Colonização oral por Candida spp. em pacientes com infecção pelo HIV em uso de terapia anti-retroviral : estudo epidemiologico, clinico e microbiologico / Colonization by oral Candida spp. in patients with HIV infection in use of antiretroviral therapy : study epidemiological, clinical and microbiological testing




OBJECTIVES: Evaluating de incidence of oral colonization by Candida spp. in patients in use of antiretroviral therapy, comparing the results of the groups of patients colonized and non-colonized, as well as study the microbiological aspects of the isolated strains. PATIENTS AND METHODS: It was made a cross sectional study assisted at HC/UNICAMP, from August, 2003 to April, 2004, with unique collect of the oral cavity by patient using a swab. CHROMagar Candida® and ID32C® were used in growth, isolation and identification of Candida spp. and Candida Check® for determination of C. albicans sorotypes. C. dubliniensis was identified by sequencing in ABI PRISM 3100® GENETIC ANALYZER device. The genomic profile was studied by PFGE, using the system CHEF and azoles, 5-FC, amphotericin B and nistatine sensibility, based broth microdilution (CLSI). It was evaluated through the review of the prontuaries: genre, age, race, year of HIV infection diagnosis, type of exposition, viral load, TCD4+ linfocyte counting, opportunistic infections, antiretroviral therapy and antifungal therapy. RESULTS: It was identified 140/324 colonized patients and 184/324 non-colonized patients: male gender (63% and 60%), sexual exposition (81,5% and 80,5%) and average age of 39,8 years old. The presence of colonization was significantly greater in patients with detectable viral load (p=0,002) e CD4+<200/mm3 (p=0,006). The incidence of oral candidiasis (31,2%), tuberculosis (20,9%), herpes zoster (16,3%), Pneumocystis carinii pneumonia (PCP) (15,7%) and toxoplasmosis (11,7%) was seen among the total of studied patients. It was not observed a significant difference regarding colonization by Candida among the patients in use of ARVT with or without usage of PI. The early usage of nistatine was bigger in the colonized group (p=0,014). It was isolated 115/154 C. albicans sorotype A, 15/154 C. albicans sorotype B and 24/154 non albicans Candida . Twelve patients presented mixed colonization. The genomic study of C. albicans sorotype A, identified 15 different profiles, with dominance of A1 (56,5%), which shown 100 % similarity between C. albicans sorotype B and predominant B1 (86,6%). The genomic profile of C. glabrata showed heterogeneous. C. albicans serotype A and B showed sensible to all evaluated antifugicals. C. glabrata e C. krusei showed S-DD to azoles. CONCLUSION: This work contributed significantly to trace an epidemiological/clinical profile of the HIV patients in usage of ARV therapy and the lack of influence of IP in the presence or absence of colonization of oral Candida


candida albicans eletroforese em gel antifungicos antifungal agents gel eletrophoresis terapia anti-retroviral de alta atividade candida dubliniensis highly active antiretroviral therapy

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