyene, echinocandin, and azole groups of antifungal agents as well as chlorhexidine. After oral application, however, the concentrations of these agents tend to decrease quickly to subtherapeutic levels due to the peculiarity of the oral environment. In this study, we have evaluated the effect of short-term exposure of sublethal concentrations of these drugs on hemolysin production by oral C. dubliniensis isolates obtained from two different geographical locale.. Twenty C. dubliniensis oral isolates obtained from Kuwait and Sri Lanka were exposed to sublethal concentrations of nystatin, amphotericin B, caspofungin, ketoconazole, fluconazole, and chlorhexidine for 1 h. Thereafter, the drugs were removed by dilution and the hemolysin production determined by a previously described plate assay.. Hemolysin production of these isolates was significantly suppressed with a percentage reduction of 17.09, 16.45, 17.09, 11.39, 8.23 and 12.03 following exposure to nystatin, amphotericin B, caspofungin, ketoconazole, fluconazole, and chlorhexidine, respectively.. Brief exposure to sublethal concentrations of drugs with antifungal properties appears to reduce the pathogenic potential of C. dubliniensis isolates by suppressing hemolysin production.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Caspofungin; Chlorhexidine; Echinocandins; Fluconazole; Hemolysin Proteins; Humans; Ketoconazole; Kuwait; Lipopeptides; Microbial Sensitivity Tests; Nystatin; Sri Lanka; Time Factors

The aim of this study was to evaluate the attitude of Jordanian dentists towards the treatment of oral candidiasis and their current antifungal prescribing habits, shedding more light on the possible influence of their socio-professional factors on the pattern of prescribing and practice.. A structured validated questionnaire was developed and tested; it was then emailed to a random sample of 600 Jordanian dental practitioners during the period of this cross-sectional survey. The questionnaire recorded practitioners' personal details and their attitude and prescribing of antifungal therapy for oral candidiasis. Statistical significance was based on probability values of <0.05 and was measured using the chi-square and Fisher's exact tests. Multiple logistic regression analysis was used to analyse the influence of respondents' socio-professional factors on their attitude towards oral candidiasis.. Of the 423 questionnaires returned, only 330 were included. The attitude of respondents was significantly influenced by their experience [odds ratio (OR) = 0.14; P < 0.001] and workplace (OR = 4.70; P < 0.001). Nystatin was the most commonly prescribed antifungal agent (78.2%), followed by miconazole (62.4%), which was prescribed for topical use. Systemic antifungals were prescribed by 21.2% of respondents, with a significant (P < 0.05) association with the country in which their qualification was obtained.. The attitude towards the treatment of oral candidiasis is much better among the least-experienced dentists working in private practice. Nystatin and miconazole are the most popular choices of antifungal agents among Jordanian dentists.

Topics: Administration, Topical; Adult; Aged; Amphotericin B; Antifungal Agents; Attitude of Health Personnel; Candidiasis, Oral; Cross-Sectional Studies; Drug Prescriptions; Female; Fluconazole; Humans; Jordan; Male; Miconazole; Middle Aged; Nystatin; Practice Patterns, Dentists'; Private Practice; Professional Practice; Public Health Dentistry; Referral and Consultation; Sex Factors; Workplace

Oral hairy leukoplakia (OHL) is an EBV-associated condition of the oral mucosa, which is often painless. It is found predominantly in HIV-positive patients and is considered a clinical indicator of immunosuppression. OHL has rarely been described in HIV-negative patients, being found most often in association with iatrogenic immunosuppression. OHL induced by topical steroids remains extremely rare.. An 81-year-old HIV-negative woman, treated for 3 months with topical steroids for oral lichen planus, developed an asymptomatic white, corrugated, non-removable plaque with vertical folds on the lateral edge of the tongue. Associated oral candidiasis was noted. Based upon histological findings and in situ hybridisation showing numerous EBV-infected epithelial cells, a diagnosis of oral hairy leucoplakia was made.. To our knowledge, we report herein only the second recorded case of OHL induced strictly by topical steroids. Self-medication and poor adherence to dosage recommendations were noted in the patient's medical history. Physicians must be aware of the rare but nevertheless possible adverse events associated with topical steroid use, particularly when such medication is prescribed over a long period for inflammatory diseases of the oral mucosa.

Topics: Administration, Topical; Aged, 80 and over; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Betamethasone Valerate; Candidiasis, Oral; Clobetasol; Epithelial Cells; Female; Herpesvirus 4, Human; HIV Seronegativity; Humans; Leukoplakia, Hairy; Lichen Planus, Oral; Self Medication; Tongue

The isolation frequency and susceptibility to antifungal agents of oral Candida isolates from patients with oral candidiasis (OC) were compared between studies conducted in 2006-2007 and 2012-2013.. A total158 strains was isolated from 112 patients who visited Kagoshima University Hospital for the treatment of OC during the 14-month period from February 2012 and March 2013, and evaluated on the isolation frequency of each Candida strain and the susceptibility against antifungal drugs as compared to those evaluated in 2006-2007.. There was a higher frequency of xerostomia as a chief complaint and of autoimmune disease in the 2012-2013 study than in the 2006-2007 study. More than 95% of Candida isolates were C. albicans and C. glabrata. In addition, the proportion of the latter increased from 12.3% in the 2006-2007 study to 23.4% in the 2012-2013 study, while the proportion of the former decreased from 86.2% to 72.8%, respectively. C. albicans was isolated in almost all patients, while C. glabrata was only isolated concomitantly with C. albicans. Minimal inhibitory concentrations (MICs) were not significantly different between groups with a few exceptions. Candida isolates, of which MICs surpassed break points, apparently increased for miconazole and itraconazole against C. glabrata in the 2012-2013 study, but this was not statistically significant. As a result, more cases of autoimmune disease, a greater number of C. glabrata isolates, and higher resistance to azoles were seen in the 2012-2013 study than in the 2006-2007 study.. These data indicate that with recent increases in C. glabrata infection, a causative fungus of OC, and in C. glabrata resistance to azoles, caution is needed in the selection of antifungal drugs for the treatment of OC.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Autoimmune Diseases; Bacterial Load; Candida; Candida albicans; Candida glabrata; Candidiasis, Oral; Coinfection; Drug Resistance, Fungal; Echinocandins; Female; Fluconazole; Flucytosine; Humans; Itraconazole; Japan; Lipopeptides; Male; Micafungin; Miconazole; Microbial Sensitivity Tests; Middle Aged; Xerostomia

Secretion of hydrolytic enzymes such as hemolysin is considered an important virulence attribute of the opportunistic pathogenic fungus Candida. It is known that Candida spp. isolated from HIV-infected patients produce copious hemolysins. As common antifungal agents may perturb the production of extracellular enzymes, we evaluated the effect of three antifungals nystatin, amphotericin B and fluconazole on the hemolytic activity of Candida albicans and Candida tropicalis isolates from HIV-infected individuals. The impact of antimycotics on hemolytic activity was assessed by a previously described in vitro plate assay, after exposing ten isolates each of C. albicans and C. tropicalis recovered from HIV-infected individuals to sub-minimum inhibitory concentrations (sub-MIC) of nystatin, amphotericin B and fluconazole. All Candida isolates showed a significant reduction in hemolytic activity. The reduction was highest for amphotericin B-exposed C. albicans and C. tropicalis followed by nystatin and fluconazole. The effect of antimycotics was more pronounced on the hemolytic activity of C. tropicalis compared to that of C. albicans. Commonly used antifungal agents significantly suppress hemolysin activity of Candida species. This implies that the antifungals, in addition to their lethality, may modulate key virulence attributes of the yeast. The clinical relevance of this phenomenon in HIV disease and other similar pathologies remains to be determined.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candida tropicalis; Candidiasis, Oral; Fluconazole; Hemolysin Proteins; HIV Infections; Humans; Microbiological Techniques; Nystatin; Virulence Factors

Oral candidiasis is an important side effect of topical corticotherapy. The purpose of this study was to assess oral mucosa colonization by five Candida species during topical corticotherapy and to investigate Candida spp. pathogenicity and in vitro susceptibility to fluconazole and amphotericin B.. Oral swabbing samples from 11 erosive oral lichen planus (OLP) patients were collected before (day 0) and at days 7 and 30 of topical corticotherapy. Conventional methods for identification and quantification of Candida species, quantitative PCR (qPCR), pathogenicity tests and in vitro susceptibility to fluconazole and amphotericin B assays were performed.. Candida albicans was the most prevalent species in the oral mucosa after corticotherapy. Increased number of colony-forming units (CFU) and Candidaalbicans DNA copies were observed at day 30 of corticotherapy, despite no clinical evidence of candidiasis in any patient. Colony-forming units’ count of Candida species was less sensitive than qPCR, but both methods positively correlated. No resistance to fluconazole or amphotericin B was observed.. Topical corticoid used for oral erosive lichen planus treatment was associated with increase in Candida spp., in particular, C. albicans, in the oral cavity, independent of clinical manifestation of the disease.

Topics: Administration, Topical; Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida tropicalis; Candidiasis, Oral; Clobetasol; Colony Count, Microbial; Drug Resistance, Fungal; Female; Fluconazole; Follow-Up Studies; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth; Peptide Hydrolases; Phospholipases

In comparison to the range of antibiotics used in medicine, the spectrum of antifungal and antiviral drugs used in primary dental care is relatively limited. In practical terms, there are only three antifungal agents and two antiviral agents that have a role. This paper will describe the clinical presentation of orofacial candidal and viral infections and the use of antimicrobial drugs in their management.

Topics: Acyclovir; Amphotericin B; Antifungal Agents; Antiviral Agents; Candidiasis, Oral; Cheilitis; Dental Care; Fluconazole; Glossitis; Guanine; Herpes Zoster; Humans; Miconazole; Mouth Diseases; Nystatin; Primary Health Care; Stomatitis, Herpetic

This study investigated the susceptibility of 198 clinical isolates of Candida species against caspofungin, amphotericin B, itraconazole, and fluconazole.. Suspensions of the microorganisms were spread on Roswell Park Memorial Institute (RPMI) agar plates. Etest strips were placed on the plates, and the minimal inhibitory concentration (MIC) was read after incubation (48 h at 37 °C). Data were analyzed by a factorial analysis of variance and a 2 × 2 post hoc test (α = .05).. C glabrata showed the highest MIC values (P < .001) against caspofungin, itraconazole, and fluconazole. For amphotericin B, the MIC values of C tropicalis and C glabrata (P = .0521) were higher than those of C albicans (P < .001). Itraconazole was the least effective antifungal; 93.3% of the C glabrata isolates, 3.3% of the C albicans, and 1.3% of the C tropicalis were resistant. All microorganisms were susceptible to caspofungin and amphotericin B.. Caspofungin and amphotericin B should be recommended as an effective alternative for the management of oral Candida infections when treatment with topical or other systemic drugs has definitely failed.

