International Journal of Current Research and Review
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IJCRR - 6(10), May, 2014

Pages: 100-107

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ORAL CANDIDIASIS IN HIV INFECTED PATIENTS

Author: Ramya Chellammal

Category: Healthcare

Abstract:Oral candidiasis is a general opportunistic infection of the oral cavity caused by an over growth of Candida genus,the most common being Candida albicans.The prevalence varies depending on certain predisposing factors and age.There are three extensive groupings consisting of acute candidiasis, chronic candidiasis, angularcheilitis.Risk factors comprise impaired salivary gland function,drugs, dentures, high carbohydrate diet, and extremes of life, smoking, diabetes mellitus, Cushing's syndrome and immunosuppressive conditions.Fluconazole oral suspension as a systemic therapy was used to treat oral candidiasis in HIV-infected patients and provided a longer disease-free interval before relapse

Keywords: Candidiasis, Candida albicans, HIV infected.

Full Text:

INTRODUCTION

Oropharyngeal candidasis is a common manifestation in immunocompromised patients, including individuals undergoing immuno suppressive therapy for cancer or organ transplantation and those exposed to broad-spectrum antibacterial therapy [1,2,3]. Most notably, oropharyngeal candidasis is a major problem in indiviuals affected with the human immunodeficiency virus [4,5,6]. Candida albicans the species most commonly isolated from patients with these infections. Colonization of the mouth by Candida species has a long recorded history. Hippocrates,as early as 37BCE,reported oral lesions that were probably caused by Candida [7]. Although C. albicans survives poorly on dry surfaces [7], it can remain viable for some time on moist objects. Candida often colonizes the human epidermis, especially moist webs of skin between fingers or toes, but the gastro-intestinal tract is considered to be the major reservoir [7]. The existence of such reservoirs ensures regular seeding of the oral cavity. Oropharyngeal candidiasis is an important disease of immunocompromised individuals such as organ transplant recipients, cancer patients [8], and individuals with AIDS [9].Oral candidiasis is one of the earliest indicators of the progression from HIV sero- positive status to AIDS. Esophageal lesions in AIDS patients can be extensive, requiring systemic Fluconazole therapy [10], and these lesions can be a source of infection for other forms of oral candidiasis that are often seen in AIDS patients[11]. The high frequency of oral Candida carriage [12] No single factor appears to be responsible for the pathogenicity of C. albicans. It has been proposed that a combination of different factors contributes at each stage of infection[13,14,15,16]Candida cells adhere to several hostcelltypes, including epithelia [17], endothelia [18], and phagocytic cells [19] C. albicans expresses adhesions that recognize extra cellular matrix proteins, including laminin, collagen, fibrinogen, fibronectin, and entactin [20,21] Several studies have shown that patients with acquirkedimmunodeficiency syndrome (AIDS) have

one predominant strain of C albicans,” but others have found multiple strains. The incidence of C albicans isolated from the oral cavity has been reported to be 45% in neonates,[22] 45%–65% of healthy children,[23] 30%–45% of healthy adults,[24,25]50%–65% of people who wear removable dentures,[26] 65%– 88% in those residing in acute and long term care facilities,[26,27,28] 90% of patients with acute leukemia undergoing chemo- therapy,[29]and 95% of patients with HIV.[30] C albicans is a normal commensal of the mouth and generally causes no problems in healthy people . Pathogenesis Candida albicans is the most common and most invasive fungal organism present in the oral cavity and causes both systemic and superficial infections. C. albicans is more adherent to human buccal epithelial cells than are other Candida species; a relationship has been suggested between the adherence of C. albicans and its ability to colonize and cause disease[31].The pathogenic significance of the yeast vs. the filamentous form of the organisms not clear[33].The blastospore form appears to be necessary for colonization and subsequent disease to occur[31].The filamentous form of C. albicans develops under suboptimal conditions invitro; however, the stimuli for its formation invivo are not known. The yeast form of most dimorphic fungi is considered the pathogenic but an association between the presence of the filamentous forms of C. albicans and candidiasis has been noted[33].The significance of the surface antigen city of the filamentous forms in oral candidiasis requires further study[33,34].Simonetti and Strippoli[32]have present evidence indicating greater pathogenicity of the yeast form. The yeast form of C. albicans may be the pathogenic form, and with clinical infection, the altered micro environment favors change to the filamentous form[32,35,36,and 37].The pathogenic effects of c. albicans in candidiasis are uncertain. It has been suggested that C. albicans produces an endotoxin[38],and immunity to the endotoxin may

