MOLECULAR EPIDEMIOLOGY OF RECURRENT ORAL CANDIDIASIS IN HUMAN-IMMUNODEFICIENCY-VIRUS POSITIVE PATIENTS - EVIDENCE FOR 2 PATTERNS OF RECURRENCE

The causative strains in 22 patients with recurrent oral candidiasis w ere examined using two DNA probes (a Histoplasma capsulatum DNA probe that cross-hybridizes with Candida albicans and a C. albicans strain-s pecific probe derived from repetitive sequence DNA). C. albicans was t he causative organism in all 22 initial episodes of infection and was also obtained from 17 patients with recurrent oral disease. Molecular analysis showed that in 11 cases, the same isolate was identified in e ach episode. Six patients had a clearly different isolate of C. albica ns causing a later episode of candidiasis. Five patients had different Candida species causing recurrent disease: 4, Torulopsis glabrata; 1, Candida parapsilosis. Patients with a new isolate (either new species or a new C. albicans strain) were more immunosuppressed and were sign ificantly more likely (P < .001) than patients with the same recurrent strain to have received suppressive azole antifungal agents. These da ta indicate that the epidemiology of recurrent candidiasis in individu al patients seropositive for the human immunodeficiency virus is compl ex and that both failure of eradication of Candida from the oral cavit y and new infection occur.