Topics: Amphotericin B; Antifungal Agents; Brazil; Candida; Candidiasis, Oral; Caspofungin; Diabetes Mellitus; Drug Resistance, Fungal; Echinocandins; Fluconazole; Humans; Itraconazole; Lipopeptides; Microbial Sensitivity Tests; Stomatitis, Denture

Yeasts occur as part of the normal human microbiota. Nevertheless, some species are opportunistic, affecting immunocompromised patients such as those undergoing oncologic treatment.. To detect the presence of yeasts in patients suffering from head and neck cancer who are receiving radiation therapy and display lesions in the oral cavity, compatible with candidiasis; and to evaluate the antifungal susceptibility of the isolates recovered.. Sixty samples from patients were obtained by swabbing the oral mucosa. Identification of isolates were performed by classical taxonomic, morphological and biochemical methods as well as by using commercial identification kits. Susceptibility to antifungal drugs was determined by the agar diffusion method with Neosensitabs(®) disks.. Forty-six samples (77%) yielded positive findings, and species recovered were: Candida albicans (22 isolates), Candida tropicalis (13 isolates), Candida parapsilosis (six strains), Candida krusei (three strains), Candida dubliniensis and Saccharomyces cerevisiae (one each). All strains were susceptible to itraconazole, clotrimazole, voriconazole, nystatin and amphotericin B. On the other hand, 65% of strains were miconazole-susceptible while 35%, showed intermediate susceptibility. With regard to ketoconazole, only three strains (7%) corresponding to C. albicans (one isolate) and C. krusei (two isolates) displayed intermediate susceptibility. Only C. krusei strains were resistant to fluconazole while all the other species were susceptible. Eventually, only six isolates (13%) were susceptible to terbinafine while the remaining strains were resistant in vitro.. Early detection of etiological agents causing lesions, as well as the evaluation of their susceptibility to commonly used drugs, are crucial in order to choose the appropriate treatment that will minimize complications while improving the quality of patients' lives.

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Oral; Drug Resistance, Fungal; Head and Neck Neoplasms; Humans; Microbial Sensitivity Tests; Mycoses; Naphthalenes; Nystatin; Opportunistic Infections; Saccharomyces cerevisiae; Species Specificity; Terbinafine; Triazoles

Establishment of an effective prophylaxis against oral candidiasis by local treatment is essential for immunocompromised patients. The aim of the study is to assess effectiveness and stability of antifungal suspensions for mouthrinses. The assessed suspensions are compounded by one solvent among sterile water, spring water or sodium bicarbonate associated with amphotericin B (Fungizone®) or nystatine (Mycostatine®). Two others mixes are assessed: Mycostatine®-bicarbonate and Mycostatine®-Hextril®-bicarbonate as well as the two straight antifungal. In vitro activity is tested on five Candida species (C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis) after a five minutes contact between yeasts and the assessed suspension. A galenic study is realized during 3 days. Mixes associating a polyene with sodium bicarbonate have no effectiveness on Candida albicans, others mixes shows intermediate effectiveness (the percentage of yeast growth inhibition lies between 35% and 68%). Effectiveness results of Hextril®-based mixes are not explainable because of alcohol in its composition. Spring water-based mixes must be evicted due to microbiologic contaminations after 48hours. Mycostatine®-Hextril®-bicarbonate mix is not stable during 3 days. All those mouthrinses, poorly effective, excepted on C. glabrata, should be avoided. Straight Mycostatine® shows a good antifungal effectiveness excepted on C. krusei and its use should be recommended.

Topics: Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candidiasis, Oral; Drug Stability; Hexetidine; Humans; Mouthwashes; Nystatin; Sodium Bicarbonate; Suspensions

The aim of this investigation was to measure the postantifungal effect (PAFE) of 6 different oral Candida species following exposure to amphotericin B.. Five oral isolates each of Candida albicans, Candida tropicalis, Candida krusei, Candida parapsilosis, Candida glabrata and Candida guilliermondii (total of 30 isolates) were examined for the presence of PAFE after 1 h of exposure to the minimum inhibitory concentration of amphotericin B. The PAFE was determined as the difference in time (hours) required for the growth of the drug-free control and the drug-exposed test cultures to increase to 0.05 absorbance level following removal of amphotericin B.. The mean duration of amphotericin B-induced PAFE was lowest for C. albicans (5.91 ± 0.31 h) and greatest for C. parapsilosis (12.72 ± 0.11 h), while C. guilliermondii (8.32 ± 0.33 h), C. glabrata (8.43 ± 0.21 h), C. krusei (9.68 ± 0.23 h) and C. tropicalis (10.98 ± 0.18 h) elicited intermediate values.. Even a limited exposure to sublethal concentrations of amphotericin B suppressed growth of Candida species of oral origin. The significant variation in amphotericin B-induced PAFE amongst different Candida species may have clinical implications in terms of amphotericin B regimens used in the management of oral candidiasis.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Humans; Microbial Sensitivity Tests

At present, few data are available on the prevalence and antifungal susceptibility of Candida parapsilosis complex isolates from HIV-infected individuals. The C. parapsilosis complex comprises three species, C. parapsilosis sensu stricto, C. metapsilosis and C. orthopsilosis. Fifteen of 318 Candida isolates were identified as members of the C. parapsilosis complex by PCR and restriction fragment length polymorphism (RFLP). The prevalence of C. parapsilosis complex isolates was 4.7 %, 2.2 % being identified as C. parapsilosis sensu stricto and 2.5 % as C. metapsilosis, while no C. orthopsilosis was isolated. This is believed to be the first study that has identified isolates of C. metapsilosis obtained from the oral cavity of HIV-infected individuals. Antifungal susceptibility tests indicated that all the isolates were susceptible to amphotericin B (AMB), fluconazole (FLC), ketoconazole (KTC), itraconazole (ITC), voriconazole (VRC) and caspofungin (CASPO). Although isolates of C. parapsilosis sensu stricto and C. metapsilosis were susceptible to FLC, isolates of C. metapsilosis showed a tendency for higher MICs (≥1.0 µg ml(-1)). Based upon the frequency of candidiasis and the fact that certain isolates of the C. parapsilosis complex respond differently to FLC therapy, our data may be of therapeutic relevance with respect to susceptibility and potential resistance to specific antifungal agents. Our data suggest that C. metapsilosis can be a human commensal; its importance as a pathogen has yet to be confirmed.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Caspofungin; Echinocandins; Female; Fluconazole; HIV Infections; Humans; Lipopeptides; Male; Microbial Sensitivity Tests; Mouth; Mycological Typing Techniques; Polymorphism, Restriction Fragment Length; Pyrimidines; Triazoles; Voriconazole

The aim of this pharmaco-epidemiological study was to evaluate the prevalence of oropharyngeal candidiasis (OPC) in cancer patients treated with chemotherapy and/or radiotherapy.. Signs and symptoms of OPC were noted for all patients. Antifungal therapeutic management was recorded in OPC patients. Patients receiving local antifungal treatments were monitored until the end of treatment.. Enrolled in the study were 2,042 patients with solid tumor and/or lymphoma treated with chemotherapy and/or another systemic cancer treatment and/or radiotherapy. The overall prevalence of OPC was 9.6% (95% confidence interval, 8.4%-11.0%] in this population. It was most frequent in patients treated with combined chemoradiotherapy (22.0%) or with more than two cytotoxic agents (16.9%). Local antifungal treatments were prescribed in 75.0% of OPC patients as recommended by guidelines. The compliance to treatment was higher in patients receiving once-daily miconazole mucoadhesive buccal tablet (MBT; 88.2%) than in those treated with several daily mouthwashes of amphotericin B (40%) or nystatin (18.8%).. OPC prevalence in treated cancer patients was high. Local treatments were usually prescribed as per guidelines. Compliance to local treatments was better with once-daily drugs.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candidiasis; Candidiasis, Oral; Female; France; Humans; Male; Middle Aged; Neoplasms; Oropharynx; Pharyngeal Diseases; Young Adult

Nigeria is a West African country of more than 150 million persons with the second highest case of HIV/AIDS infected patients in the world. The species spectrum of oral yeast colonization and the susceptibility to a wide range of antifungal agents is poorly understood in Nigeria especially in the south east, south south, and the northern axis. This study evaluates the species spectrum of oral colonization by Candida species in HIV-infected patients in Nigeria and the in vitro susceptibility pattern of the Candida isolates to a broad range of antifungal agents.. Two hundred oropharyngeal swabs from HIV-infected patients and 100 age-matched healthy controls were screened for yeast isolates using standard procedures and confirmed by the analytical profile index 20C along with other biochemical tests. In vitro susceptibility testing of the yeast isolates to antifungals were performed using the broth microdilution method protocol recommended by the Clinical Laboratory Scientific Institute.. Of 200 patients screened, 120 (60%) were colonized by yeasts. C albicans was the dominating species in both groups with 54 (45%) isolated from HIV subjects. The non-albicans Candida species accounted for 55% with C tropicalis 22 (18.3%) showing the highest frequency. We observed that 11.7% of all yeasts isolates were resistant to fluconazole, 8.3% to flucytosine, 7.5% to itraconazole, and 1.7% to voriconazole. All isolates were susceptible to amphotericin B and most of them demonstrated very low voriconazole minimal inhibitory concentrations. Apart from C albicans, C tropicalis and C parapsilosis isolates were also recovered from apparently healthy control subjects.. Although C albicans continues to be the dominant Candida species in oral Candida carriage of HIV-infected patients in Nigeria, the nonalbicans Candida species are increasing. Furthermore, the finding of resistant isolates in our study emphasizes the need for antifungal susceptibility testing whenever antifungal treatment is desired especially in HIV-infected subjects.

Topics: Adult; Aged; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Drug Resistance, Fungal; Female; Fluconazole; Flucytosine; HIV Infections; Humans; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged; Mycological Typing Techniques; Nigeria; Pyrimidines; Triazoles; Voriconazole

Topics: Administration, Inhalation; Aged; Amphotericin B; Anti-Asthmatic Agents; Asthma; Candidemia; Candidiasis, Oral; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Glucocorticoids; Humans; Nystatin; Risk Factors

Candida oral flora from 52 Brazilian HIV-infected children was characterized while they received antiviral monotherapy therapy and subsequently, HAART with the use of protease inhibitor. There was a significant increase in non-C. albicans Candida isolates from 9.6-28.8% (P=0.005) after the children were placed on protease inhibitor therapy. Although Candida albicans still remained the most commonly isolated species, relative presence of C. tropicalis (n=9) followed by C. parapsilosis (n=8) markedly increased in association with protease inhibitor therapy. Furthermore, rare Candida species including C. dubliniensis, C. norvegensis, C. humicula and C. rugosa also appeared after the onset of protease inhibitor therapy. Subsequent investigation of the antifungal sensitivity of these diverse isolates, derived during protease inhibitor therapy, demonstrated some variation in antifungal sensitivity. With notable exceptions, the majority were sensitive to amphotericin B while most C. albicans and non-C. albicans Candida isolates were also susceptible to fluconazole, itraconazole and ketoconazole. Amongst exceptions was a single C. tropicalis isolates which was resistant to fluconazole (MIC>64 microl/ml) and one C. albicans-B isolate which showed cross-resistance to all azoles and amphotericin.