confer immunity to the disease[39,40].However, the levels of endotoxin found invivo may not be sufficient to produce toxic effects[41].Alternatively, the organisms may produce enzymes that allow penetration of the mucous membranes[42-44].Pugh and Cawson[43,44]state that invasion of epithelial cells by C. albicans depends on hydrolytic enzyme activity and mechanical force. Some evidence suggests that toxic products of the organism do not initiate candidiasis is but act as irritants, aggravating tissue lesions[45].Immediate or delayed hypersensitivity may have a role in pathogenesis[46,47];up to 80% of the population without evidence of infection possess cellular hypersensitivity to C. albicans and others[48]not cell mediated hypersensitivity to Candida in pathogenesis and suggest that enzymes and toxins may aggravate immune-related lesions. Several reports indicate that specific immune imbalance in response to C. albicans plays a role in the pathogenesis of oral candidiasis [49,50,51]. Mackieetal.[50]described eight patients with candidiasis is due to resistant C. albicans and reported humoral antibody formation with poor cell-mediated immunologic activity. Similar findings were noted in patients with acute pseudomembraneous esophageal candidiasis[52]. Inpatients with candidiasis, excess humoral antibodies may inhibit a cell-mediated response .General abnormalities of host immunity have not been described; however, specific deficiencies of the cell-mediated response to Candida antigen have been reported[52,51].The specific abnormality of cell-mediated immunity may be reversible following successful treatment of acute candidiasis[49].Deficient serum or salivary IgA, abnormal complement function, and auto antibodies to various tissues are described. Antibody for Candida (antimannan) is present in serum, andlevels increase in chronic disease[40].However, the significance of cellmediated immune deficiencies in localized oral candidiasis is uncertain

HIV-Related Oral Candidiasis

Candida infections, with oral thrush and esophagitis as frequent clinical manifestations, are the most widespread opportunisticinfections encountered in AIDS [53, 54, 55]. Ever since the first clinical definition of AIDS (1981), the CDC/WHO have recognized candidasis of the mouth, esophagus, trachea, bronchi, and lungs as "major" opportunistic infections and important indicator diseases. Subsequently, in 1986 the Walter Reed Army Institute of Research [56] adopted a staging classification of HIV infection, applicable to adults only, based on HIV-antibodies and virus isolation, chronic lymphadenopathy, Thelper cells/mm3, delayed hypersensitivity, appearance of thrush, and other opportunistic infections [57]. Also, it has been shown in prospective studies of HIV-infected patients that the occurrence of an otherwise unexpected mycosis (typically oral candidasis) in an HIVinfected individual can be predictive of the subsequent development of full blown AIDS [53, 58]. Retrospective studies have shown that at least 58 to 81% of all AIDS patients contract a fungal infection at some time, and 10 to 20% die as a direct consequence [54].Clearly, Candida infections appear to be the most common fungal infection, occurring in at least 75% of HIVinfected patients [59] have shown that 92% of patients with a diagnosis of AIDS had oral candidasis, compared with only 24% of HIV infected patients who had not developed AIDS.

Diagnosis

Diagnosis of candidasis depends upon the presence of the organismin a direct smear, the culture of significant numbers of organisms indirectly, the effectiveness of antimycotic medication[lIS].Culturing of Candida from whole, unstimulated saliva may be the most accurate method of distinguishing the carrier from the non carrier state [60,61]. Quantitative culture. unstimulated saliva or imprint culture technique say aid in diagnosis of patients with oral candidiasis[60,62,63]. Oral candidiasis has been

