Masters Degrees (Health Systems and Public Health)

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Browsing Masters Degrees (Health Systems and Public Health) by Subject "Candidiasis -- Treatment"

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    A study at the Brooklyn Chest Hospital to assess the change in the oral carriage of Candida species in patients co-infected with HIV and TB, before and after antifungal therapy
    (Stellenbosch : Stellenbosch University, 2002-03) Fisher, Julian Marcus; Basson, N. J.; Van Zyl, A. W.; Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Dentistry.
    ENGLISH ABSTRACT: The aim of this study at the Brooklyn Chest Hospital (BCH) was to assess the change in the oral carriage of Candida species in twenty-nine patients co-infected with the Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), before and after anti-fungal treatment. Each patient accepted onto the study underwent a comprehensive oral and peri-oral examination where the presence, site and clinical features of all oral and peri-oral lesions were recorded. The purpose of the examination was to provide a clinical diagnosis of oral candidasis. Each patient was also asked to provide a sample of oral fluid for laboratory analysis. This was collected using an oral rinse. The results of a variety of laboratory investigations were used to identify the species of Candida obtained from the oral rinse. Both the oral and peri-oral examination and the oral rinse procedure were repeated after one month and at three months. A sample from each oral rinse was inoculated on CHROMagar Candida chromogenic medium (CHROMagar Candida, France, Paris). CHROMagar is used for the isolation and presumptive identification of Candida sp. from other yeasts on the basis of strongly contrasted colony colours, which are produced by the reactions of species-specific enzymes with a proprietary chromogenic substrate. After forty-eight hours the CHROMagar plate was examined for growth, when a record of colony morphology and colour was made. A single sample from each different colour-coded colony was taken and streaked onto a Sabouraud plate (Oxoid, Basingstake, England) and then incubated for forty eight hours at thirty-seven degrees centigrade. A variety of laboratory investigations were subsequently carried out on a single colony taken from the Sabouraud agar plate (Oxoid). The results of these tests were used to identify the individual species of Candida isolated from each oral rinse. Oral candidasis was the most prevalent oral lesion observed on admission and at three months. Six different species of Candida were identified during this study, namely Candida albicans, Candida dubliniensis, Candida krusei, Candida glabrata, Candida parapsilosis, and Candida tropicalis. C.albicans was the most commonly identified species in study population. Candida dubliniensis was isolated and identified for the first time in a South African HIV population. Each specimen of Candida sp. identified by laboratory analysis was tested for sensitivity to Nystatin, Amphotericin B and Fluconazole anti-fungal agents. An additional sensitivity test was performed using Ajoene and Allicin (extracts of garlic) to assess the comparative antifungal properties of these compounds.
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    A systematic review of the management of oral candidiasis associated with HIV/AIDS
    (Stellenbosch : Stellenbosch University, 2002-03) Albougy, Hany Ahed; Naidoo, S. (Sudeshni); Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Dentistry.
    ENGLISH ABSTRACT: The purpose of this review was to investigate the management of oral candidiasis in HIV/AIDS patients and to evaluate the different guidelines that are available for its management. To achieve this aim, three objectives were identified: (i) to identify and report on the different interventions used to manage oral candidiasis, in patients with HIV/AIDS, (ii) to determine the efficacy of these interventions, and (iii) to provide guidelines for management. A thorough systematic search of the literature was carried out and all relevant papers were graded into three levels of evidence (A, B, and C) and scored for quality according to set criteria. A number of topical and systemic antifungal medications are used to treat oral candidiasis in HIV-positive patients. These include the poleyne antibiotics, nystatin and amphotericin B. Milder episodes of oral candidiasis respond to topical therapy with nystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensively evaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% has been achieved with a daily oral dose of 50 mg. Fluconazole was found to be a better choice of treatment for relapsing oropharyngeal candidiasis, resulting in either better cure rates or better prevention of relapse. Intravenous amphotericin B has been found to be effective therapy in azole refractory candidiasis where it was shown to be safe and well tolerated. Topical therapies were found to be effective treatment for uncomplicated oropharyngeal candidiasis, however patients relapsed more quickly than those treated with oral systemic antifungal therapy. Overall, nystatin appears less effective than clotrimazole and the azoles in the treatment of oropharyngeal candidiasis. With regard to the resolution of clinical symptoms, clotrimazole was found to be just as effective as the azoles, except when patient compliance was poor. Fluconazole-treated patients were more likely to remain disease-free during the fluconazole follow-up period than with those treated with other interventions. Relatively few studies were qualified to address the provision of guidelines for the management of oral candidiasis in primary health care settings. Most of the studies found were of moderate and low quality level of evidence. These studies included the assessment of different guidelines for identification, treatment and dental needs. They stressed that patients with HN need dentists who will act as primary health care providers, together with other providers to ensure adequate overall care. Given the level of interest and importance of candidiasis associated with treatment of HN -positive patients, it is surprising to find that little high quality research has been undertaken. As such, it is hoped that this review would provide researchers, oral health care workers and other health care providers with an overview of the management of oral candidiasis associated with HN/AIDS.