Topics: Adolescent; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Azoles; Brazil; Candida; Candidiasis, Oral; Child; Child, Preschool; Drug Administration Schedule; Drug Therapy, Combination; Female; HIV Infections; HIV Protease Inhibitors; Humans; Male; Microbial Sensitivity Tests; Species Specificity

Candida albicans and C. tropicalis obtained from whole saliva of patients presenting signs of oral candidosis were assayed for quantification of colony forming units, exoenzyme activity (phospholipase and proteinase) and antifungal drug sensitivity (amphotericin B, fluconazole and itraconazole) by the reference method of the Clinical and Laboratory Standards Institute. The number of colony forming units per milliliter varied according to the Candida species involved and whether a single or mixed infection was present. Proteinase activity was observed in both C. albicans and C. tropicalis, but phospholipase activity was noted only in C. albicans. In vitro resistance to antifungals was verified in both species, but C. tropicalis appears to be more resistant to the tested antifungals than C. albicans.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspartic Acid Endopeptidases; Candida albicans; Candida tropicalis; Candidiasis, Oral; Colony Count, Microbial; Drug Resistance, Fungal; Female; Fluconazole; Humans; Itraconazole; Male; Middle Aged; Phospholipases

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Diabetes Mellitus, Type 2; Female; Humans; Mediastinitis; Opportunistic Infections; Pyrimidines; Triazoles; Voriconazole

A male patient with HIV and past history of tuberculosis and suspected neurotoxoplasmosis was admitted to the hospital with vomiting and small nodules through all his body. Few of the nodules were found forming chains of enlarged lymphatic vessels, especially on lesions located on the limbs. Some of the nodules were ulcerated with a serosanguineous discharge. Collected samples from ulcerated and the nodular lesions showed the presence of Sporothrix schenckii in culture. Although all hemocultures were negative, a spinal fluid collected from this patient and cultures from the cutaneous lesions were both positive for S. schenckii. The patient showed improvement after treatment with Amphotericin B. Sadly, he later died of complications not related to the S. schenckii infection. This case of disseminated sporotrichosis is a remainder that in patients with immunological disorders exotic forms of this fungal clinical entity could be expected.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Cerebrospinal Fluid; Diagnosis, Differential; Fatal Outcome; Humans; Male; Meningitis, Fungal; Skin; Sporotrichosis; Toxoplasmosis, Cerebral

Topics: Aged; Amphotericin B; Candidiasis, Oral; Drug Eruptions; Humans; Male; Skin Diseases, Vesiculobullous

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Drug Resistance, Fungal; Female; Fluconazole; HIV Infections; Humans

Amphotericin B and nystatin are two polyene antibiotics that are potent antifungal agents. These drugs are active against most pathogenic fungi like Aspergillus and Candida. Mouthrinses containing these drugs are used for preventive and curative treatment of fungal infections like oral candidiasis, which can cause multiple diseases in cancer patients. Because there were no marketed antifungal mouthrinses available, their preparations were performed at the hospital and town pharmacies. To date, there are no data available on the stability of both these drugs in the form of mouthrinses. Therefore, each mouthrinse had to be prepared extemporaneously. The aim of this study was to investigate the stability of amphotericin B (Fungizone) and nystatin (Mycostatine) in the form of mouthrinses containing 1.4% sodium hydrogen carbonate. The stability of these solutions was tested at different temperatures (4-37 degrees C) with or without electric- or sunlight exposure and in two types of containers (glass and polypropylene) over a 15-day period. The admixtures were also monitored for colour change and pH. Amphotericin B and nystatin were quantified by high-performance liquid chromatography. At 4 degrees C, amphotericin B and nystatin were stable for 15 days in polypropylene. When stored in polypropylene at room temperature, with or without light protection, amphotericin B and nystatin were stable for 3 and 4 days, respectively.

Topics: Amphotericin B; Antifungal Agents; Candidiasis, Oral; Chromatography, High Pressure Liquid; Drug Stability; Hydrogen-Ion Concentration; Mouthwashes; Nystatin; Sodium Bicarbonate; Temperature

The in vitro antifungal activity of posaconazole was compared with that of fluconazole and amphotericin B.. A microdilution method (M27-A2) was used with 331 clinical yeast isolates.. The geometric mean MICs of posaconazole, fluconazole and amphotericin B were 0.16, 0.91 and 0.15 mg/L, respectively. Posaconazole was markedly more active than fluconazole and was active against 9/11 fluconazole-resistant Candida albicans, and five Candida glabrata had an MIC of posaconazole of 16 mg/L.. These data indicate that posaconazole is a potentially effective antifungal agent for the treatment of mycoses caused by yeasts.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Fluconazole; Humans; Microbial Sensitivity Tests; Triazoles

Aspiration of oropharyngeal bacteria and fungi is occasionally suspected in patients with pneumonia. A patient with oral carcinoma underwent chemoradioimmunotherapy and, about 4 weeks from the start of the therapy, the patient suffered from severe oral mucositis induced by chemoradiotherapy, and candidal pneumonia was subsequently induced. The candidal pneumonia was insufficiently improved by potent antifungal drugs, taking a lethal course. Randomly amplified polymorphic DNA analysis and DNA sequence examination of strains isolated from the oral cavity 1 week before the onset of pneumonia and autopsied lung revealed the identity of both strains as Candida albicans, and the DNA analysis supported aspiration of oral Candida. These results indicate that the pathogen of the pneumonia, C. albicans, was aspirated from the oral cavity and that oral Candida is easily aspirated and becomes the pathogen of pneumonia.

Topics: Aerosols; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Base Sequence; Candida albicans; Candidiasis; Candidiasis, Oral; Carcinoma, Squamous Cell; DNA, Fungal; Fatal Outcome; Female; Fluconazole; Humans; Miconazole; Mouth Neoplasms; Pneumonia, Aspiration; Random Amplified Polymorphic DNA Technique

The incidence of Candida dubliniensis in immunocomprimised patients in Turkey has not yet been determined. In this study the presence of C. dubliniensis in oral rinse samples of human immunodeficiency virus (HIV)-positive patients and healthy controls were investigated. Phenotypic tests like inability of growth at 45 degrees C, colony formation on Staib agar, intracellular beta-D-glucosidase activity, carbohydrate assimilation profiles and polymerase chain reaction with species-specific primers (DUBF and DUBR) were carried out for differentiation of C. dubliniensis. Of the 35 patients, four (11.4%) had C.dubliniensis in their oral cavity. Antifungal susceptibility testing of these C. dubliniensis isolates showed fluconazole MICs ranging from <0.06 to 32 microg ml(-1) and amphotericin B from <0.06 to 0.25 microg ml(-1). One isolate was dose-dependently susceptible to fluconazole (32 microg ml(-1)). This study demonstrates C. dubliniensis in HIV-positive patients from Turkey.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Female; Fluconazole; HIV Infections; Humans; Immunocompromised Host; Male; Microbial Sensitivity Tests; Middle Aged; Mycological Typing Techniques; Oropharynx; Polymerase Chain Reaction; Turkey

The in vitro susceptibility of 618 Candida isolates to fluconazole, itraconazole, voriconazole, ketoconazole, miconazole, amphotericin B, and nystatin was determined. The isolates were obtained from 559 patients who had attended the UK dental hospital departments in Cardiff, Belfast, Glasgow or London. Antifungal susceptibility was assessed using a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS) M27-A guidelines. The majority of the test strains were C. albicans (n = 521) with few of these being resistant to fluconazole (0.3%). A low incidence of fluconazole resistance (0-6.8%) was similarly evident with all non albicans species (Candida glabrata, 5 of 59 resistant; Candida krusei, 0 of 7 resistant; Candida tropicalis, 0 of 13 resistant; Candida parapsilosis, 0 of 12 resistant; other Candida species, 0 of 6 resistant). Voriconazole, ketoconazole, and miconazole also revealed high activity against both C. albicans and non albicans isolates, and 23.7% of C. glabrata isolates were found to be resistant to itraconazole. There was little difference in the antifungal susceptibilities of Candida isolated from patients who had a history of previous antifungal therapy compared with those who had not received antifungal treatment. In summary, this surveillance study of antifungal susceptibility of oral candidal isolates in the UK, through the collaboration of four dental hospitals, demonstrates that oral Candida species have a high level of susceptibilities to a range of antifungal agents.

Topics: Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida tropicalis; Candidiasis, Oral; Drug Resistance, Fungal; Fluconazole; Humans; Itraconazole; Ketoconazole; Miconazole; Mouth Diseases; Nystatin; Pyrimidines; Triazoles; Voriconazole

Anti-Candida activity by oral epithelial cells is considered one of several innate mucosal defense mechanisms against oropharyngeal candidiasis (OPC). OPC is the most common fungal infection in HIV disease. Previously we reported that oral epithelial cell anti-Candida activity is reduced in those with OPC, potentially representing a contributing factor to OPC. However, testing clinical epithelial cells possessing high levels of Candida has been limiting due to high background in the assay controls. HIV+ smokers often develop OPC sooner than non-smokers during progression to AIDS, suggesting additional immune aberrations. The purpose of this study was to design a means to reduce Candida associated with epithelial cells collected from saliva without affecting their in vitro growth inhibitory activity, and to employ that approach to evaluate antifungal activity in HIV+ smokers. To do so, oral epithelial cells with and without known levels of Candida were subjected to various treatments including azole, polyene, or echinocandin antifungal drugs or fixation followed by the standard growth inhibition (GI) assay. The results indicated that antifungal drugs, while effectively reducing cell-associated Candida, also affected epithelial cell function. In contrast, fixation with paraformaldehyde eliminated cell-associated Candida and had minimal effects on epithelial cell anti-Candida activity. Employing the fixation design that allowed a broad range of patients to be evaluated showed no difference in oral epithelial anti-Candida activity between HIV+ smokers and non-smokers. Therefore, oral epithelial cell antifungal activity does not appear compromised in those who smoke, reducing it as a contributing factor in susceptibility to premature OPC.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Caspofungin; Echinocandins; Epithelial Cells; Fixatives; Fluconazole; HIV; HIV Infections; Humans; Lipopeptides; Mouth Mucosa; Peptides, Cyclic; Smoking

To examine the current practice of antifungal prescribing by GDPs in the United Kingdom. Design A postal questionnaire circulated to a random selection of 400 dentists.. The questionnaires were analysed and the responses expressed as absolute and relative frequencies.. Responses to the questionnaire were received from 297 (74.3%) GDPs. Nystatin was the most popular choice of antifungal agent that GDPs would use, followed by miconazole, amphotericin B and fluconazole. The likelihood of use of miconazole was positively linked to recent date of graduation. Lack of knowledge regarding contraindications and problems with azole antibiotics was found in a significant minority of practitioners (36%).. The present study indicates that azole antifungal agents (especially miconazole) are becoming more widely used by GDPs, but that knowledge regarding potential problems with their use is sub-optimal. Nystatin remains the most popular choice of antifungal agent.

