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dc.contributor.authorMcManus, Brenda A
dc.contributor.authorMcGovern, Eleanor
dc.contributor.authorMoran, Gary P
dc.contributor.authorHealy, Claire M
dc.contributor.authorNunn, June
dc.contributor.authorFleming, Pádraig
dc.contributor.authorCostigan, Colm
dc.contributor.authorSullivan, Derek J
dc.contributor.authorColeman, David C
dc.date.accessioned2012-05-02T14:40:57Z
dc.date.available2012-05-02T14:40:57Z
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/10147/221591
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.
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
html.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.


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