Oral candidiasis: The clinical challenge of resistance and management

Oral candidiasis is a common fungal infection in patients with an impaired immune system, such as those undergoing chemotherapy for cancer and patients with AIDS. It has a high morbidity amongst the latter group with approximately 85% of patients being infected at some point during the course of their illness. A major predisposing factor in HIV-infected patients is a decreased CD4 T-cell count. The majority of infections are due to C. albicans although other species such as C. glabrata, C. tropicalis, C. krusei and C. parapsilosis are increasingly isolated. The systemic azoles, ketoconazole, fluconazole and itraconazole, have been an important benefit in treatment. To date, resistance has primarily been a problem with fluconazole in AIDS. However, it is important that measures are instituted to prevent the spread of resistant strains and the development of cross-resistance. Although the NCCLS has established a reference method to measure in vitro susceptibility, besides already published papers, more data are necessary to demonstrate that resistance correlates with clinical failure.