grouped into the following descriptive categories[64,65,66]: (1)acute pseudomembranous candidiasis(thrush);(2)acute atrophiccandidiasis;(3)chronicatrohphic candidiasis(denturestomatitis,angularcheilitis);and (4)chronic hyperplastic candidiasis(candidal leukoplakia),which takes two forms-chronic, localized, mucocutaneous candidiasis(monilial granuloma)and endocrine candidiasis is syndrome (endocrine moniliasis syndrome. It is important for all physicians looking after older patients to be aware of the risk factors, diagnosis, and management of oral candidiasis. In a recent study 30% of doctors said they would prescribe in for oral candidiasis on the request of nursing staff without examination of the oral. [63] This is unfortunate as other pathology may be missed, the diagnosis maybe incorrect, and failure to address risk factors may lead to recurrence of the candidiasis. The diagnosis of oral candidiasis can serve as a diagnostic marker of HIV infection and also as a signal of disease progression in patients known to be HIV seropositive, as evidenced by the relationship of this infection to decreasing CD4 lymphocyte counts [67]

Treatment

Topical antifungal therapy is the recommended first line treatment for uncomplicated oral candidiasis and where systemic treatment is needed topical therapy should continue as this reduces the dose and duration of systemic treatment required.[68] Itraconazole has a wider spectrum of activity than Fluconazole and is therefore valuable in salvage treatment of the immunocompromised patients with Fluconazole resistant candidasis. Increasing resistance to antifungals has become increasingly common since the introduction of Fluconazole especially in patients with advanced HIV disease, and recurrent and long term treatment [69, 70] Nystatin: Nystatin, if swallowed, may lead occasionally to gastrointestinal side effects such as Nausea, vomiting, and diarrhea [71]

Clotrimazol: Clotrimazole are the most potent topical agent in this class of antifungals but is used as a topical agent only because of its gastrointestinal and neurological toxicity [72] Miconazole: Miconazole is used mainly for topical treatment of candidasis. It is available for parenteral use against systemic mycoses, but the injection contain polyethoxylate castor oil, which may provoke allergic reactions [73]. Ketoconazole: Ketoconazole was the first of the imidazole agents shown to be capable of achieving therapeutic Blood levels when given orally. This led to the drug being used in the treatment of CMC and Candidasis in immunocompromised patients, but adverse effects, including nausea, rashes, pruritus, and hepatotoxicity, have restricted its use [74] Fluconazole: Fluconazole is a recently introduced bistriazole antifungal that acts by inhibiting fungal ergosterol production essential in cell wall formation[75] Itraconazole: This is an orally active bis-triazole, similar to Fluconazole, which inhibits ergosterol biosynthesis in the fungal cell. It has a long halflife and fewer side effects than ketoconazole but is expensive [76] and is eliminated hepatically. Prognosis The prognosis is good for oral candidiasis with appropriate and effective treatment[77] Relapse when it occurs is more often than not due to poor observance with therapy, failure to remove and clean dentures properly, orinability to resolve the underlying/predisposing factors to the infection. Prophylaxis with anti fungal agents reduces the incidence of oral candidiasis in patients with cancer undergoing and fluconazole are more effective than topical polyenes.[78] Prophylaxis on either a daily or weekly basis with anti fungal reduces the incidence of oral candidiasis in patients with HIV with their ductions being most marked in those with low CD 4 counts and recurrent oral candidiasis.[79,80,81,82] .The use of a chlorhexidinerinse only in bone marrow transplantpatients as prophylaxis was found to be very effective [83]

CONCLUSION

A wide range of therapeutic approaches exists to treat patients with HIV infection or AIDS and even oropharyngeal or esophageal candidiasis. Although the more traditional anti fungal agents such as the topical polyenes and imidazole maybe satisfactory for the treatment of relatively mild and transient episodes of oropharyngeal candidiasis (e.g., thrush),the clinical utility of these agents ultimately can become promised by the numerous encumbrances imposed by a demanding dosing schedule and the need for extended contact with the oroesophageal mucosa. Although ketoconazole has a long history of use for the treatment of oropharyngeal and esophageal candidiasis, concerns about potentially serious side effects have favored the use of alternative antifungal agents instead. Moreover, oral solutions are better tolerated, with fewer drug-drug interactions and more convenient dosing schedules and are easier to administor than tablets or capsules to patients with severe oral lesions, restricted oral intake, or inability to swallow. Also that the development of these new oral solution formulations other turning point in the ongoing quest for optimal treatment strategies for oropharyngeal and esophageal candidiasis in immunocompromised patients

ACKNOWLEDGEMENTS

Authors acknowledge theimmense help received from the scholars whose articles are cited and included inreferences of this manuscript. The authors are also grateful to authors / editors /publishers of all those articles, journals and books from where the literature for thisarticle has been reviewed and discussed.

