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.
McManus, Brenda A McGovern, Eleanor Moran, Gary P Healy, Claire M Nunn, June Fleming, Pádraig Costigan, Colm Sullivan, Derek J Coleman, David C
McManus, Brenda A
McGovern, Eleanor
Moran, Gary P
Healy, Claire M
Nunn, June
Fleming, Pádraig
Costigan, Colm
Sullivan, Derek J
Coleman, David C
Advisors
Editors
Other Contributors
Date
2011-05
Date Submitted
Keywords
Other Subjects
Subject 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
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
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
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.
Language
en
ISSN
1098-660X
eISSN
ISBN
DOI
10.1128/JCM.00026-11
PMID
21367996