Skip to main content

Advertisement

Log in

Oral candidiasis and oral yeast carriage among institutionalised South African paediatric HIV/AIDS patients

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

South Africa currently has an estimated 500,000 AIDS orphans, many of whom are HIV-positive. Oral candidiasis commonly occurs in both adult and paediatric HIV/AIDS patients. Published information on HIV-positive children in Africa mainly concerns hospitalised patients. The objective of this study was to determine the prevalence of oral candidiasis and oral yeast carriage among paediatric HIV/AIDS patients residing in orphanages in Gauteng, South Africa, and to compare the prevalence of isolated yeast species with species obtained from adult HIV/AIDS patients. Eighty-seven paediatric HIV/AIDS patients residing in five homes were examined and a swab taken from the dorsal surface of the tongue, cultured on CHROMagar and yeast isolates identified with the ATB 32C commercial system. The species prevalence of 57 identified isolates was compared with that of 330 isolates from adult HIV/AIDS patients. Twelve (13.8%) children presented with clinically detectable candidiasis. Yeasts were isolated from 0% to 53% of children in the individual homes, with Candida albicans (40.4%) and C. dubliniensis (26.3%) constituting the most frequently isolated species. Gentian violet prophylaxis was administered in one particular home and a higher carriage rate (66.6%) of non-C. albicans and non-C. dubliniensis was observed among these children. The prevalence of C. albicans was lower while the prevalence of C. dubliniensis, C. glabrata and C. tropicalis was significantly higher (p ≤ 0.001) among the children than among adult HIV/AIDS patients. These findings indicate a role for yeast culture and species determination in cases with candidiasis in institutionalized paediatric HIV/AIDS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dorrington R, Bradshaw D, Budlender D. HIV/AIDS profile of the provinces of South Africa — indicators for 2002. Centre for Actuarial Research, Medical Research Council and the Actuarial Society of South Africa. 2002

  2. Johnson L, Dorrington R. The impact of AIDS on orphanhood in South Africa: A quantitaive analysis. CARE Monograph No 4. 2001

  3. Greenspan JS and Greenspan D (2002). The epidemiology of the oral lesions of HIV infection in the developed world. Oral Dis 8(Suppl 2): 34–39

    Article  PubMed  Google Scholar 

  4. Patton LL, Phelan JA, Ramos-Gomez FJ, Nittayananta W, Shiboski CH and Mbuguye TL (2002). Prevalence and classification of HIV-associated oral lesions. Oral Dis 8(Suppl 2): 98–109

    Article  PubMed  Google Scholar 

  5. Flaitz CM, Hicks MJ, Carter AB, Rossmann SN, Demmler GJ, Simon CL, et al. Saliva collection technique for cytologic, microbiologic and viral evaluation in pediatric HIV infection. ASDC J Dent Child 1998; 65(5): 318–324, 355

    CAS  PubMed  Google Scholar 

  6. Flaitz C, Wullbrandt B, Sexton J, Bourdon T and Hicks J (2001). Prevalence of orodental findings in HIV-infected Romanian children. Pediatr Dent 23(1): 44–50

    CAS  PubMed  Google Scholar 

  7. Kline MW (1996). Oral manifestiations of pediatric human immunodeficeincy virus infection: a review of the literature. Pediatrics 97(3): 380–388

    CAS  PubMed  Google Scholar 

  8. Ramos-Gomez FJ, Flaitz C, Catapano P, Murray P, Milnes AR and Dorenbaum A (1999). Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection. J Clin Pediatr Dent 23(2): 85–96

    CAS  PubMed  Google Scholar 

  9. Ramos-Gomez FJ, Hilton JF, Canchola AJ, Greenspan D, Greenspan JS and Maldonado YA (1996). Risk factors for HIV-related orofacial soft-tissue manifestations in children. Pediatr Dent 18(2): 121–126

