Abnormal vaginal discharge in reproductive age group women with special implication to antifungal susceptibility of candida species

Introduction And Background: Vaginal discharge is a common complaint in reproductive age group women2. Vaginal discharge is one of the common reasons in women of reproductive age group seeking gynecological consultation. It is the second most common clinical problem after menstrual disorders. Globally, it is estimated that one in ten women will present with vaginal discharge in the course of one year and approximately, ten million office visits each year are attributed to vaginal discharge complaints. The prevalence of vaginal discharge in India is estimated to be 30%3. Ÿ Abnormal vaginal discharge predisposes to significant morbidity to the women in the form of pelvic inflammatory disease, infertility, endometriosis, cuff cellulitis, urethral syndrome, pregnancy loss, and preterm labour.5 Ÿ Certain conditions such as prolonged use of combined oral contraceptive, pregnancy, malnutrition, diabetes, neutropenia, prolonged antibiotic therapy, candida become pathogenic and causes candidiasis.8 Ÿ Isolation, identification, characterization, and susceptibility of candida species became critical management of fungal infections.9 Need For The Study: The study was done to emphasize the role of laboratory investigations in patients with vaginitis, as presumptive clinical diagnosis alone can lead to false interpretation and treatment mismanagement. TheMethods: present study is a cross sectional observational study conducted from January 2019 to February 2020 for about a period of one year among 300 women aged 15-49 years with vaginal discharge attending gynecology OPD, Government Maternity Hospital, Tirupati. This study included 300 subjects with a mean age of 30.4 ± 7.26 years. Nearly halfResults: of (49.33%) our study population was aged between 25 to 34years, a majority (47%) of women had bacterial vaginosis, followed by Candida in 39.33%, trichomonas vaginalis in 14.33%, mixed infections in 6.67% and 6% with no organisms. Among Candida species, 48.31% of participants had candida albicans, 23.73% had candida tropicalis, 19.49% had candida krusei, and 8.47% had candida glabrata, and of them 38.33% participants had voriconazole sensitivity, 32.33% participants had ketoconazole sensitivity, 26% participants had clotrimazole sensitivity, and 21.33% participants had fluconazole sensitivity. Among 118 candida infected 106 (89.83%) participants came for follow-up, of which symptoms subsided in 90 (84.91%) participants. In conclusion, our study with 300 women patients complaining ofConclusion: vaginal discharge found a majority of them belonging to the sexually active age group. Vaginal discharge was more prevalent in lower economic status and rural areas. Bacterial vaginosis was the most common and frequent etiology, followed by Candida. TV was the least common etiology for vaginal discharge

Efficacy of 7.5% povidone-iodine and 1% clotrimazole in the treatment of otomycosis – A prospective randomized study

Background: Otomycosis is a common condition of the external auditory canal. Aspergillus species and candida species are common causative agents for otomycosis. Clotrimazole is effective in controlling candida species than Aspergillus species. The povidone-iodine is a routinely used antiseptic solution in surgical care. Aims and Objectives: To assess the efficacy of 7.5% povidone-iodine and 1% clotrimazole in the treatment of otomycosis. Materials and Methods: This prospective randomized study recruited 128 cases of both genders. The study participants were randomly divided into two groups. Group 1 received 7.5% povidone-iodine and group 2 received clotrimazole (1%). After removal of otomycotic debris, the study cases were randomly administered with study drugs three drops once a day. All the cases were strictly advised to adhere to the treatment procedure not <2 weeks. Descriptive statistics and Chi-square test was used to test the significance of qualitative data by SPSS 16.0. The P < 0.005 was considered as statistically significant. Results: After 14 days treatment, 1% clotrimazole group, showed continuous ear discharge (6.25%), pruritus (3.12%), tinnitus (3.12%), otalgia (1.56%), and deafness (1.56%), which was higher than 7.5% povidone-iodine group. Aspergillus niger (1 case) and Aspergillus flavus (2 cases) isolates were observed in 1% clotrimazole group. Good treatment response after the 5th day was seen in 15.62% and 18.75% cases, after the 9th day in 45.31% and 48.43%, and after the 14th day in 87.5% and 75% in 7.5% povidone-iodine and 1% clotrimazole groups, respectively. Conclusion: The cases treated with 7.5% povidone-iodine were showed comparatively less bacterial and fungal isolates and less clinical signs and symptoms than cases treated with 1% clotrimazole after 2 weeks of treatment follow-up.