References:

REFERENCES

1. Clift, R. A. 1984. Candidiasis in the transplant patient. Am. J. Med. 77:34-38.

2. Goodman, J. L., D. J. Winston, R. A. Greenfield, P. H. Chandrasekar, B. Fox, H. Kaizer, R. K. Shadduck, T. C. Shea, P. Stiff, D. J. Friedman, W. G. Powderly, J. L. Silber, H. Horowitz, Lichtin, S. N. Wolff, K. F. Mangan, S. M. Silver, D. Weisdorf, W. G. Ho, G. Gilbert, and D. Buell. 1992. A controlled trial of Fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N. Engl. J. Med. 326:845-851.

3. Meunier, F., M. Aoun, and M. Gerard. 1990. Therapy for oropharyngeal candidiasis in the immunocompromised host: a randomized double-blind study of Fluconazole vs. ketoconazole. Rev. Infect. Dis. 12(Suppl 3):S364-S368.

4. Dupont, B., L. Improvisi, M. Eliaszewicz, G. Pialoux, and the GEMO. 1992. Resistance of Candida albicans to Fluconazole (FcZ) in AIDS patients. Program Abstr. 32nd Intersci. Conf. Antimicrob. Agents Chemother., abstr. 1203.

5. Klein, R. S., A. H. Carol, C. B. Small, B. Moll, M. Lesser, and G. H. Friedland. 1984. Oral candidiasis in high-risk patients as the initial manifestation of the acquired immunodeficiency syndrome. N. Engl. J. Med. 311:354-358.

6. Quintiliani, R., N. J. Owens, R. A. Quercia, J. J. Klimek, and C. H. Nightingale. 1984. Treatment and prevention of oropharyngeal candidiasis. Am. J. Med. 77:44 48.

7. Odds FC (1988). Candida and candidasis. 2nd ed. London: Bailli'ere Tindall.

8. Bodey GP (1988). Fungal infections in cancer patients. Ann NY Acad Sci 544:431-442.

9. Coleman DC, Bennett DE, Sullivan DJ, Gallagher PJ, Henman MC, Shanley DB, et al. (1993). Oral Candida in HIV infection and AIDS: new perspectives/new approaches. Crit Rev Microbiol 19:61-82.

10. Millon L, Manteaux A, Reboux G, Drobacheff C, Monod M, Barale T, et al. (1994). Fluconazole-resistant recurrent oral candidiasis in human immunodeficiency viruspositive patients: persistence of Candida albicans strains with the same genotype. l Clin Microbiol 32:1115-1118.

11. Holmstrup P, Samaranayake LP (1990). Acute and AIDS-related oral candidoses. In: Oral candidasis. Samaranayake LP, MacFarlane TW, editors. London: Butterworth, pp. 133- 155.

12. Hauman CHJ, Thompson IOC, Theunissen F, Wolfaardt P (1993). Oral carriage of Candida in healthy and HIVseropositive persons. Oral Surg Oral Med Oral Pathol 76:570- 572. 13. Cutler JE, Kanbe T (1993). Antigenic variability of Candida albicans cell surface. Curr Top Med Mycol 5:27-47.

14. Calderone RA (1993a). Molecular interactions at the interface of Candida albicans and host cells. Arch Med Res 24:275-279.

15. Odds FC (1994). Candida species and virulence. ASM News 60:313-318.

16. Matthews RC (1994). Pathogenicity determinants of Candida albicans: potential targets for immunotherapy? Microbiol 140:1505-1511.

17. Critchley IA, Douglas LJ (1987). Role of glycosides as epithelial cell receptors for Candida albicans. J Gen Microbiol 133:637- 643.

18. Edwards JEJ, Mayer CL, Filler SG, Wadsworth E, Calderone RA (1992). Cell extracts of Candida albicans block adherence of the organisms to endothelial cells. Infect Immun 60:3087-3091.