Topics: Age Factors; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Drug Prescriptions; Fluconazole; General Practice, Dental; Humans; Miconazole; Nystatin; Practice Patterns, Dentists'; Surveys and Questionnaires; United Kingdom

The prevalence of Candida species with and without denture-related stomatitis were evaluated in 167 Jordanian patients. The study revealed that 47 (28%) of the patients with denture-related stomatitis were colonized with Candida species (clinical group). Candida albicans was responsible for most cases of denture-related stomatitis (72%), and it was the only species capable of secreting aspartic proteinases. The study also indicated that candidal colonization was not influenced by predisposing haematological deficiencies, as both the clinical and control patient groups showed comparable haematological parameters and the differences were not significant (P > 0.05). All Candida species isolates were 100% susceptible to amphotericin B, while these isolates were less susceptible (25-75%) to fluconazole.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspartic Acid Endopeptidases; Candida; Candidiasis, Oral; Female; Fluconazole; Humans; Jordan; Male; Middle Aged; Prevalence; Stomatitis, Denture

A conventional and easy method to establish a murine oral candidiasis model, which has not only a stable yeast population in the oral cavity but also symptoms characteristic of oral thrush, was developed by using a sedative agent. Mice were immunosuppressed with prednisolone and were given tetracycline hydrochloride. They were orally infected with 10(6) viable cells of Candida albicans by means of a cotton swab and enough chlorpromazine chloride had been injected to keep them in a sedative state about for 3 hr after inoculation. From day 3 to day 7 post inoculation, 10(5)-10(6) colony forming units of Candida were recovered from the oral cavity of each mouse and whitish, curd-like patches were observed on most parts of tongue. Microscopically, germ tubes had appeared on the tongue surface. This model would be a useful experimental oral candidiasis for investigating the pathogenesis of C. albicans oral infection and the efficacy of various antifungal agents microbiologically and symptomatically.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis, Oral; Chlorpromazine; Disease Models, Animal; Female; Fluconazole; Immunocompromised Host; Mice; Mice, Inbred ICR; Prednisolone; Tetracycline; Virulence

Oropharyngeal candidiasis (OPC) and esophageal candidiasis (EPC) are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibility tests are necessary to predict a therapeutic failure. Etest is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A).. To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB) and Fluconazole (Flu) using Etest.. Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar.. All studied strains showed minimal inhibitory concentrations (MICs) < 1 mg/mL for AmB. A highly resistant strain to Flu (> 256 mg/mL) was isolated from a patient previously treated with Flu.. In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest is a reliable alternative in these cases, for laboratories that cannot use the reference method.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Candidiasis, Oral; CD4 Lymphocyte Count; Drug Resistance, Fungal; Esophageal Diseases; Female; Fluconazole; Humans; Male; Microbial Sensitivity Tests; Pharyngeal Diseases

Antimicrobial peptides in saliva appear to play a crucial role in the regulation of oral Candida growth, and study on antimicrobial excretion in saliva and oral candidiasis appears useful for the analysis of pathophysiology of oral candidiasis.. To clarify the role of saliva in the regulation of oral Candida growth, the levels of antimicrobial proteins and peptides and their excretion rates were examined in saliva obtained from 50 patients with oral candidiasis and 35 healthy individuals.. The inhibitory activities of patients' saliva against Candida adhesion with HeLa cells and against Candida growth (radiolabeled glucose incorporation) were lower than those of saliva from the healthy controls. The salivary levels of lactoferrin (Lf; 11 +/- 9 microg/ml), secretory immunoglobulin A (sIgA; 160 +/- 37 microg/ml), beta-defensin 1 (375 +/- 37 ng/ml), and beta-defensin 2 (412 +/- 51 ng/ml) in the patients were largely lower than those in the control group (33 +/- 14 microg/ml, 204 +/- 51 microg/ml, 452 +/- 89 ng/ml, and 530 +/- 142 ng/ml, respectively), although the transferrin (Tf) and secretory component (SC) levels were almost same in both groups, and alpha-defensin 1 was slightly increased in the patient group (660 +/- 115 ng/ml vs. 467 +/- 168 ng/ml). In addition, the excretion rates of the proteins and peptides were largely decreased in the patients (Tf: 14 +/- 2 microg/10 min vs. 34 +/- 7 microg/10 min; Lf: 18 +/- 11 microg/10 min vs. 139 +/- 43 microg/10 min; sIgA: 300 +/- 132 microg/10 min vs. 900 +/- 207 microg/10 min; SC: 112 +/- 46 microg/10 min vs. 292 +/- 64 microg/10 min; alpha-defensin 1: 1223 +/- 431 ng/10 min vs. 2044 +/- 612 ng/10 min; beta-defensin 1: 687 +/- 243 ng/10 min vs. 1985 +/- 295 ng/10 min; and beta-defensin 2: 784 +/- 299 ng/10 min vs. 2288 +/- 278 ng/10 min).. These results conclusively suggest that oral candidiasis is associated with salivary gland hypofunction and that decreases of salivary antibacterial proteins induce Candida overgrowth.

Topics: Aged; Amphotericin B; Anti-Infective Agents; Antifungal Agents; beta-Defensins; Candida albicans; Candidiasis, Oral; Case-Control Studies; Female; HeLa Cells; Humans; Immunoglobulin A, Secretory; Lactoferrin; Male; Middle Aged; Saliva; Salivary Proteins and Peptides; Secretory Component; Secretory Rate; Transferrin

To report a case of successful treatment of azole-refractory oropharyngeal candidiasis with topical amphotericin B.. 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.. 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.. 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.

Topics: Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Azoles; Candidiasis, Oral; Drug Resistance, Fungal; Esophagitis; Female; Humans

Due to an increasing number of leukemic patients with invasive gingival aspergillosis during neutropenia (neutrophils <500 cells/microl for >10 days), we evaluated the efficacy of oral itraconazole prophylaxis for preventing this invasive infection at our hospital.. This was a retrospective, non-randomized study to analyze the onset of identified invasive gingival aspergillosis among 536 patients with acute leukemia at risk due to the presence of neutropenia from 1991 to 1998. Patients received itraconazole capsules 100 mg/day prophylactically between April 1994 and December 1996, and 200 mg/day between January 1997 and December 1998. Itraconazole serum levels at day 10 were measured in some patients.. In the 39 months prior to April 1994 without itraconazole prophylaxis, 15 cases of invasive gingival aspergillosis were detected in 192 high risk patients with 469 episodes of neutropenia (7.8% of the high risk patients). Between April 1994 and December 1996, using itraconazole prophylaxis at 100 mg/day, there was a dramatic decrease in the infections resulting in 3 of 198 high risk patients with 511 episodes of neutropenia (1.5% of the high risk patients). Furthermore, between January 1997 and December 1998, using itraconazole prophylaxis at 200 mg/day, no cases of the infection were observed in the 146 high risk patients with 380 episodes of neutropenia. The incidence of invasive gingival aspergillosis was significantly lower among patients administered itraconazole than among those without itraconazole (100 mg/day; P = 0.006 and 200 mg/day; P = 0.001). The mean itraconazole serum level in 20 patients receiving 100 mg/day was 71.78 ng/mL and in 16 patients receiving 200 mg/day was 202.67 ng/ml.. These findings suggest that oral itraconazole could be effective for preventing invasive gingival aspergillosis in neutropenic patients with acute leukemia and warrants further randomized investigation.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis, Oral; Capsules; Chi-Square Distribution; Chromatography, High Pressure Liquid; Cohort Studies; Fluconazole; Flucytosine; Gingival Diseases; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myeloid, Acute; Leukocyte Count; Neutropenia; Neutrophils; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Risk Factors; Treatment Outcome

V-echinocandin (VER-002; LY303366) is a semisynthetic derivative of echinocandin B and a potent inhibitor of fungal (1, 3)-beta-D-glucan synthase. We studied the antifungal efficacy, the concentrations in saliva and tissue, and the safety of VER-002 at escalating dosages against experimental oropharyngeal and esophageal candidiasis caused by fluconazole-resistant Candida albicans in immunocompromised rabbits. Study groups consisted of untreated controls, animals treated with VER-002 at 1, 2.5, and 5 mg/kg of body weight/day intravenously (i.v.), animals treated with fluconazole at 2 mg/kg/day i.v., or animals treated with amphotericin B at 0.3 mg/kg/day. VER-002-treated animals showed a significant dosage-dependent clearance of C. albicans from the tongue, oropharynx, esophagus, stomach, and duodenum in comparison to that for untreated controls. VER-002 also was superior to amphotericin B and fluconazole in clearing the organism from all sites studied. These in vivo findings are consistent with the results of in vitro time-kill assays, which demonstrated that VER-002 has concentration-dependent fungicidal activity. Esophageal tissue VER-002 concentrations were dosage proportional and exceeded the MIC at all dosages. Echinocandin concentrations in saliva were greater than or equal to the MICs at all dosages. There was no elevation of serum hepatic transaminase, alkaline phosphatase, bilirubin, potassium, or creatinine levels in VER-002-treated rabbits. In summary, the echinocandin VER-002 was well tolerated, penetrated the esophagus and salivary glands, and demonstrated dosage-dependent antifungal activity against fluconazole-resistant esophageal candidiasis in immunocompromised rabbits.

Topics: Amphotericin B; Anidulafungin; Animals; Antifungal Agents; Candidiasis; Candidiasis, Oral; Drug Resistance, Microbial; Echinocandins; Esophageal Diseases; Esophagus; Female; Fluconazole; Immunosuppression Therapy; Peptides, Cyclic; Pharyngeal Diseases; Rabbits; Saliva

Denture biofilms represent a protective reservoir for oral microbes. The study of the biology of Candida in these biofilms requires a reliable model. A reproducible model of C. albicans denture biofilm was developed and used to determine the susceptibility of two clinically relevant C. albicans isolates against 4 antifungals. C. albicans, growing as a biofilm, exhibited resistance to amphotericin B, nystatin, chlorhexidine, and fluconazole, with 50% reduction in metabolic activity (50% RMA) at concentrations of 8, 16, 128, and > 64 microg/mL, respectively. In contrast, planktonically cultured C. albicans were susceptible (50% RMA for the same antifungals was obtained at 0.25, 1.0, 4.0, and 0.5 microg/mL, respectively). In conclusion, results obtained by means of our biofilm model show that biofilm-associated C. albicans cells, compared with cells grown in planktonic form, are resistant to antifungals used to treat denture stomatitis.

