Microbiological screening of Irish patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy reveals persistence of Candida albicans strains, gradual reduction in susceptibility to azoles, and incidences of clinical signs of oral candidiasis without culture evidence.

Hdl Handle:
http://hdl.handle.net/10147/221855
Title:
Microbiological screening of Irish patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy reveals persistence of Candida albicans strains, gradual reduction in susceptibility to azoles, and incidences of clinical signs of oral candidiasis without culture evidence.
Authors:
McManus, Brenda A; McGovern, Eleanor; Moran, Gary P; Healy, Claire M; Nunn, June; Fleming, Pádraig; Costigan, Colm; Sullivan, Derek J; Coleman, David C
Affiliation:
Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland.
Citation:
Microbiological screening of Irish patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy reveals persistence of Candida albicans strains, gradual reduction in susceptibility to azoles, and incidences of clinical signs of oral candidiasis without culture evidence. 2011, 49 (5):1879-89 J. Clin. Microbiol.
Journal:
Journal of clinical microbiology
Issue Date:
May-2011
URI:
http://hdl.handle.net/10147/221855
DOI:
10.1128/JCM.00026-11
PubMed ID:
21367996
Abstract:
Patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) are prone to chronic mucocutaneous candidiasis, which is often treated with azoles. The purpose of this study was to characterize the oral Candida populations from 16 Irish APECED patients, who comprise approximately half the total number identified in Ireland, and to examine the effect of intermittent antifungal therapy on the azole susceptibility patterns of Candida isolates. Patients attended between one and four clinical evaluations over a 5-year period, providing oral rinses and/or oral swab samples each time. Candida was recovered from 14/16 patients, and Candida albicans was the only Candida species identified. Interestingly, clinical diagnosis of candidiasis did not correlate with microbiological evidence of Candida infection at 7/22 (32%) clinical assessments. Multilocus sequence typing analysis of C. albicans isolates recovered from the same patients on separate occasions identified the same sequence type each time. Fluconazole resistance was detected in isolates from one patient, and isolates exhibiting a progressive reduction in itraconazole and/or fluconazole susceptibility were identified in a further 3/16 patients, in each case correlating with the upregulation of CDR- and MDR-encoded efflux pumps. Mutations were also identified in the ERG11 and the TAC1 genes of isolates from these four patients; some of these mutations have previously been associated with azole resistance. The findings suggest that alternative Candida treatment options, other than azoles such as chlorhexidine, should be considered in APECED patients and that clinical diagnosis of oral candidiasis should be confirmed by culture prior to the commencement of anti-Candida therapy.
Item Type:
Article
Language:
en
MeSH:
Adolescent; Adult; Antifungal Agents; Azoles; Candida albicans; Candidiasis, Oral; Child; Child, Preschool; Drug Resistance, Fungal; Female; Fluconazole; Humans; Incidence; Ireland; Itraconazole; Male; Mass Screening; Mouth Mucosa; Multilocus Sequence Typing; Mycological Typing Techniques; Polyendocrinopathies, Autoimmune
ISSN:
1098-660X

Full metadata record

DC FieldValue Language
dc.contributor.authorMcManus, Brenda Aen_GB
dc.contributor.authorMcGovern, Eleanoren_GB
dc.contributor.authorMoran, Gary Pen_GB
dc.contributor.authorHealy, Claire Men_GB
dc.contributor.authorNunn, Juneen_GB
dc.contributor.authorFleming, Pádraigen_GB
dc.contributor.authorCostigan, Colmen_GB
dc.contributor.authorSullivan, Derek Jen_GB
dc.contributor.authorColeman, David Cen_GB
dc.date.accessioned2012-05-03T13:53:11Z-
dc.date.available2012-05-03T13:53:11Z-
dc.date.issued2011-05-
dc.identifier.citationMicrobiological screening of Irish patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy reveals persistence of Candida albicans strains, gradual reduction in susceptibility to azoles, and incidences of clinical signs of oral candidiasis without culture evidence. 2011, 49 (5):1879-89 J. Clin. Microbiol.en_GB
dc.identifier.issn1098-660X-
dc.identifier.pmid21367996-
dc.identifier.doi10.1128/JCM.00026-11-
dc.identifier.urihttp://hdl.handle.net/10147/221855-
dc.description.abstractPatients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) are prone to chronic mucocutaneous candidiasis, which is often treated with azoles. The purpose of this study was to characterize the oral Candida populations from 16 Irish APECED patients, who comprise approximately half the total number identified in Ireland, and to examine the effect of intermittent antifungal therapy on the azole susceptibility patterns of Candida isolates. Patients attended between one and four clinical evaluations over a 5-year period, providing oral rinses and/or oral swab samples each time. Candida was recovered from 14/16 patients, and Candida albicans was the only Candida species identified. Interestingly, clinical diagnosis of candidiasis did not correlate with microbiological evidence of Candida infection at 7/22 (32%) clinical assessments. Multilocus sequence typing analysis of C. albicans isolates recovered from the same patients on separate occasions identified the same sequence type each time. Fluconazole resistance was detected in isolates from one patient, and isolates exhibiting a progressive reduction in itraconazole and/or fluconazole susceptibility were identified in a further 3/16 patients, in each case correlating with the upregulation of CDR- and MDR-encoded efflux pumps. Mutations were also identified in the ERG11 and the TAC1 genes of isolates from these four patients; some of these mutations have previously been associated with azole resistance. The findings suggest that alternative Candida treatment options, other than azoles such as chlorhexidine, should be considered in APECED patients and that clinical diagnosis of oral candidiasis should be confirmed by culture prior to the commencement of anti-Candida therapy.en_GB
dc.language.isoenen
dc.rightsArchived with thanks to Journal of clinical microbiologyen_GB
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshAntifungal Agents-
dc.subject.meshAzoles-
dc.subject.meshCandida albicans-
dc.subject.meshCandidiasis, Oral-
dc.subject.meshChild-
dc.subject.meshChild, Preschool-
dc.subject.meshDrug Resistance, Fungal-
dc.subject.meshFemale-
dc.subject.meshFluconazole-
dc.subject.meshHumans-
dc.subject.meshIncidence-
dc.subject.meshIreland-
dc.subject.meshItraconazole-
dc.subject.meshMale-
dc.subject.meshMass Screening-
dc.subject.meshMouth Mucosa-
dc.subject.meshMultilocus Sequence Typing-
dc.subject.meshMycological Typing Techniques-
dc.subject.meshPolyendocrinopathies, Autoimmune-
dc.titleMicrobiological screening of Irish patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy reveals persistence of Candida albicans strains, gradual reduction in susceptibility to azoles, and incidences of clinical signs of oral candidiasis without culture evidence.en_GB
dc.typeArticleen
dc.contributor.departmentMicrobiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin 2, Republic of Ireland.en_GB
dc.identifier.journalJournal of clinical microbiologyen_GB
dc.description.provinceLeinsteren
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