{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:40:13Z","timestamp":1788813613566,"version":"build-2803163510"},"reference-count":33,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[1998,11,1]],"date-time":"1998-11-01T00:00:00Z","timestamp":909878400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[1998,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Resistance to fluconazole is becoming an increasing problem in the management of oropharyngeal candidiasis in human immunodeficiency virus-infected patients. Strains obtained from five patients developed decreased fluconazole susceptibility over time. DNA strain typing confirmed the high degree of relatedness among isolates from one patient and the variability among isolates from different patients. Expression of genes involved in development of fluconazole resistance was monitored in each isolate using probes specific for\n            <jats:italic>ERG11<\/jats:italic>\n            (lanosterol 14\u03b1-demethylase),\n            <jats:italic>MDR1<\/jats:italic>\n            (a major facilitator), and\n            <jats:italic>CDR<\/jats:italic>\n            (ATP-binding cassette or ABC transporter) genes. Increased expression of\n            <jats:italic>CDR<\/jats:italic>\n            genes was detected in the series of isolates from two patients. Isolates from one of the two patients also demonstrated increased\n            <jats:italic>ERG11<\/jats:italic>\n            expression, whereas isolates from the other patient did not. Increased levels of\n            <jats:italic>MDR1<\/jats:italic>\n            mRNA correlated with increased resistance in sequential isolates from another patient. Initial overexpression of\n            <jats:italic>MDR1<\/jats:italic>\n            with subsequent overexpression of\n            <jats:italic>CDR<\/jats:italic>\n            genes and a final isolate again overexpressing\n            <jats:italic>MDR1<\/jats:italic>\n            were detected in serial isolates from another patient. In another patient, overexpression of these genes was not detected despite an eightfold increase in fluconazole MIC. In this patient, sequence data of the\n            <jats:italic>ERG11<\/jats:italic>\n            gene revealed no point mutations associated with decreased susceptibility. Five different patterns of gene expression were observed in isolates recovered from five patients who developed resistance. Therefore, these experiments demonstrate that a variety of mechanisms or combinations of mechanisms are associated with the development of fluconazole drug resistance. Additional studies are needed to estimate the frequency and clinical impact of these mechanisms of resistance.\n          <\/jats:p>","DOI":"10.1128\/aac.42.11.2932","type":"journal-article","created":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T00:29:45Z","timestamp":1539044985000},"page":"2932-2937","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":182,"title":["Distinct Patterns of Gene Expression Associated with Development of Fluconazole Resistance in Serial\n            <i>Candida albicans<\/i>\n            Isolates from Human Immunodeficiency Virus-Infected Patients with Oropharyngeal Candidiasis"],"prefix":"10.1128","volume":"42","author":[{"given":"Jose L.","family":"Lopez-Ribot","sequence":"first","affiliation":[{"name":"<!--label omitted: 1-->Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-78811;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert K.","family":"McAtee","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-78811;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda N.","family":"Lee","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-78811;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-78811;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore C.","family":"White","sequence":"additional","affiliation":[{"name":"<!--label omitted: 2-->Department of Pathobiology, School of Public Health and Community Medicine, University of Washington, and Seattle Biomedical Research Institute, Seattle, Washington, 981092; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Sanglard","sequence":"additional","affiliation":[{"name":"<!--label omitted: 3-->Institut de Microbiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas F.","family":"Patterson","sequence":"additional","affiliation":[{"name":"<!--label omitted: 1-->Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-78811;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.40.12.2835"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/jb.179.23.7210-7218.1997"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0005-2728(94)90102-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.41.3.535"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00259685"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.42.11.2938"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.cb.08.110192.000435"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0378-1119(88)90025-X"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/17.2.804"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.272.9.5682"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0378-1097(97)00172-9"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0968-0004(93)90081-W"},{"key":"e_1_3_2_14_2","unstructured":"National Committee for Clinical Laboratory Standards\n          Reference method for broth dilution antifungal susceptibility testing of yeasts: approved standard. NCCLS document M27-A.\n          1997\n          National Committee for Clinical Laboratory Standards\n          Wayne Pa"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.34.12.3237-3239.1996"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.34.7.1794-1797.1996"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00352101"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/174.4.821"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.36.1.153-156.1998"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/24.2.235"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.39.1.1"},{"key":"e_1_3_2_22_2","unstructured":"Sambrook\n              J. F.\n              Fritsch\n              E. 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