1 Candida albicans is the species with the highest prevalence among human yeast isolates and is the main opportunistic yeast pathogen in most warm-blooded animals. Of the numerous pathogenic fungi, Candida is the dominant genus responsible for fungal diseases in humans. Depending on the interaction between the host’s mucosal defense mechanisms, fungal virulence factors, and antifungal utilization, colonization may be transient or persistent and local disease may ensue. ![]() Accordingly, humans are continually exposed to multiple genera of fungi via various routes, but particularly by the ingestion of food, allowing for the colonization of the gastrointestinal tract. In patients with fluconazole-refractory mucosal candidiasis, treatment options now include itraconazole solution, voriconazole, posaconazole, and the newer echinocandins (caspofungin, micafungin, and anidulafungin).įungi are found ubiquitously in nature in association with plants and mammals. However, itraconazole and posaconazole have similar clinical response rates as fluconazole and are also effective alternative agents. Fluconazole has become the most widely used antifungal in the management of mucosal candidiasis. Candida esophagitis (CE) is also an important concern since it occurs in more than 10% of patients with AIDS and can lead to a decrease in oral intake and associated weight loss. A constant concern in these patients is relapse, which is dependent on the degree of immunosuppression commonly seen after topical therapy, rather than with systemic azole therapy. The systemic azoles, are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole, voriconazole, posaconazole) have replaced older topical antifungals (gentian violet and nystatin) in the management of oropharyngeal candidiasis in these patients. ![]() Over 90% of patients with AIDS will develop oropharyngeal candidiasis (OPC) at some time during their illness. Mucocutaneous candidiasis is frequently one of the first signs of human immunodeficiency virus (HIV) infection.
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