Differentiation of Oral Candida Species in Chronic Renal Failure Patients Undergoing Hemodialysis

Background: Oral candidiasis occur as an opportunistic infection. The transition of candida from commensal to pathogen is often associated with immune- compromised chronic renal patients receiving hemodialysis. Candida species identification and differentiation is important for treatment in these patients. Aim: To differentiate candida species present in the oral cavity of chronic renal failure patients undergoing hemodialysis. Material and Methods: A total of 120 individuals with study group (n=60) of chronic renal failure patients undergoing hemo- dialysis (CRF with HD) and control group (n=60) healthy individuals, were studied. Salivary samples were cultured for candida species using Sabouraud’s Dextrose Agar (SDA) and CHROM agar culture media, for the growth of candida species in 24, 48 to 72 hours at 37ºC. Colonies were counted and quantitatively expressed as colony forming units/milliliter (CFU). Results: Positive candidal growth was seen on SDA and CHROM agar medium among CRF with HD and Control Groups, can- dida species were present in 55 (91.6%) and absent in 5(8.3%) and 57(95%) and absent 3(5%) in individuals respectively. Can- dida species differentiation in CRF with HD and Control groups were C. albicans (green colonies), C. Kruzei (pink colonies) and C. Tropicalis (blue colonies) were 46(81.6%), 6(10.0%), 2(3.3%) in CRF with HD cases while 45(75%) 11(18.3%) and 0(0%) in control cases respectively. Conclusion: Isolation and differentiation of candida was highly significant (p<0.05) in chronic renal failure patients undergoing hemodialysis than healthy individuals.

Original Research Article (Experimental): Targeting fungal menace through copper nanoparticles and Tamrajal

WHO reports, an escalation of antibiotic resistance in opportunistic pathogens like Candida. Tamrajal, i.e., water stored in copper vessels has been proclaimed as health elixir by ancient Ayurveda. Vis-a-Vis the use of copper contact surfaces and nanoparticles has gained significance for their antimicrobial effects. It thus seems imperative to examine copper nanoparticles and tamrajal as promising alternatives to existing antifungals.ObjectiveThis study not only assessed the influence of Tamrajal and copper nanoparticles on the morphological alterations of the Candida and its biofilm forming ability, but also on their ability to destroy preformed biofilms.Materials and methodsCopper oxide nanoparticles as well as Tamrajal were evaluated as complementary as well as stand-alone antimicrobial agents. ‘Time kill assay’ and ‘germ tube inhibition test’ were performed as end-point analysis for pathogenesis, while biofilm quantification, performed to assess the colonizing capability of Candida. Scanning Electron Microscope was used for visualizing the cells, whilst ICP-AES to determine the copper concentration.Results92–100% cytotoxicity to the fluconazole resistant Candida species was observed with copper oxide nanoparticles as well as tamrajal during 24hr time kill assay. The study also confirmed complete germ tube inhibition by copper in both its forms in addition to the reduction in the biofilm production.ConclusionCompared to the classes of antifungals like azoles, echinocandins etc, copper based anti-candidal agents highlight a potential way to combat resistant candidiasis. The possibility of accumulation of NP resulting in cytotoxicity puts tamrajal as the choice due to its efficacy as well as non-toxicity as per the EPA.

Assessment Of Risk Factors And Identification Of Fungal And Bacterial Agents In Otomycosis At Rural Community Attending A Tertiary Care Hospital

Introduction: Otomycosis is a sub-acute or a chronic superficial fungal infection of the external auditory canal.It is one of the frequently encountered fungal infections of the ear. The prevalence of otomycosis is higher intropical and subtropical climates zones. This study was planned to identify the most common organismsinvolved in otomycosis, clinical features and various predisposing factors of the disease in south India.Materials and Methods: Prospective study on 187 confirmed cases of Otomycosis who attended the ENT OPD. Apredesigned proforma was administered to the participants to know the clinical symptoms, predisposingfactors, sociodemographic details, and comorbid conditions. Clinical findings in both ears were recorded.Results: The majority of the study population (31%) were in the age group of 31-40. Around 47% of the studypopulation had a history of manipulation of the external auditory canal. Around 32 % gave the history of theinstallation of either antibiotic drops or steroid drops into the ear. Around 97% of the study population hadblocked, 83% had pain and 77 % had itching. The discharge was present in 47% of the study population. Femaleprevalence was high and more than 88% was unilateral. Aspergillus species and Candida species were morecommonly present in the fungal culture. Around 88% had a bacterial infection along with fungal growth.Conclusion: the diagnosis of Otomycosis must be considered for all cases of ear discharge for prompt andaccurate treatment and to save time and suffering.