19. Diamond RD (1993). Interactions of phagocytic cells with Candida and other opportunistic fungi. Arch Med Res 24:361- 369.

20. Bouchara J-P, Tronchin G, Annaix V, Robert R, Senet J-M (1990). Laminin receptors on Candida albicans germ tubes. Infect Immun 58:48-54

21. Negre E, Vogel T, Levanon A, Guy R, Walsh TJ, Roberts DD (1994). The collagen bindindomain of fibronectin contains a high affinity binding site for Candida albicans. r Biol Chem 269:22039-22045.

22. Manning DJ, Coughlin RP, Poskit EM. Candida in mouth or on dummy? Arch Dis Child 1985;60:381–2.

23. Berdicevsky I, Ben-Aryeh H, Sazargel R, et al. Oral candida in children. Oral Surg Oral Med Oral Pathol 1980;57:37–40.

24. Lucas VS. Association of psychotropic drugs, prevalence of denture-related stomatitis and oral candidasis. Community Dent Oral Epidemiol 1993;21:313–16.

25. Arendorf TM, Walker DM. The prevalence and intra-oral distribution of Candida albicans in man. Arch Oral Biol 1980;25:1–10.

26. Aldred MJ, Addy M, Bagg J, et al. Oral health in the terminally ill: a cross sectional pilot survey. Spec Care Dentist 1991;11:59–62.

27. Cumming CG, Wight C, Blackwell CL, et al. Denture stomatitis in the elderly. Oral Microbiol Immunol 1990;5:82–5.

28. Holbrook WP, Hjorleifsdottir DV. Occurrence of oral Candida albicans and other yeast-like fungi in edentulous patients in geriatric units in Iceland. Gerodontics 1986;2;153–6.

29. Rodu B, Carpenter JT, Jones MR. The pathogenesis and clinical significance of cytologically detectable oral candida in acute leukaemia. Cancer 1988;62:2042–6.

30. Dupont B, Graybill JR, Armstrong D, et al. Fungal infections in AIDS patients. J Med Vet Mycol 1992; 30(suppl 1):19–28.

31. King RD, Lee JC, Morris AL. Adherence of Candida albicans and other Candida' species to mucosal epithelial cells. Infect Immun 1980;27:667-74

32. Simonetti N, Strippoli V. Pathogenicity of the Y form as compared to M form in experimentally induced Candida a/bieansinfections. Mycopathologia et Mycologia Applicata 1973;51:19-28

33. Kimura LH, Pearsall NN. Relationship between germination of Candida a/bieans and increased adherence to human buccal epithelial cells. Infect Immun 1980;28: 464-8

34. Evans EOY, Richardson MD, Odds FC, Holland KT. Relevance of antigenicity of Candida a/bieans growth phases to the diagnosis of systemic candidiasis. Br Med J 1973;4:86-7

35. Brantzaeg P. Immunoglobulin systems of oral mucosa and saliva. In: Dolby AB, ed. Oral mucosa in health and disease. Oxford, England: Blackwell, 1972:137-61, 193-213

36. Budtz-Jorgensen, E. The significance of Candida a/bieans in denture stomatitis. Scand J Dent Res 1974;82:151-90

37. Valdimarsson H, Higgs JM, Wells RS, Yamamura M, Hobbs JR, Holt PJL. Immune abnormalities associated with chronic mucocutaneous candidiasis. Cell Immuno1 1973;6:348-61

38. Dobias B. Specific and nonspecific immunity in Candida infections. Acta Med Scand 1964; 176(Suppl 421):1-79

39. Hasenclever HF, Mitchell WOo Production in mice of tolerance to the toxic manifestations of Candida a/bicans. J Bacteriol 1962; 84:402-9

40. Isenberg HD, Allerhand J, Berkman JI. An endotoxinlike fraction extracted from the cells of Candida a/bicans. Nature 1963; 197:516-7

41. Chattaway F, Odds C, Barlow AJ. An examination of the production of hydrolytic enzymes and toxins by pathogenic strains of Candida albicans. 1 Gen Microbiol 1971; 67:255-63