    CAS  PubMed  Google Scholar 

  10. Pongsiriwet S, Iamaroon A, Kanjanavanit S, Pattanaporn K and Krisanaprakornkit S (2003). Oral lesions and dental caries status in perinatally HIV-infected children in Northern Thailand. Int J Paediatr Dent 13(3): 180–185

    Article  CAS  PubMed  Google Scholar 

  11. Flynn PM, Cunningham CK, Kerkering T, San Jorge AR, Peters VB and Pitel PA (1995). Oropharyngeal candidiasis in immunocompromised children: a randomized, multicenter study of orally administered fluconazole suspension versus nystatin. The Multicenter Fluconazole Study Group. J Pediatr 127(2): 322–328

    Article  CAS  PubMed  Google Scholar 

  12. Jabra-Rizk MA, Enwonwu CO, Merz WG, Meiller TF, Falkler WA and Onwujekwe DI (2001). Prevalence of yeast among children in Nigeria and the United States. Oral Microbiol Immunol 16(6): 383–385

    Article  CAS  PubMed  Google Scholar 

  13. Reef SE, Lasker BA, Butcher DS, McNeil MM, Pruitt R and Keyserling H (1998). Nonperinatal nosocomial transmission of Candida albicans in a neonatal intensive care unit: prospective study. J Clin Microbiol 36(5): 1255–1259

    CAS  PubMed  Google Scholar 

  14. Sharp AM, Odds FC and Evans EG (1992). Candida strains from neonates in a special care baby unit. Arch Dis Child 67(1 Spec No): 48–52

    Article  CAS  PubMed  Google Scholar 

  15. Mehta SK, Stevens DA, Mishra SK, Feroze F and Pierson DL (1999). Distribution of Candida albicans genotypes among family members. Diagn Microbiol Infect Dis 34(1): 19–25

    Article  CAS  PubMed  Google Scholar 

  16. Muller FM, Kasai M, Francesconi A, Brillante B, Roden M and Peter J (1999). Transmission of an azole-resistant isogenic strain of Candida albicans among human immunodeficiency virus-infected family members with oropharyngeal candidiasis. J Clin Microbiol 37(10): 3405–3408

    CAS  PubMed  Google Scholar 

  17. Sullivan D and Coleman D (1997). Candida dubliniensis: an emerging opportunistic pathogen. Curr Top Med Mycol 8(1–2): 15–25

    CAS  PubMed  Google Scholar 

  18. Sullivan D and Coleman D (1998). Candida dubliniensis: characteristics and identification. J Clin Microbiol 36(2): 329–334

    CAS  PubMed  Google Scholar 

  19. Jabra-Rizk MA, Ferreira SM, Sabet M, Falkler WA, Merz WG and Meiller TF (2001). Recovery of Candida dubliniensis and other yeasts from human immunodeficiency virus-associated periodontal lesions. J Clin Microbiol 39(12): 4520–4522

    Article  CAS  PubMed  Google Scholar 

  20. Meiller TF, Jabra-Rizk MA, Baqui A, Kelley JI, Meeks VI and Merz WG (1999). Oral Candida dubliniensis as a clinically important species in HIV-seropositive patients in the United States. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88(5): 573–580

    Article  CAS  PubMed  Google Scholar 

  21. Scheutz F, Matee MI, Simon E, Mwinula JH, Lyamuya EF and Msengi AE (1997). Association between carriage of oral yeasts, malnutrition and HIV-1 infection among Tanzanian children aged 18 months to 5 years. Community Dent Oral Epidemiol 25(3): 193–198

    Article  CAS  PubMed  Google Scholar 

  22. Akpede GO, Ambe JP, Rabasa AI, Akuhwa TR, Ajayi BB and Akoma MA (1997). Presentation and outcome of HIV-1 infection in hospitalised infants and other children in north-eastern Nigeria. East Afr Med J 74(1): 21–27

