Epidemiology and prevalence of oral candidiasis in HIV patients from Chad

by Liliane Taverne-Ghadwal
Doctoral thesis
Date of Examination:2016-03-03
Date of issue:2016-03-03
Advisor:Prof. Dr. Uwe Groß
Referee:Prof. Dr. Uwe Groß
Referee:Prof. Dr. Harald Schwörer
Persistent Address: http://dx.doi.org/10.53846/goediss-5533

 

 

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Abstract

English

The study was performed to determine the prevalence and epidemiology of oral candidiasis among HIV-positive patients in Chad and evaluate the susceptibility of the yeasts found in the oral cavity to five antifungals. The prevalence of oral candidiasis and colonization among HIV-positive patients was surprisingly low with 10.2% and 25.4% respectively. The main types of oral candidiasis seen were an atypical type of pseudomembranous candidiasis and the median rhomboid glossitis.Last type was mainly seen in HIV+/HAART- patients.High fungal burden was highly associated with oral candidiasis, CD4 T cell counts <200 CD4 T cells/µl and the presence of C. albicans. There were no cases of oral candidiasis caused by non-C. albicans yeast spp. Candida albicans was the predominant species found in all subgroups with the highest prevalence in HIV+/HAART- patients. HIV-negative as well as HIV+/HAART+ patients had a higher yeast species diversity, but no C. dubliniensis was found. HAART significantly reduced the rate of oral candidiasis and colonization with yeasts, and was associated with a shift towards non-C. albicans yeast spp. correlating with the duration of HAART. Clinically, neither antifungal drug resistance nor therapy refractory cases were found, but higher MICs for azoles in the species C. glabrata, I. orientalis and C. tropicalis were present. The emergence of non-C. albicans yeast spp. was not associated with antifungal treatment, but was rather the result of a recovered immune system under extended HAART with a rise in CD4 T cell counts.  In conclusion, our results suggest that (i) severe oral lesions as oral candidiasis are strong markers of immunodeficiency and may be used to evaluate the patient's immune status and guide therapy, (ii) oral candidiasis is associated with the species Candida albicans, (iii) antifungal resistance and infection caused by non-C. albicans yeast spp. is not yet a point of concern in Chad.
Keywords: oral candidiasis; HIV; Chad
Schlagwörter: oral candidiasis; HIV; Chad
 
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