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Case 4: Fluconazole-Resistant Oropharyngeal Candidiasis

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D Major identified risk factors for the development of fluconazole-resistant candidiasis include low CD4 cell count and cumulative fluconazole use.

This answer is correct. The most important risk factors identified related to the development of fluconazole-resistant candidiasis include low CD4 cell count, greater number of fluconazole-treated episodes, and longer median duration of fluconazole therapy. Fluconazole resistance can involve an alteration in the target enzyme 14-alpha demethylase (change in binding site or over expression of the enzyme) or enhanced drug efflux caused by plasma membrane transporters. Many strains have developed multiple resistance mechanisms.


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