Topics: Acrylic Resins; Amphotericin B; Anti-Infective Agents, Local; Antifungal Agents; Biofilms; Candida albicans; Candidiasis, Oral; Chlorhexidine; Colony Count, Microbial; Denture Bases; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Fluconazole; Galactose; Glucose; Humans; Indicators and Reagents; Nystatin; Polymethyl Methacrylate; Saliva; Statistics as Topic; Stomatitis, Denture; Sucrose; Tetrazolium Salts; Time Factors

The increased frequency and severity of candidal infections in human immunodeficiency virus (HIV)-infected individuals has prompted the wide use of antifungals, such as amphotericin B, ketoconazole, and fluconazole, resulting in the emergence of drug-resistant strains of Candida albicans. To study this phenomenon in an ethnic Chinese cohort, we isolated multiple colonies of Candida from the oral cavities of 16 HIV-infected patients on single and subsequent sequential visits over a period of 12 months. Ten of the 16 patients had sporadic episodes of oropharyngeal candidiasis (Group A), while the remainder were asymptomatic with respect to this condition (Group B). Oral rinses were collected and immediately processed in the laboratory for the isolation of C. albicans in a standard manner. A total of 433 C. albicans isolates were tested for their susceptibility to amphotericin B, ketoconazole and fluconazole by an agar diffusion method using the commercially available E-test. All tested isolates demonstrated variable susceptibility to amphotericin B, ketoconazole and fluconazole. The minimum inhibitory concentration (MIC) of the isolates for amphotericin B, ketoconazole and fluconazole ranged from <0.002-1.5 microg/ml, <0.002-4.0 microg/ml and <0.016-32 microg/ml, respectively. Sequential isolates of a few patients demonstrated variable susceptibility to all the antifungals, and no discernible MIC pattern emerged either in group A or B over time. Interestingly, significant variation in antifungal susceptibility was also noted in isolates obtained from the same patient on a single visit. Sequential yeast isolates in 9 of 16 patients (56%) demonstrated significant differences in MIC within and between visits for both amphotericin B and ketoconazole, while a lower percentage--44%(7/16)--exhibited this trait for fluconazole. Our study demonstrates the diversity in antifungal susceptibility in either commensal or "infective" oral strains of C. albicans in HIV disease, and shows the need for vigilance for the emergence of resistant strains, and for frequent antifungal susceptibility studies.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Analysis of Variance; Antifungal Agents; Candida albicans; Candidiasis, Oral; China; Cohort Studies; Drug Resistance, Microbial; Ethnicity; Female; Fluconazole; Follow-Up Studies; HIV Infections; Humans; Ketoconazole; Male; Middle Aged; Oropharynx; Pharyngeal Diseases; Recurrence

Oropharyngeal candidiasis (OPC) is the most frequent AIDS-associated opportunistic infection, as up to 90% of HIV-infected individuals suffer at least one episode during the course of their disease. Various in vivo and in vitro procedures have been used to assess the effectiveness of antifungal agents used in HIV infection. In the present study, we evaluated in vitro the minimum inhibitory concentration (MIC) and the post-antifungal effect (PAFE) of two polyenes, two azoles and one DNA-analogue against 10 oral isolates of Candida albicans and 10 of Candida tropicalis, all from HIV-infected individuals, in order to obtain basic data on the pharmacodynamics of these drugs. One-hour exposure to twice the MIC of all the drugs, except fluconazole, elicited a consistently high PAFE in both Candida species. Furthermore, the PAFE elicited by the antifungals (except fluconazole) was significantly prolonged for C. tropicalis compared with C. albicans. This speedy recovery of C. albicans isolates exposed to transient low concentrations of antifungals appeared to reflect its virulence compared with lesser potent species, such as C. tropicalis. Taken together, the current data, while confirming the existence of PAFE in a non-albicans species of Candida, also provide further clues for the recalcitrance of C. albicans species in the face of antifungal therapy for oropharyngeal candidiasis.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candidiasis, Oral; Fluconazole; Flucytosine; HIV Infections; Humans; Ketoconazole; Microbial Sensitivity Tests; Nystatin; Oropharynx; Pharyngeal Diseases; Statistics as Topic; Time Factors; Virulence

Early use of inhaled steroids is recommended for bronchial asthma. The side effects are rare, but oral discomfort and candidiasis are clinically important complications. Most previous studies reported that the use of spacer and water gargling was necessary to prevent oral complications. However, in some patients, this may fail to prevent such complications.. To compare the effects of water gargling with those of amphotericin B, in the prevention of oral complications in asthmatics using inhaled steroids.. Pharyngeal swab samples were obtained aseptically from the posterior pharyngeal wall of 128 asthmatics who have been using inhaled steroids (beclomethasone dipropionate) for more than 1 year. The amount of Candida albicans in cultured swabs was evaluated based on the following criteria: oral symptoms, method of gargling, dose of inhaled steroids, type of spacer and serum cortisol level.. The number of isolated C. albicans was significantly higher in asthmatics with oral symptoms than in those free of symptoms. It was also significantly higher in patients who gargled with water or 1,000 times dilution than in those who gargled with 100 or 50 times dilutions of amphotericin B. Moreover, it was significantly higher in patients with low levels of serum cortisol than in those with normal serum cortisol.. We demonstrated that at least in a subgroup of asthmatics using steroid inhalers, gargling with water or even weak concentrations of amphotericin B does not prevent colonization of the throat with C. albicans. This group at high risk of developing oral candidiasis should gargle with amphotericin B at concentrations higher than 100 times dilution that can prevent clinically detectable oral candidiasis.

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Asthma; Candida albicans; Candidiasis, Oral; Dose-Response Relationship, Drug; Female; Humans; Hydrocortisone; Japan; Male; Middle Aged; Mouthwashes; Respiratory Therapy; Steroids

This study was conducted to examine biotypes and antifungal susceptibility patterns of oral Candida albicans isolated from HIV-infected patients, HIV-free patients with candidiasis and healthy subjects. All isolates were biotyped using a typing system based on enzyme profiles, carbohydrate assimilation patterns and boric acid resistance. Thirty-eight biotypes were found amongst 218 oral C. albicans isolates. The major biotype found was A1S, which accounted for 32.6% of all isolates, and this biotype was the most common in all groups. There was a greater variety of biotypes of C. albicans in the HIV-infected group than in the other groups; however, there was no statistically significant difference between the groups. The minimum inhibitory concentrations (MICs) of a total of 118 isolates were determined for amphotericin B and for ketoconazole using the National Committee for Clinical Laboratory Standards (NCCLS) broth macrodilution method and the E-test. When the antifungal susceptibility patterns among the groups were compared, a statistically significant difference was found only with amphotericin B. The median MIC of amphotericin B in the HIV-infected group was higher than in the healthy group (P=0.013, NCCLS method; P=0.002, E-test). However, this difference in sensitivity was not restricted to any sub-type investigated. Our results showed that the biotype patterns of C. albicans isolates that colonize HIV-infected patients are similar to those of HIV-free subjects, and there is no relationship between antifungal susceptibility patterns and the biotypes.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Candida albicans; Candidiasis, Oral; Dose-Response Relationship, Drug; HIV Seronegativity; Humans; Ketoconazole; Microbial Sensitivity Tests; Mycological Typing Techniques; Saliva

Post-antifungal effect (PAFE) is defined as the suppression of growth that persists following limited exposure of fungi to antimycotics and subsequent removal of the drug. The fungal pathogen Candida albicans is the major aetiologic agent of oral candidosis, and the cell surface hydrophobicity (CSH) of this yeast is considered a critical factor contributing to its colonisation potential. As the concentration of topically prescribed antifungals reach sub-therapeutic levels at dosage intervals, the study of the polyene-induced PAFE and its impact on the CSH of oral C. albicans should be of clinical relevance. Hence the aims of this investigation were to measure the PAFE and CSH of 12 isolates of C. albicans following limited exposure (1 h) to nystatin and amphotericin B and also to investigate the ultrastructural features of yeast cells following such antifungal exposure. The yeasts were exposed to sub-lethal concentrations of nystatin (x2 MIC) and amphotericin B (x2 MIC) for a period of 1 h. Following subsequent removal of the drug, the PAFE and the CSH of the isolates were assessed by a turbidometric measurement of growth and a biphasic aqueous-hydrocarbon assay, respectively. The mean duration of PAFE of nystatin and amphotericin B were 5.99 (+/-0.49) h and 8.73 (+/-0.93) h, respectively, while the reduction in CSH following exposure to these drugs were 17.32% (P<0.05 for 83% of the isolates) and 14.26% (P<0.05 for 66% of the isolates), respectively. On scanning electron microscopy the exposed cells were seen to undergo collapse of the internal cell membrane, leaving an intact cell wall, while a proportion of cells were deflated. Some cells showed intense puckering of the cell wall, resulting in a mulberry appearance. Taken together, these data elucidate additional mechanisms by which polyene antimycotics may operate in vivo to suppress candidal pathogenicity.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Oral; Cell Membrane; Dose-Response Relationship, Drug; Humans; Microbial Sensitivity Tests; Microscopy, Electron, Scanning; Nystatin; Virulence

Strain differentiation of 66 clinical isolates of Candida albicans obtained from healthy dentate and complete denture wearers was performed. Resistogram method based on differences in the resistance of C. albicans isolates to sodium selenite, boric acid, cetrimide, sodium periodate and silver nitrate was used for strain differentiation. Of the 32 potential strains that can be distinguished, 14 different resistogram strains of C. albicans were found among the 66 isolates tested. Strain-C--was the most predominant (24.3% of total isolates), while strain A-CDE was the least predominant (1.5%). The results showed no particular association of certain strains with Candida infections in complete denture wearers. Sensitivity to antifungal agents showed that isolates from different strains were most sensitive to amphotericin B and nystatin and least sensitive to miconazole.

Topics: Amphotericin B; Antifungal Agents; Boric Acids; Candida albicans; Candidiasis, Oral; Cetrimonium; Cetrimonium Compounds; Denture, Complete; Drug Resistance, Microbial; Humans; Miconazole; Microbial Sensitivity Tests; Nystatin; Periodic Acid; Silver Nitrate; Sodium Selenite; Stomatitis, Denture

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Female; Fluconazole; Humans; Itraconazole; Lactoferrin; Mouthwashes; Muramidase

Oropharyngeal candidiasis (OPC) is the most frequent opportunistic infection associated with HIV infection. Therapies such as topical clotrimazole and nystatin, as well as oral azoles, which had previously been effective prior to the advent of HIV, are increasingly only partially effective in OPC in HIV infection. The effectiveness of oral amphotericin B suspension for OPC is described in 17 HIV-infected patients whose response to other therapies had been unsatisfactory. Three patients yielded isolates of Candida albicans with a minimum inhibitory concentration (MIC) to fluconazole of >/=16 microg/mL. Eleven patients received amphotericin B suspension monotherapy. Of the 17 patients, the symptoms of six resolved entirely, seven patients partially responded, and four failed therapy. These data suggest that amphotericin B suspension may be a useful additional therapy for OPC in HIV-infected patients.

Topics: Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Suspensions; Treatment Outcome

Candidal adherence has been implicated as the first step in the pathogenesis of oral candidosis, and germ tube formation by Candida albicans has been attributed as a co-factor that promotes adherence. Oral candidosis is treated with polyenes and the azole group of antifungal agents. As the intraoral concentrations of antifungals fluctuate considerably due to the dynamics of the oral cavity, we investigated the effect of short exposure to sub-lethal concentrations of antifungals on the germ tube formation of Candida albicans. After determining the minimum inhibitory concentration (MIC) of the antifungal agents, ten oral isolates of Candida albicans were exposed to sub-lethal concentrations of nystatin (6xMIC), amphotericin B (8xMIC), 5-fluorocytosine (8xMIC), ketoconazole (4xMIC) and fluconazole (4xMIC), for 1 h. Following removal of the antifungal agent and subsequent incubation in a germ tube-inducing medium, the germ tube formation of these isolates was quantified. When compared with the controls, exposure to nystatin and amphotericin B almost completely inhibited germ tube formation of all the isolates (mean percentage reduction of 97.68 and 97.52%, respectively; P<0.0001), while ketoconazole suppressed this activity to a lesser degree (30.84%; P=0.0174). However, 5-fluorocytosine- and fluconazole-mediated germ tube suppression was minimal (12.63 and 15.93%, respectively; P=0.3255 and P=0.3791). In clinical terms, these findings indicate that short exposure to sub-therapeutic levels of commonly prescribed antifungals may modulate candidal germ tube formation, and thereby the clearance of the organisms from the oral cavity.

