Document 0156
 DOCN  M9650156
 TI    Fluconazole- and itraconazole-resistant Candida albicans strains from
       AIDS patients: multilocus enzyme electrophoresis analysis and antifungal
       susceptibilities.
 DT    9605
 AU    Le Guennec R; Reynes J; Mallie M; Pujol C; Janbon F; Bastide JM;
       Laboratoire d'Immunologie et Parasitologie, Faculte de; Pharmacie,
       Montpellier, France.
 SO    J Clin Microbiol. 1995 Oct;33(10):2732-7. Unique Identifier : AIDSLINE
       MED/96087219
 AB    Multilocus enzyme electrophoresis and in vitro susceptibility testing
       with a broth microdilution method were used to analyze Candida albicans
       strain diversity in four AIDS patients with recurrent oropharyngeal
       candidiasis who successively developed clinical resistance to
       fluconazole (FCZ) and itraconazole (ITZ). One to ten colonies per sample
       were randomly chosen from oral washings collected before the initial FCZ
       treatment and just before every other antifungal treatment; a total of
       98 isolates were analyzed. Multilocus enzyme electrophoresis analysis
       revealed 14 different electrophoretic types (ETs). Statistical analysis
       of genetic distances showed that C. albicans isolates clustered into
       five subpopulations (I to V). In each subpopulation, isolates are
       closely related, and genetic distances between subpopulations I to IV
       are short. In contrast, subpopulation V, which contained isolates typed
       as ET8 and ET14, is strongly divergent from the others; these isolates
       may represent atypical C. albicans isolates. Only one patient was
       infected with a single strain during the course of azole therapy; for
       the three remaining patients, variants of the same strain and different
       strains were concurrently isolated. Clinical FCZ resistance was clearly
       correlated with in vitro data for three patients. Moreover, MICs of ITZ
       increased during FCZ therapy, and MICs of ITZ which were > or = 1.56
       micrograms/ml were found when clinical ITZ resistance occurred; isolates
       from subpopulation V showed the highest MICs of ITZ. Because of the
       emergence of clinical ITZ resistance after clinical FCZ resistance, the
       feasibility of long-term azole therapy for mucosal candidiasis in AIDS
       patients is questioned.
 DE    Acquired Immunodeficiency Syndrome/COMPLICATIONS/*MICROBIOLOGY  Adult
       Alleles  Antifungal Agents/*PHARMACOLOGY  Candida
       albicans/*CLASSIFICATION/ENZYMOLOGY  Candidiasis,
       Oral/COMPLICATIONS/*MICROBIOLOGY/THERAPY  Drug Resistance, Microbial
       Electrophoresis/METHODS  Enzymes/GENETICS  Fluconazole/PHARMACOLOGY
       Human  Itraconazole/PHARMACOLOGY  Microbial Sensitivity Tests
       Triazoles/*PHARMACOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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