Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 27, Num. 2, 2009, pp. 174-175

Indian Journal of Medical Microbiology, Vol. 27, No. 2, April-June, 2009, pp. 174-175

Correspondence

Immunosuppression level in HIV-positive patients with oropharyngeal candidiasis

Arora Usha, Jagdev Maninder, Jindal Neerja

Department of Microbiology, Government Medical College, Amritsar, Punjab - 143 001
Correspondence Address:Department of Microbiology, Government Medical College, Amritsar, Punjab - 143 001, usha_arora@yahoo.co.in

Date of Submission: 17-May-2007
Date of Acceptance: 20-May-2008

Code Number: mb09056

PMID: 19384052

DOI: 10.4103/0255-0857.49442

Dear Editor,

Oropharyngeal candidiasis (OPC) is the most common opportunistic fungal infection in patients with HIV infection. Its incidence increases as the impairment of cellular immunity progresses. ^[1] A total of 60 isolates of Candida spp. obtained from HIV-positive patients having OPC were processed and their CD4 count was determined to find out the correlation of various isolates of Candida spp. and their antifungal susceptibility to the CD4 count of the patients. HIV seropositivity was confirmed by three E/R/S tests as per guidelines of NACO, Government of India. Antifungal susceptibility testing of various isolates was done for fluconazole, amphotericin B, and ketoconazole in accordance with standard procedures, ^[2] and CD4 count was measured by fluorescent activated cell sorter (FACS) counter (Becton Dickinson, Cockyesville, MD, USA).

Out of 60 Candida spp. isolates obtained, 45 (75%) were Candida albicans and 13 (22.67%) were nonalbicans Candida spp. Among the nonalbican species C. tropicalis was found to be the commonest. Other authors have also reported C. albicans to be the major isolate and C. tropicalis as the commonest nonalbicans species in HIV-positive patients having OPC. ^[1],[3] Of the 60 patients, 46 (76.66%) had CD4 count < 200 cells/mm ³ [Table - 1]. Singh et al , also reported that there is significantly increased risk of OPC in HIV-infected patients with progressive immunodeficiency (CD4 + < 200 cells/mm ³ ). ^[4] Therefore, even when patient′s CD4 cell count is not known, presence of oral lesions may be considered as an indirect marker of immunosuppression. In the current study, a close association was observed between prevalence of non albicans Candida spp. and fluconazole resistance with low CD4 count [Table - 1], which goes well with the findings of other authors. ^[4],[5] The level of immunosuppression and prior fluconazole therapy, are important risk factors in the emergence of resistance in yeast isolates.

It is concluded that C. albicans is the major isolate causing OPC in HIV-seropositive patients and nonalbicans species are emerging as important pathogens with increased immunosuppression. Since OPC may be considered as indirect marker of immunosupression in HIV-positive patients, regular oral checkup of these patients could be an indicator of the level of immunosuppression.

References

1.	Darouiche RO. Oropharyngeal and esophageal candidiasis in immunocompromised patients: Treatment Issues. Clin Infect Dis 1998;26:259.  Back to cited text no. 1  [PUBMED]
2.	Chander J. Candidiasis. In: Textbook of medical mycology.2 nd ED. New Delhi; Mehta Publishers; 2002. p. 212-30, 389-96.  Back to cited text no. 2
3.	Revankar SG, Kirkpatrick WR, McAtee RK Dib OP, Fothergill AW, Redding SW et al . Detection and significance of fluconazole resistance in oropharyngeal candidiasis in human immunodeficiency virus infected patients. J Infect Dis 1996;174:821-7.  Back to cited text no. 3
4.	Singh HR, Singh NG, Singh TB. Estimation of CD4+ and CD8 + T-lymphocytes in human immunodeficincy virus infection and acquired immunodeficiency syndrome patients in Manipur. Indian J Med Microbiol 2007;25:126-32.  Back to cited text no. 4  [PUBMED]
5.	Fichtenbaum CJ, Koletar S, Yiannoutsos C, Holland F, Pottage J, Cohn E, et al . Refractory mucosal candidiasis in advanced human immunodeficiency virus infection. Clin Infect Dis 2000;30:749-56.  Back to cited text no. 5

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