Topics: Adhesiveness; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Oral; Culture Media; Dose-Response Relationship, Drug; Fluconazole; Flucytosine; HIV Seronegativity; Humans; Ketoconazole; Microscopy, Electron, Scanning; Mouth; Nystatin

Candida dubliniensis has been associated with oropharyngeal candidiasis in patients infected with human immunodeficiency virus (HIV). C. dubliniensis isolates may have been improperly characterized as atypical Candida albicans due to the phenotypic similarity between the two species. Prospective screening of oral rinses from 63 HIV-infected patients detected atypical dark green isolates on CHROMagar Candida compared to typical C. albicans isolates, which are light green. Forty-eight atypical isolates and three control strains were characterized by germ tube formation, differential growth at 37, 42, and 45 degreesC, identification by API 20C, fluorescence, chlamydoconidium production, and fingerprinting by Ca3 probe DNA hybridization patterns. All isolates were germ tube positive. Very poor or no growth occurred at 42 degreesC with 22 of 51 isolates. All 22 poorly growing isolates at 42 degreesC and one isolate with growth at 42 degreesC showed weak hybridization of the Ca3 probe with genomic DNA, consistent with C. dubliniensis identification. No C. dubliniensis isolate but only 18 of 28 C. albicans isolates grew at 45 degreesC. Other phenotypic or morphologic tests were less reliable in differentiating C. dubliniensis from C. albicans. Antifungal susceptibility testing showed fluconazole MICs ranging from

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida; Candidiasis, Oral; Fluconazole; Genotype; HIV Infections; Humans; Itraconazole; Microbial Sensitivity Tests; Mouth; North America; Pharynx; Phenotype; Pyrimidines; Triazoles; Voriconazole

Candidal adherence to denture acrylic surfaces is implicated as the first step in the pathogenesis of Candida-associated denture stomatitis, the most prevalent form of oral candidosis in the West. This condition is treated by topically administered antifungal agents, mainly belonging to the polyenes and azoles. As the intraoral concentrations of antifungals fluctuate considerably due to the dynamics of the oral environment, the effect of short exposure to sublethal concentrations of antifungals on the adhesion of Candida albicans to denture acrylic surfaces was investigated. Seven oral C. albicans isolates were exposed to four-eight times minimum inhibitory concentrations (MIC) of five antifungal drugs, nystatin, amphotericin B, 5-fluorocytosine, ketoconazole and fluconazole, for 1 h. After removing the drug (by repeated washing) the adhesion of these isolates to acrylic strips was assessed by an in vitro adhesion assay. Exposure to antifungal agents significantly reduced the adherence of all seven C. albicans isolates to denture acrylic. The mean percentage reductions of adhesion after limited exposure to nystatin, amphotericin B, 5-fluorocytosine, ketoconazole and fluconazole were 86.48, 90.85, 66.72, 65.88 and 47.42%, respectively. These findings indicate that subtherapeutic doses of antifungals may modulate oral candidal colonization. Further, these results may have an important bearing on dosage regimens currently employed in treating oral candidosis.

Topics: Adhesiveness; Administration, Topical; Amphotericin B; Analysis of Variance; Antifungal Agents; Candida albicans; Candidiasis, Oral; Denture Bases; Drug Administration Schedule; Fluconazole; Flucytosine; Humans; Image Processing, Computer-Assisted; Ketoconazole; Mouth; Nystatin; Polymethyl Methacrylate; Stomatitis, Denture; Surface Properties; Time Factors

The aim of the present study was to evaluate the utility of the E test in determining the antifungal susceptibility of Candida albicans. Reproducibility of the E test was determined for amphotericin B, fluconazole, and itraconazole using three different solid media: RPMI 1640, Casitone, and yeast nitrogen base agar. Minimum inhibitory concentrations (MICs) were comparable (results at +/- 2 dilutions) in 92% of the tests for amphotericin B and in 100% for fluconazole and itraconazole. Determination of MIC endpoints was easiest on Casitone agar. Candida albicans isolates from 23 patients undergoing fluconazole therapy for oropharyngeal candidiasis were tested for fluconazole susceptibility. Good correlation was obtained between the MICs of fluconazole and clinical outcome. Clinical failure was associated with strains for which MICs were > or = 48 micrograms/ml. These results suggest that the E test has potential utility for fluconazole susceptibility testing of clinical yeast isolates.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Oral; CD4 Lymphocyte Count; Fluconazole; HIV Infections; HIV Seronegativity; HIV Seropositivity; Humans; Itraconazole; Microbial Sensitivity Tests; Reproducibility of Results; Sensitivity and Specificity

Topics: AIDS-Related Opportunistic Infections; Ambulatory Care; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Esophagitis; Fluconazole; Guidelines as Topic; Humans; Itraconazole; Ketoconazole; Medical Audit; Nystatin; Retrospective Studies

This report describes a distinctive case of zygomatic candidiasic osteomyelitis in a diabetic patient with oral candidiasis and malar ulceration secondary to topic 5-fluoroacil toxicity that eventually exposed part of the underlying bone. The mechanism of infection may have been self-inoculation of spores from muguet plaques on the oral mucosa to the exposed bone tissue by hand contact. Such a mechanism of bone infection probably should be considered in patients who frequently have oral candidiasis (diabetes, malignancies, and HIV infection) and open lesions of the skin and soft tissues. Treatment with fluconazole was ineffective, but amphotericin B was curative.

Topics: Administration, Inhalation; Amphotericin B; Biopsy; Candidiasis; Candidiasis, Oral; Diabetes Complications; Fluconazole; Fluorouracil; Humans; Male; Middle Aged; Osteomyelitis; Steroids; Zygoma

We report on a 32-year-old male patient with advanced acquired immunodeficiency syndrome (AIDS), who had severe candidiasis of the gastrointestinal tract. Treatment with fluconazole, 200 mg/day, was introduced. After oral intake of fluconazole over 5 months itraconazole 200 mg/day was given for 1 month. However, fungal infection still persisted. The antifungal activity of fluconazole, itraconazole and ketoconazole against Candida albicans was evaluated by means of the microdilution test by determining the 90% inhibitory concentration of each drugs. A high minimal inhibitory concentration (MIC) was detected for fluconazole (50 micrograms/ml) revealing fluconazole resistance. The susceptibility to itraconazole was borderline (MIC 0.125 micrograms/ml) and that to ketoconazole was markedly lowered (MIC 0.25 micrograms/ml). Plasma levels of itraconazole were also found to be lowered. In HIV patients the gastrointestinal absorption of azole derivatives is often reduced. Therefore, the clinical resistance of Candida albicans to itraconazole can be explained by reduced susceptibility after azole therapy and also by the decreased absorption of the drug in HIV patients.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Candidiasis, Oral; Drug Resistance, Multiple; Drug Therapy, Combination; Fluconazole; Flucytosine; Gastrointestinal Diseases; Humans; Ketoconazole; Male; Microbial Sensitivity Tests

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Drug Resistance, Microbial; Fluconazole; HIV Seropositivity; Humans; Male; Treatment Failure

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiprotozoal Agents; Antiviral Agents; Atovaquone; Candidiasis, Oral; Clindamycin; Clotrimazole; Cryptosporidiosis; Cytomegalovirus Infections; Dapsone; Didanosine; Drug Combinations; Drug Therapy, Combination; Fluconazole; Flucytosine; Folic Acid Antagonists; Foscarnet; Glucuronates; Herpes Simplex; Herpes Zoster; Humans; Isoniazid; Itraconazole; Ketoconazole; Lamivudine; Mycobacterium avium-intracellulare Infection; Naphthoquinones; Nystatin; Pentamidine; Pneumocystis Infections; Pneumonia, Pneumocystis; Prednisone; Primaquine; Reverse Transcriptase Inhibitors; Stavudine; Syphilis; Toxoplasmosis; Trimetrexate; Tuberculosis; Zalcitabine; Zidovudine

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Candidiasis; Candidiasis, Oral; Child, Preschool; Drug Resistance, Microbial; Esophageal Diseases; Female; Humans; Male; Middle Aged; Triazoles

Topics: Amphotericin B; Candidiasis, Oral; Female; Humans; Melkersson-Rosenthal Syndrome; Middle Aged; Tongue, Fissured

Apart from direct skin attacks, yeasts of the Candida group hold a place that is much discussed in the occurrence of immuno-allergic reactions of the skin, because of their usual saprophytic characteristics. We report here on observation of a patient of 62 years who presented with a secondary purpuric maculo-papular eruption making a tri-symptom of Gougerot, for which we have incriminated the role of the immunogenicity of Candida. Skin histology confirmed the presence of an angiitis and necrotising capillarity. An intradermal test with candidine reproduced the skin symptoms and histology, whilst other microbial and fungal tests remained within normal limits. Other examinations showed the transitory presence of circulating immune complexes, although the remainder of the immunity factors were negative. A digestive focus of Candida was present. Recovery occurred after systemic mycological treatment was started, though there was a return of symptoms after a temporary initial check.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Candida; Candidiasis, Oral; Humans; Male; Miconazole; Middle Aged; Recurrence; Vasculitis, Leukocytoclastic, Cutaneous

An overview of the following fungal infections: thrush, vaginal candidiasis, cryptococcal meningitis, histoplasmosis, and blastomycosis is provided. The symptoms and treatment options of each infection are discussed. New information concerning the use of fluconazole in reducing the frequency of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections is included. The use of preventive treatment for fungal infections is cautioned due to the possibility of resistance to treatment.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Blastomycosis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Clotrimazole; Fluconazole; Histoplasmosis; Humans; Itraconazole; Meningitis, Cryptococcal; Mycoses

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.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Candida albicans; Candidiasis, Oral; Drug Resistance, Microbial; Fluconazole; Humans; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candida; Candidiasis, Oral; Female; Fluconazole; Fungemia; Humans; Recurrence; Zidovudine

Reports of thrush clinically refractory to azoles in AIDS patients are increasing with the more widespread use of these agents. We studied our own oral preparation of amphotericin B in the treatment of two AIDS patients who developed oral thrush due to Candida glabrata after prolonged fluconazole use. Improvement occurred in both in less than 1 week, with eventual clearing and absence of side effects. Oral amphotericin B may have advantages over alternatives for this increasing problem.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adult; Amphotericin B; Candidiasis, Oral; Cost-Benefit Analysis; Drug Resistance, Microbial; Fluconazole; Humans; Male; Treatment Outcome

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Candida albicans; Candidiasis; Candidiasis, Oral; Drug Administration Schedule; Drug Resistance, Microbial; Fluconazole; Humans; Pharyngitis; Treatment Failure

Congenital candida infection is a rare disease, although the incidence of candida vaginitis during pregnancy is high. We report on five cases each showing patterns considered typical for candida infection. The infective agent can cause chorioamnionitis even in the presence of intact fetal membranes. An intrauterine device (IUD) has been proved to be a risk factor for a congenital candida infection. The pathogenetic significance of contamination with candida for the fetus appears to depend largely on gestational age. A premature infant with a birth-weight less than 1500 g presented with bilateral candida endophthalmitis which was cured by intravenous Fluconazole therapy. Another premature infant weighing 800 g at birth developed a systemic candida infection. The other three more mature infants had milder symptoms, two of them presented with cutaneous candidiasis.