42. Holmberg K. Oral mycoses and antifungal agents. Swed Dent 1 1980; 4:53-61

43. Pugh D, Cawson RA. The cytochemical localization of phospholipase in Candida albicans infecting the chicks chorio-allantoic membrane. Sabouraudia 1977; 25: 29-35

44. Pugh D, Cawson RA. The cytochemical localization of acid hydrolases in four common fungi. Cell Mol Bioi 1977; 22:125-32

45. Weeke B. Rocket immunoelectrophoresis. Scand 1 Immunol 1975; 2(Suppl):37-46

46. Hoerman KC, Englander HR, Shklair IL. Lysozyme: its characteristics in human parotid and submaxillolingual saliva. Proc Soc Exp Bioi Med 1956; 92:875-8

47. Jenkins WMM, MacFarlane TW, Ferguson MM, Mason DK. Nutritional deficiency in oral candido sis. Int 1 Oral Surg 1977; 6:204- 10

48. Olsen I. Studies on oral yeast infection, with emphasis on denture stomatitis. Nor Tannlaegeforen Tid 1976; 86: 497-501

49. Dutta SK, AI-Ibrahim MS. immunological studies in acute pseudomembranous esophageal candidiasis. Gastroenterology 1978; 76:292-6

50. Mackie RM, Parratt D, lenkinsWMM. The relationship between immunological parameters and response to therapy in resistant oral candidiosis Br 1 Dermatol 1978; 98:343-8

51. Scherr SA, Nespeca lA, Mikaelian DO, Simonian SK. Chronic candidiasis of the oral cavity and esophagus. Laryngoscope 1980; 90:769-74

52. Sams WM 1r, Jorizzo 1L, Synderman R, legasothy BV, Ward FE, Weiner M, Wilson lG, Yount W1, Dillard lB. Chronic mucocutaneous candidiasis: immunologic studies of three generations of a single family. Am 1 Med 1979;67:948-59

53. Klein. R. S., C. A. Harris, C. B. Small, B. Moll, M. Lesser, and G. H. Friedland: Oral Candidiasis in High-Risk Patients as the Initial Manifestation of Acquired Immunodeficiency Syndrome. N. Eng. J. Med. 311(6):354- 358 (1984).

54. Holmberg, K. and R. Meyer: Fungal Infections in Patients with AIDS and AIDS-Related Complex. Scand. J. Infect. Dis. 18:179-192 (1986).

55. Samaranayake, L. P. and P. Holmstrup: Oral Candidiasis and Human Immunodeficiency Virus Infection. J. Oral Pathol. Med. 18:554- 564 (1989).

56. Redfield, R., D. Wright, and E. Tramont: The Walter Reed Staging Classification for HTLHIII/LAV Infection. N. Engl. J. Med. 314:131- 132 (1980).

57. Drouhet, E. and B. Dupont: Candidosis in Heroin Addicts and AIDS: New Immunologic Data on Chronic Mucocutaneous Candidosis. In: Candida and Candidamycosis (E. Tumbay, Ed.) Plenum Press, New York

58. Sabin, C. A., A. N. Phillips, J. E. Elford, and C. A. Lee: Progression to AIDS in HIVInfected Patients with Oral Candidiasis or Hairy Leukoplakia. AIDS 6:750-751 (1992).

59. McCarthy, G. M., I. D. Mackie, J. Koval, H. S. Sandhu, and T. D. Daley: Factors Associated with Increased Frequency of HIVRelated Oral Candidiasis. J. Oral Pathol. Med. 20:332-336 (1991).

60. Arendorf TM, Walker DM. Oral candidal populations in health and disease. Br Dent J 1979;147:267-72

61. Burket LW, In: Lynch MA, ed. Oral Medicine. Philadelphia: JB Lippincott, 1977;72-81

62. Epstein JB, Pearsall NN, TrueloveEL. Quantitative relationships between Candida a/bieans in saliva and the clinical status of human subjects. J Clin Microbiol 1980;12:475-6

63. Epstein, JE, TrueloveEL, Pearsall NN, Menard TW. Clinical aspects and effects of treatment on host parasite interactions of Candida a/bieans. In: Annual summary progress report 1979-1980.Seattle: Center for Research in Oral Biology, University of Washington, 1980:122-7