    CAS  PubMed  Google Scholar 

  23. Ferguson FS, Nachman S and Berentsen B (1997). Implications and management of oral diseases in children and adolescents with HIV infection. N Y State Dent J 63(2): 46–50

    CAS  PubMed  Google Scholar 

  24. Gehrke FS and Johnsen DS (1991). Bottle caries associated with anti-HIV therapy. Pediatr Dent 13(1): 73

    CAS  PubMed  Google Scholar 

  25. Madigan A, Murray PA, Houpt M, Catalanotto F and Feuerman M (1996). Caries experience and cariogenic markers in HIV-positive children and their siblings. Pediatr Dent 18(2): 129–136

    CAS  PubMed  Google Scholar 

  26. Akdeniz BG, Koparal E, Sen BH, Ates M, Denizci AA. Prevalence of Candida albicans in oral cavities and root canals of children. ASDC J Dent Child 2002; 69(3): 289–292, 235

    PubMed  Google Scholar 

  27. Beighton D and Lynch E (1993). Relationships between yeasts and primary root-caries lesions. Gerodontology 10(2): 105–108

    Article  CAS  PubMed  Google Scholar 

  28. Jacob LS, Flaitz CM, Nichols CM and Hicks MJ (1998). Role of dentinal carious lesions in the pathogenesis of oral candidiasis in HIV infection. J Am Dent Assoc 129(2): 187–194

    CAS  PubMed  Google Scholar 

  29. Marchant S, Brailsford SR, Twomey AC, Roberts GJ and Beighton D (2001). The predominant microflora of nursing caries lesions. Caries Res 35(6): 397–406

    Article  CAS  PubMed  Google Scholar 

  30. Arendorf TM and Walker DM (1979). Oral candidal populations in health and disease. Br Dent J 147(10): 267–272

    Article  CAS  PubMed  Google Scholar 

  31. Odds FC and Bernaerts R (1994). CHROMagar Candida, a new differential isolation medium for presumptive identification of clinically important Candida species. J Clin Microbiol 32(8): 1923–1929

    CAS  PubMed  Google Scholar 

  32. Blignaut E, Messer S, Hollis RJ and Pfaller MA (2002). Antifungal susceptibility of South African oral yeast isolates from HIV/AIDS patients and healthy individuals. Diagn Microbiol Infect Dis 44(2): 169–174

    Article  CAS  PubMed  Google Scholar 

  33. Blignaut E, Botes M and Nieman H (1999). The treatment of oral candidiasis in a cohort of South African HIV/AIDS patients. J SADA 54(12): 605–608

    CAS  Google Scholar 

  34. Khongkunthian P, Grote M, Isaratanan W, Piyaworawong S and Reichart PA (2001). Oral manifestations in 45 HIV-positive children from Northern Thailand. J Oral Pathol Med 30(9): 549–552

    Article  CAS  PubMed  Google Scholar 

  35. Arendorf T and Holmes H (2000). Oral manifestations associated with human immunodeficiency virus (HIV) infection in developing countries–are there differences from developed countries?. Oral Dis 6(3): 133–135

    Article  CAS  PubMed  Google Scholar 

  36. Henley LD (2002). End of life care in HIV-infected children who died in hospital. Developing World Bioeth 2(1): 38–54

    Article  Google Scholar 

  37. Sano A, Vilela MM, Takahashi I, Fukushima K, Takizawa K and da Silva MT (2000). Isolation of Candida dubliniensis from the oral cavity of an HIV-positive child in Brazil. Nippon Ishinkin Gakkai Zasshi 41(3): 177–181

    CAS  PubMed  Google Scholar 

  38. Blignaut E, Pujol C, Joly S and Soll DR (2003). Racial distribution of Candida dubliniensis colonization among South Africans. J Clin Microbiol 41(5): 1838–1842