Topics: Adult; Amniocentesis; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Chorioamnionitis; Drug Therapy, Combination; Endophthalmitis; Female; Fetal Membranes, Premature Rupture; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nystatin; Pregnancy

The use of corticosteroids to reduce the morbidity associated with laryngotracheobronchitis (croup) has been a controversial issue for many years. Recent literature, however, does support a decreased morbidity and increased clinical response when short-term steroids are used. As a prophylactic measure against bacterial superinfection, antibiotics are commonly utilized in the treatment of croup. We present the case of an otherwise healthy infant with severe croup who was hospitalized and treated with both steroids and antibiotics. A relapse in her symptoms led to the diagnosis of candida laryngotracheitis. We recommend close monitoring of patients with croup treated aggressively with steroids and antibiotics. Steroid use should be limited to 24 h with antibiotics reserved for patients with signs of bacterial infection.

Topics: Amphotericin B; Candidiasis; Candidiasis, Oral; Cefaclor; Cefuroxime; Croup; Dexamethasone; Female; Humans; Infant; Ketoconazole; Laryngitis; Tracheitis

Topics: Amphotericin B; Candida; Candidiasis, Oral; Drug Resistance, Microbial; Fluconazole; Humans

We describe a patient with the acquired immunodeficiency syndrome who had persistent oral esophageal pseudomembranous candidiasis clinically refractory to nystatin, clotrimazole, and ketoconazole. In vitro resistance to clotrimazole was demonstrated as well. The patient received temporary relief with intravenous amphotericin B therapy, but this was associated with serious adverse effects, including transfusion-requiring anemia, azotemia, and severe thrombophlebitis. Despite two courses of intravenous amphotericin B therapy, the patient's highly symptomatic, recurrent oral and esophageal candidiasis continued. The patient was then treated with fluconazole and obtained immediate relief without associated adverse effects.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candida albicans; Candidiasis, Oral; Clotrimazole; Deglutition Disorders; Drug Resistance, Microbial; Esophageal Diseases; Fluconazole; Humans; Ketoconazole; Male

Using serial examination and oral cytology, 50 adult patients undergoing induction therapy for acute leukemia were studied for oral colonization with candida species. Ninety percent of patients were found to be colonized with Candida, with most of these colonizations present by day 14. The 30 patients exhibiting colonization with pseudohyphae received ketoconazole 400 mg daily by mouth. Of 20 patients in this group treated for 5 or more days, Candida organisms were eradicated in nine. Sixteen patients from the above group with persistent colonization on ketoconazole were treated by independent clinical decision for sustained fever and neutropenia with Amphotericin B, but only one responded by elimination of colonization. Seven of the 15 patients who did not initially receive ketoconazole developed Candida dissemination in contrast to two of 30 who received ketoconazole initially (P = 0.003, Fisher's exact test). No patient who initially had or acquired a negative cytology developed oral or disseminated candidiasis. Clinical oral candidiasis occurred in three patients, all of whom were receiving amphotericin B. Approximately 90% of these patients have or develop oral colonization with Candida organisms as identified by oral cytology. Those with colonization, both with and without pseudohyphae present, are at risk for dissemination. Amphotericin B does not eliminate colonization remaining after treatment with 400 mg of ketoconazole daily. More effective diagnostic and therapeutic strategies are needed to identify and eliminate Candida organisms and to prevent disseminated candidiasis in this population of patients.

Topics: Acute Disease; Adolescent; Adult; Aged; Amphotericin B; Candida; Candidiasis, Oral; Female; Humans; Ketoconazole; Leukemia; Male; Middle Aged

Topics: Amphotericin B; Candidiasis, Oral; Humans

Topics: Aged; Amphotericin B; Candidiasis, Oral; Female; Humans

Topics: Amphotericin B; Candidiasis, Oral; Esophagitis; Humans

Topics: Amphotericin B; Blood Transfusion; Candidiasis, Oral; Female; Humans; Leukemia, Myeloid; Lung Diseases; Middle Aged

Topics: Administration, Topical; Adult; Aged; Amphotericin B; Candidiasis, Oral; Female; Humans; Male; Middle Aged; Mouthwashes

Topics: Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Child; Esophagitis; Female; Humans; Ketoconazole; Leukemia, Lymphoid; Male; Nystatin; Thrombocytopenia

The acquired immune deficiency syndrome (AIDS) has reached epidemic proportions in the USA and the incidence of this potentially fatal viral infection is increasing rapidly in Australia. The loss of normal cellular immunity in affected individuals predisposes them to severe opportunistic infections and neoplasms, especially Kaposi's sarcoma. Both of these pathological processes may affect the eye, and ocular involvement with an opportunistic infection or malignancy may be the first clue to the presence of AIDS. We present here the first Australian report of a patient with AIDS presenting with ocular involvement. The case is discussed in relation to current concepts of AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candidiasis, Oral; Cryptococcosis; Eyelid Neoplasms; Flucytosine; Humans; Male; Sarcoma, Kaposi; Vinblastine

Disseminated histoplasmosis developed in a previously healthy man as the initial manifestation of the acquired immune deficiency syndrome. Following apparently successful therapy with intravenous amphotericin B, he presented two months later with a subacute pneumonitis syndrome diagnosed by bronchoscopy as Pneumocystis carinii pneumonia. He showed response to intravenous trimethoprim/sulfamethoxazole with resolution of his symptoms and clearing of chest radiographic findings. While he was receiving antibiotics, oral candidiasis developed and has persisted for more than two months despite topical therapy and discontinuation of all antibiotics.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candidiasis, Oral; Histoplasmosis; Humans; Lymphocytes; Male; Pneumonia; Pneumonia, Pneumocystis; Pseudomonas Infections

Sensitivity of 146 clinical strains of Candida albicans to nystatin, levorin and amphoglucamine was studied on solid media with the replica method. The strains were isolated from 79 patients with candidiasis of the oral mucosa. It was found that sensitivity of the fungi to the polyenic antibiotics was different which should be considered in treatment of candidiasis. On the basis of the mean MICs for the clinical strains and their distribution by the MICs it was shown that the activity level of levorin and amphoglucamine was higher than that of nystatin. During the treatment resistance of the Candida strains to the polyenic antibiotics increased and cross resistance developed which required application of other treatment means.

Topics: Amphotericin B; Antifungal Agents; Candicidin; Candida albicans; Candidiasis, Oral; Drug Resistance, Microbial; Humans; Nystatin

The presence of yeasts in oral lichen planus (OLP) lesions was studied in cultivations from 41 OLP patients and by histological examination in 39 of these cases. The histological features of OLP were also recorded. The cultivation results were compared with those of a randomly selected, age- and sex-matched control group without mucosal changes. The extent of growth was recorded as "sparse" (1-10 colonies), "model-rate" (11-40 colonies), or "heavy" (greater than 40 colonies). Yeasts were found to be present on cultures or histologic sections from a total of 19 OLP patients (46%). "Moderate-heavy" growth was obtained in 29% of the OLP cases but in only 7% of the control group. Candida albicans accounted for over 80% of the yeasts. The histological examination revealed only 3 cases of invasive fungal growth. Regarding the criteria of OLP, hyperortho- or hyperparakeratosis and a band-shaped subepithelial infiltration of lymphocytes were present in all specimens, basilar liquefaction degeneration in 87% and an eosinophilic zone in 77%. Local treatment with amphotericin B (Fungizone) in 18 OLP patients with positive findings resulted in subjective relief of symptoms in 89% of the patients. Clinical improvement was seen in 94%. The presence of Candida was significantly correlated to low secretion rate in unstimulated saliva.

Topics: Adult; Aged; Amphotericin B; Candida; Candidiasis, Oral; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases; Saliva; Secretory Rate; Yeasts

Invasive fungal infections are becoming increasingly frequent among immunocompromised patients and especially among cancer patients. The most common pathogens identified are Candida species, Aspergillus species, Cryptococcus neoformans, and Mucor species. Amphotericin B remains the mainstay of antifungal therapy. However, the toxicity of this drug may limit its use and, in addition, both failures and relapses have been reported. 5-Fluorocytosine and imidazoles, such as miconazole and ketoconazole, have been shown to be active, mainly on yeast organisms. The emergence of 5-fluorocytosine-resistant strains warrants caution for its administration as a single agent. The specific role of ketoconazole has not yet been established in large studies. In our experience, ketoconazole seems to be effective in the treatment of severe oral candidiasis in non-neutropenic cancer patients. Moreover, ketoconazole administered prophylactically to neutropenic patients decreases the number of positive surveillance cultures in these patients. The rare incidence of major toxicity and the ability to administer ketoconazole orally represent also major arguments for further investigation of ketoconazole activity by prospective controlled studies.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Candidiasis, Oral; Drug Therapy, Combination; Humans; Imidazoles; Ketoconazole; Lung Diseases, Fungal; Miconazole; Microbial Sensitivity Tests; Mycoses; Neoplasms; Neutropenia; Piperazines

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Candidiasis; Candidiasis, Oral; Dermatomycoses; Flucytosine; Griseofulvin; Humans; Imidazoles; Injections, Intravenous; Ketoconazole; Miconazole; Piperazines; Tinea; Tinea Versicolor

A retrospective evaluation was made on the value of amphotericin B lozenges in the selective elimination of yeasts from the oropharynx. Four different groups of severely granulocytopenic patients were studied. All 77 patients received amphotericin B orally as a suspension or as tablets. Four amphotericin B lozenges were also administered daily for topical antimycotic decontamination of the oropharynx. This was done in the presence of colonization-resistance decreasing factors such as a nasogastric tube (Group I, 19 patients) or mucosal damage (Group III, 25 patients) and in patients with four or more consecutive throat swab cultures with yeasts (Group IV, 11 patients). The 22 patients in Group II did not receive lozenges. The addition of lozenges resulted in a decrease in the mean "growth density" of Candida cells in the oropharynx. This reduction was significant in Group III (p less than 0.01) and Group IV (p less than 0.02) and became evident during the first week of treatment. In patients with a nasogastric tube, however, 51.8% of the throat swab cultures revealed yeasts. Increasing the dose of the lozenges might improve the results in these patients. Topical treatment of the oropharynx with amphotericin B lozenges is advocated for patients who are susceptible to Candida infections.

Topics: Amphotericin B; Candida; Candidiasis, Oral; Dosage Forms; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Neutropenia; Oropharynx; Retrospective Studies

This article deals with the etiology, pathogenesis, clinical manifestations, diagnosis, and treatment of oral candidosis. Emphasis is placed on drug therapy, and the literature reviewed indicates that although many drugs are available, amphotericin B (10 mg. lozenges) is favored as the drug of choice in the treatment of this condition. Attention is drawn to predisposing factors, particularly diabetes mellitus. A case in which the pathogen was identified as Candida parapsilosis is reported.

Topics: Amphotericin B; Candida; Candidiasis, Oral; Deficiency Diseases; Humans; Male; Middle Aged; Nystatin

Amphotericin B concentrations were measured in the saliva of ten healthy volunteers who had sucked on lozenges with this drug. It appeared that high amphotericin B concentrations can be achieved in this way in the saliva. Even half an hour after swallowing the last remnant of a lozenge, the amphotericin B concentration was found to be high enough to suppress the growth of sensitive Candida albicans strains. The possible usefulness of amphotericin B lozenges in the selective decontamination of the oropharynx of yeasts and other fungi is discussed and compared with the application of this drug in orabase.