64. Burket LW, In:LynchMA, ed. Oral Medicine Philadelphia: JBLippincott,1977;72-81

65. Fletcher J, Mather H, Lewis MJ, Whiting O. Mouth lesions in iron-deficient anemia:relationship to Candida albieans in saliva and to ipairment of lymphocyte transformation.JInfectDis1975;131:44-50

66. Lehner T,Wilton JMA,Ivanyi L.Immunodeficiencies in chronic mucocutaneous candidiosis.Immunology 1972;22:775-87

67. Imam N,Carpenter CCJ,Mayer KH,Fisher A,Stein M,Danforth SB. Hierarchical pattern of mucosal Candida infections in HIVseropositive women.AmJMed1990;89:142–6 (1991).

68. Epstein JB, Polsky B. Oropharyngeal candidiasis: a review of its clinical spectrum and current therapies. Clin Ther 1998;20:40– 57.

69. Heine GS, Stevens DS, Greenspan D. Fluconazole-resistant candida in AIDS patients. Oral Surg Oral Med Oral Pathol 1993;76:711–15.

70. Rex JH, Rinaldi MG, Pfaller MA. Resistance of candida species to Fluconazole. Antimicrob Agents Chemother 1995;39:1–8.

71. Epstein, J.: Antifungal Therapy in Oropharyngeal Mycotic Infections. Oral Surg. Oral Med. Oral Pathol. 69: 32-41 (1990).

72. Odds, F. C.: Candida and Candidosis: A Review and Bibliography, 2nd ed., Balliere Tindall, London (1988).

73. Bodey, G., G. Samonis, and K. Rolston: Prophylaxis of Candidiasis inCancerPatients. Semin. Oncol. 17(SuppL 6): 24-28 (1990).

74. Brammer, K. W., P. R. Farrow, and J. W. Faulkner: Pharmacokinetics and Tissue Penetration of Fluconazole in Human. Rev. Infect. Dis. 12:318-326 (1990).

75. Brass, C., J. Galgiani, T. Blaschke, et al.: Disposition of Ketoconazole, an Oral Antifungal in humans. Antimicrob. Agents, Chemoth. 21(1):151-158 (1982).

76. Jansen, T., M. van de Ven, M. J. Borgers, F. C. Odds, and J. van Cutsem: Fungal Morphology After treatment with Itraconazole as a Single Oral Dose in Experimental Vaginal Candidosis in Rats. Am. J. Obstet. Gynecol. 165:1552-1557 (1991).

77. Clarkson JE, Worthington HV, Eden OB. Prevention of oral mucositis or oral candidiasis for patients with cancer receiving chemotherapy (excluding head and neck cancer).The Cochrane Library,Issue4,2000. Oxford.

78. LumbrerasC, Cuervas-Mons V, Jara P, et al. Randomised trial of Fluconazole versus nystatin for the prophylaxis of candida infection following liver transplantation. J Infect Dis 1996;174:583±8.

79. SchumanP, Capps L, Peng G, et al. Weekly Fluconazole for the prevention of mucosal candidiasis in women with HIV infection. A randomised, double blind, placebo controlled trial. Terry Beirn community programs for clinical research on AIDS. Ann Intern Med 1997;126:689±96.

80. MacPhailLA,HiltonJF,DoddCL,etal.Prophylax is with nystatin pastilles for HIV-associated or al candidiasis.JAcquirImmuneDeficSyndr 1996;12:470±6.

81. PowderlyWG, Finklestein DM, Feinberg J, et al. A randomised trial comparing Fluconazole with cotrimazoletroches fr the prevention of fungal infection in patients with advanced human immunodeficiency virus infection.N Engl J Med1995;332:700±5.

82. Smith D, Midgley J, Gazzard B.A randomised, double-blind study of itraconazole versus placebo in the treatment and prevention of oral or oesophageal candidiasis in patients with HIV infection.Int J Clin Pract 1999;53:349±52.

83. Ferretti GA, Ash RC, Brown AT, et al. Chlorhexidine for prophylaxis against or al infections and associated complications in patients receiving bonemarrow transplants. Am Dent Assoc 1987;114:461±7

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A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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