    Article  CAS  PubMed  Google Scholar 

  39. Moran GP, Sullivan DJ, Henman MC, McCreary CE, Harrington BJ and Shanley DB (1997). Antifungal drug susceptibilities of oral Candida dubliniensis isolates from human immunodeficiency virus (HIV)-infected and non-HIV-infected subjects and generation of stable fluconazole-resistant derivatives in vitro. Antimicrob Agents Chemother 41(3): 617–623

    CAS  PubMed  Google Scholar 

  40. Vazquez JA, Arganoza MT, Boikov D, Yoon S, Sobel JD and Akins RA (1998). Stable phenotypic resistance of Candida species to amphotericin B conferred by preexposure to subinhibitory levels of azoles. J Clin Microbiol 36(9): 2690–2695

    CAS  PubMed  Google Scholar 

  41. Cartledge JD, Midgely J and Gazzard BG (1997). Clinically significant azole cross-resistance in Candida isolates from HIV-positive patients with oral candidosis. AIDS 11: 1839–1844

    Article  CAS  PubMed  Google Scholar 

  42. Kleinegger CL, Lockhart SR, Vargas K and Soll DR (1996). Frequency, intensity, species, and strains of oral Candida vary as a function of host age. J Clin Microbiol 34(9): 2246–2254

    CAS  PubMed  Google Scholar 

  43. Pfaller MA (2000). Epidemiology of nosocomial candidiasis: the importance of molecular typing. Braz J Infect Dis 4(4): 161–167

    CAS  PubMed  Google Scholar 

  44. Ticklay IMH, Nathoo KJ, Siziya S and Brady JP (1997). HIV infection in malnourished children in Harare, Zimbabwe. East Afr Med J 74: 217–220

    CAS  PubMed  Google Scholar 

  45. Flynn P, Cunningham C, Kerkering T, San Jorge A, Peters V and Pitel P (1995). Oropharyngeal candidiasis in immunocompromised children: A randomized, multicentre study of orally administered fluconazole suspensionversus nystatin. J Pediatr 127: 322–328

    Article  CAS  PubMed  Google Scholar 

  46. Pfaller MA, Diekema DJ, Messer SA, Boyken L, Hollis RJ and Jones RN (2003). In vitro activities of voriconazole, posaconazole, and four licensed systemic antifungal agents against Candida species infrequently isolated from blood. J Clin Microbiol 41(1): 78–83

    Article  CAS  PubMed  Google Scholar 

  47. Diekema DJ, Pfaller MA, Messer SA, Houston A, Hollis RJ and Doern GV (1999). In vitro activities of BMS-207147 against over 600 contemporary clinical bloodstream isolates of Candida species from the SENTRY Antimicrobial Surveillance Program in North America and Latin America. Antimicrob Agents Chemother 43(9): 2236–2239

    CAS  PubMed  Google Scholar 

  48. Flaitz CM, Hicks MJ. Oral candidiasis in children with immune suppression: clinical appearance and therapeutic considerations. ASDC J Dent Child 1999; 66(3): 161–166, 154

    CAS  PubMed  Google Scholar 

  49. Ball LM, Bes MA, Theelen B, Boekhout T, Egeler RM and Kuijper EJ (2004). Significance of amplified fragment length polymorphism in identification and epidemiological examination of Candida species colonization in children undergoing allogeneic stem cell transplantation. J Clin Microbiol 42(4): 1673–1679

    Article  CAS  PubMed  Google Scholar 

  50. Milnes AR (1996). Description and epidemiology of nursing caries. J Public Health Dent 56(1): 38–50

    Article  CAS  PubMed  Google Scholar 

  51. Horowitz A (1998). Response to Weinstein: public health issues in early childhood caries. Community Dent Oral Epidemiol 26(1): 91–95

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elaine Blignaut.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blignaut, E. Oral candidiasis and oral yeast carriage among institutionalised South African paediatric HIV/AIDS patients. Mycopathologia 163, 67–73 (2007). https://doi.org/10.1007/s11046-006-0087-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-006-0087-9

Keywords

Navigation