Topics: Administration, Oral; Amphotericin B; Candida albicans; Candidiasis, Oral; Humans; Saliva

Many patients with oral candidiasis respond very slowly or not at all to therapy with amphotericin. Strains of Candida albicans were collected from 17 patients clinically resistant and from 15 who responded to a normal course of amphotericin treatment. Minimal inhibitory concentrations (MIC) determined on diagnostic sensitivity test agar plates gave values of: amphotericin 0-5 mg/l; nystatin 50 i.u./ml; chlorhexidine 12.5 mg/l. No clear MIC could be determined with plates containing miconazole. No difference was noted in MIC values between the 2 groups of patients. Tube-dilution tests in Sabouraud's broth gave MIC values of: amphotericin 0.25 mg/l; nystatin 12.5 i.u./ml; chlorhexidine 1.5 mg/l; miconazole 8-32 mg/l; ketonazole 64 mg/l. Persistence of oral candidiasis is not an indication of infection with resistant organisms. Despite difficulties in in vitro sensitivity testing of miconazole a clinical trial of the drug for treating oral candidiasis is indicated.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis, Oral; Chlorhexidine; Chronic Disease; Drug Resistance, Microbial; Humans; Miconazole; Microbial Sensitivity Tests; Nystatin

The authors present a review of the epidemiology, pathology, diagnosis and treatment of candidiasis in the child. Their studies on the favoring factors in cutaneous forms as well as their experiences in pulmonary forms are emphasized.

Topics: Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Clotrimazole; Complement C5; Female; Flucytosine; Humans; Immunity, Cellular; Immunologic Deficiency Syndromes; Miconazole; Nystatin

A patient with late onset chronic mucocutaneous candidiasis developed lymphocytic lymphoma. A specific inhibitor of in vitro lymphoproliferative responses to candidal antigen was detected in her serum which persisted following clinical remission of candidiasis after combined amphotericin-B and 5-Fluorocystosine therapy. It is unclear whether the combined therapy was exclusively anticandidal, nonspecific immunostimulant or cytotoxic affecting the underlying incipient lymphoma.

Topics: Amphotericin B; Antibodies, Fungal; Antigens, Fungal; Binding, Competitive; Candidiasis, Oral; Female; Flucytosine; Humans; Immunity; Immunosuppression Therapy; In Vitro Techniques; Lymphocyte Activation; Lymphoma, Non-Hodgkin; Middle Aged

Topics: Amphotericin B; Animals; Candidiasis, Oral; Chlorhexidine; Dental Plaque; Humans; Hydrogen-Ion Concentration; Saliva; Salivation; Stomatitis; Stomatitis, Denture

Topics: Adrenal Cortex Hormones; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Female; Fingers; Glossitis; Humans; Infant, Newborn; Lip; Male; Metabolic Diseases; Middle Aged; Nutrition Disorders; Paronychia; Pregnancy; Vulvovaginitis

Use of transfer factor in the treatment of chronic mucocutaneous candidiasis is discussed. The clinical experience in treating 2 patients with different clinical expressions of the syndrome and their different responses to treatment with repeated injections of transfer factor given in conjunction with amphotericin-B are reported. Results indicate that this form of therapy is a safe and effective way of restoring cell-mediated immunity to Candida and successfully treating some patients with chronic mucocutaneous candidiasis.

Topics: Amphotericin B; Candida albicans; Candidiasis, Cutaneous; Candidiasis, Oral; Child; Female; Humans; Hypoparathyroidism; Immunity, Cellular; Immunologic Deficiency Syndromes; Lymphocyte Activation; Paronychia; Skin Tests; Thymidine; Transfer Factor; Tritium; Vitiligo

21 of 41 patients developed clinically manifest or systemic Candida albicans infection 1-36 months after renal transplantation. Asymptomatic candiduria was diagnosed in all patients even before the onset of clinical symptoms. Fungal stomatitis was the most frequent clinical sign, followed by mycotic changes in the respiratory, genito-urinary (vaginitis) and gastro-intestinal tract. In five cases intrahepatic biliary stasis was diagnosed in the course of a Candida albicans septicaemia. In 12 patients with renal transplants it was possible, by treatment with nystatin, clotrimazole, flucytosine, miconazole and amphotericine B to control a generalized or clinically manifest Candida albicans infection. Three died of the septicaemia or meningoencephalitis, six as the result of bacterial superinfections. Inspection of the mouth is an important means of early diagnosing fungal infections. Antimycotic treatment should be started if fungal cultures from urine are repeatedly positive even if the clinical findings are still negative.

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Cholestasis; Clotrimazole; Female; Humans; Kidney Transplantation; Male; Meningoencephalitis; Miconazole; Middle Aged; Nystatin; Postoperative Complications; Sepsis; Transplantation, Homologous

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Cutaneous; Candidiasis, Oral; Child; Chronic Disease; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Female; Flucytosine; Fluorouracil; Humans; Hypersensitivity, Delayed; Immunologic Deficiency Syndromes; Immunotherapy; Lymphocyte Activation; Microbial Sensitivity Tests; Nystatin; Skin Diseases; Staphylococcal Infections

Topics: Amphotericin B; Antifungal Agents; Balanitis; Candida albicans; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Coloring Agents; Contraceptives, Oral; Diabetes Complications; Female; Humans; Infant, Newborn; Male; Nails; Nystatin; Paronychia; Pregnancy; Pregnancy Complications, Infectious; Saccharomyces

Topics: Adult; Aged; Amphotericin B; Candida albicans; Candidiasis, Oral; Humans; Middle Aged; Mouth; Mouth Mucosa; Mouth Neoplasms; Pharyngeal Neoplasms; Pharynx; Radiotherapy; Radiotherapy Dosage

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Candidiasis, Oral; Diaper Rash; Drug Resistance, Microbial; Female; Griseofulvin; Humans; Male; Mouth Diseases; Nystatin; Ointments; Paronychia; Pruritus Ani; Skin Diseases; Tinea; Tinea Pedis; Tinea Versicolor

Topics: Adolescent; Adult; Aged; Amphotericin B; Candida; Candida albicans; Candidiasis, Oral; Female; Humans; Male; Middle Aged; Recurrence; Saccharomyces cerevisiae

Topics: Adolescent; Amphotericin B; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Chronic Disease; Female; Gastrointestinal Diseases; Humans

Topics: Amphotericin B; Biopsy; Candida albicans; Candidiasis, Oral; Cheilitis; Diabetes Complications; Endocrine System Diseases; Fluorescent Antibody Technique; Humans; Immunity, Cellular; Immunologic Deficiency Syndromes; Leukoplakia, Oral; Metabolic Diseases; Nutrition Disorders; Nystatin; Sjogren's Syndrome; Stomatitis, Denture

Topics: Amphotericin B; Anemia, Hypochromic; Candidiasis, Cutaneous; Candidiasis, Oral; Chronic Disease; Genes, Recessive; Humans; Immunity, Cellular; Immunologic Deficiency Syndromes

Topics: Acute Disease; Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Autopsy; Biopsy; Candidiasis; Candidiasis, Oral; Child, Preschool; Female; Fever of Unknown Origin; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged; Mucor; Mycoses; Retrospective Studies

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Exudates and Transudates; Flucytosine; Humans; Immunosuppression Therapy; Leukemia, Myeloid, Acute; Male; Retinitis

Topics: Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Contraceptive Agents; Female; Granuloma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Natamycin; Nystatin; Pregnancy

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Candidiasis, Oral; Carcinoma; Diagnosis, Differential; Female; Granuloma; Humans; Lip Diseases; Pityriasis; Skin Neoplasms

Topics: Amphotericin B; Candida albicans; Candidiasis; Candidiasis, Oral; Central Nervous System Diseases; Culture Media; Digestive System; Female; Gastroenteritis; Gentian Violet; Humans; Infant, Newborn; Mustard Compounds; Nystatin; Urinary Tract Infections

Topics: Amphotericin B; Candidiasis, Oral; Female; Geotrichosis; Glucocorticoids; Humans; Middle Aged; Mitosporic Fungi; Mouth Mucosa; Mycoses; Pemphigus

Topics: Amphotericin B; Candida; Candidiasis, Oral; Dentures; Humans; Nystatin

Topics: Amphotericin B; Candidiasis, Oral; Dentures; Humans; Nystatin; Stomatitis

Topics: Adult; Amphotericin B; Candidiasis, Oral; Female; Germany, East; Granuloma; Humans

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Female; Humans; Tetracycline; Trichomonas Vaginitis

Topics: Administration, Oral; Amphotericin B; Candida; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Microscopy, Electron; Middle Aged

Topics: Amphotericin B; Candidiasis, Oral; Female; Humans; Male; Nystatin

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Esophageal Diseases; Fluoroscopy; Humans; Leukemia; Leukemia, Myeloid; Male; Middle Aged; Nystatin

Topics: Adult; Aged; Amphotericin B; Candidiasis, Oral; Carcinoma, Squamous Cell; Chronic Disease; Humans; Hyperplasia; Male; Middle Aged; Mouth Neoplasms; Precancerous Conditions

Topics: Amphotericin B; Candida; Candidiasis, Oral; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Male; Suspensions

Topics: Adolescent; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Child, Preschool; Chronic Disease; Female; Humans; Infant; Male; Nails; Skin Diseases

Topics: Adult; Amphotericin B; Antibody Formation; Antigens; Candida; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Cell Migration Inhibition; Child; Female; Humans; Hypersensitivity, Delayed; Immunity, Cellular; Immunity, Maternally-Acquired; Immunization, Passive; Immunoglobulins; Immunosuppression Therapy; Lectins; Lymphocyte Activation; Lymphocytes; Macrophages; Saliva; Skin Tests; Thymidine; Tritium; Tuberculin Test

Topics: Amphotericin B; Anti-Infective Agents, Local; Burns; Candidiasis, Oral; Denture, Complete; Humans; Nystatin; Oral Health

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Humans; Male; Nystatin

Topics: Adolescent; Amphotericin B; Body Height; Body Weight; Candidiasis, Oral; gamma-Globulins; Humans; Intellectual Disability; Male

Topics: Adolescent; Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Drug Resistance, Microbial; Female; Humans; Lung Diseases; Middle Aged; Nystatin; Oral Manifestations; Sarcoidosis

Topics: Adult; Amphotericin B; Candida; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Feces; Female; Humans; Infant; Male; New York City; Pyelonephritis; Sputum

Topics: Amphotericin B; Candidiasis, Oral; Female; Humans; Male

Topics: Amphotericin B; Candidiasis; Candidiasis, Oral; Child; Female; Humans

Topics: Amphotericin B; Candidiasis, Oral; Dentistry

Topics: Adolescent; Amphotericin B; Candidiasis, Oral; Geriatrics; Humans; Stomatitis

Topics: Amphotericin B; Antidepressive Agents; Candidiasis, Oral; Candidiasis, Vulvovaginal; Drug Therapy; Mental Disorders; Nystatin; Oral Manifestations; Toxicology; Tranquilizing Agents; Xerostomia

Topics: Amphotericin B; Candidiasis, Oral; Dermatologic Agents; Drug Therapy; Glucocorticoids; Pharmacology; Toxicology; Triamcinolone Acetonide

Topics: Addison Disease; Administration, Cutaneous; Adrenal Insufficiency; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Gentian Violet; Humans; Hypoadrenocorticism, Familial; Hypoparathyroidism; Nystatin; Sweden

Topics: Administration, Cutaneous; Adolescent; Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Female; Humans; Infant; Infant, Newborn; Nystatin