An etiological and antifungal profile of candidemia in children

Background: Candidemia causing increased mortality rates and emergence of antifungal drug resistance needs an urgent intervention to salvage immunocompromised and severely ill patients. This study aimed to isolate and identify Candida species and evaluate their antifungal susceptibility profile from blood stream infections in children.Methods: Fungal cultures from blood recovered positive for yeasts were subcultured on Sabouraud dextrose agar. Suspected purified colonies of Candida were confirmed and identified upto species level by both conventional and automated techniques. Antifungal susceptibility testing of isolates was evaluated using agar based E-test method for fluconazole, voriconazole and caspofungin on Mueller-Hinton agar supplemented with 2% glucose.Results: Total of 43 isolates of Candida species were recovered from blood samples. Non albicans Candida species accounted for 88.30% of cases; whereas 11.60% of cases were caused by C. albicans, C. tropicalis (39%) was the most frequent isolate recovered in candidemia patients followed by C. parapsilosis (18%), C. albicans (12%), C. glabrata (12%), C. kefyr (9%), C. pelliculosa (5%), and C. krusei (5%). Antifungal susceptibility results revealed Caspofungin demonstrated good activity against all Candida spp. C. parapsilosis followed by C. tropicalis and C. glabrata demonstrated high resistance to fluconazole. For voriconazole, maximum resistance was shown by C. tropicalis as compared to others.Conclusions: Candidemia is a threatening prognostic sign in children and an important entity in our hospital. Identification of Candidaspecies and antifungal sensitivity testing is a must to select a suitable and effective antifungal therapy to abrogate the emerging resistance to antifungals.

Biofilm Formation among Various Candida Species and its Role in Antifungal Resistance at Tertiary Care Centre, Jhalawar

Introduction: Serious fungal infections particularly Candidainfection have increased in recent years.It is as a consequenceof increased immunosuppression associated with HIVinfection, organ and tissue transplant and aggressive treatmentfor neoplastic and autoimmune diseases. Study aimed toinvestigate biofilm formation among candida species isolatedfrom various clinical samples and its role in antifungalresistance.Material and methods: A retrospective observational studywas conducted from October 2017 to January 2019 in theDepartment of Microbiology, Jhalawar Medical College,Jhalawar. A total of 630 samples with suspected Candidainfections were collected and processed. A total of 313Candida isolates from various clinical samples were taken upfor the study. Samples were processed by Gram staining, KOHmount and culture on SDA and BHI agar. Isolated yeasts wereidentified and speciated by germ tube test, chlamydosporesformation on corn meal agar, color production on CHROMagar, sugar fermentation test and sugar assimilation test.Biofilm production was tested by Tube method and Tissueculture plate method. Antifungal susceptibility testing ofisolates was performed as per CLSI guidelines.Results: A total of 313 samples out 630 samples were positivefor candida infections. Out of 313 isolates, 157 (50.16%) werefound to be biofilm producers. Candida tropicalis (52.86%)was most common Candida species to be isolated as biofilmproducer followed by C. Parapsilosis (10.19%), C. glabrata(10.19%) and C. krusei (4.45%) while C. albicans was 35/157(22.29%). Antifungal resistant was found to be more in biofilmproducer and tissue culture plate method was found to be moresensitive than tube method for biofilm detection.Conclusion: There is increasing trend of antifungal resistanceamong candida isolates particularly in Non Albicans Candidaspecies. So, it is necessary to identify all yeast isolates up tospecies level and their potential for biofilm formation as it isone of the major virulence factors responsible for antifungalresistance. This will be helpful for efficient treatment,prevention of development of antifungal resistance and finally,the reduction of the treatment costs.

Antifungal effect of sesame medicinal herb on Candida Species: original study and mini-review

The aim of this study was to evaluate the antifungal susceptibility patterns of three antifungals, methanolic extracts and N-hexane oil of sesame seeds on C. albicans and C. glabrata, isolated from oral cavity of liver transplant recipients. The results were compared with other reports to develop a mini review as well. Candida species were isolated from liver transplant recipients. To evaluate the antifungal activity of sesame seed oil and methanolic extract, fluconazole, caspofungin and nystatin, the corresponding minimum inhibitory concentrations were determined by CLSI M27-A3 standard method. Minimum fungicidal concentration was also evaluated. The most prevalent species was C. albicans, followed by C. glabrata. Findings indicated sensitivity to antifungal agents and resistance to methanolic extract and N-hexane oil for all C. albicans and C. glabrata isolates. The rate of Candida colonization in the oral cavity of liver transplant recipients was high. Our results revealed that the methanolic and N-hexan extracts of sesame seeds are not effective on C. albicans and C. glabrata species, isolated from the patients. The sesame seed oil pulling and mouthwash cannot effectively cleanse and remove the Candida species in the mouth. Investigation of other medicinal plants or other parts of sesame like leaves and roots are suggested.

Distribution of clinical isolates of Candida spp. and antifungal susceptibility of high biofilm-forming Candida isolates

Abstract INTRODUCTION: The increase in the incidence of fungal infections, especially those caused by Candida albicans and other Candida species, necessitates the understanding and treatment of Candida-associated infections. In this study, we aimed to investigate the identification, distribution, and biofilm formation ability of different clinical Candida isolates and evaluate the distribution and antifungal susceptibilities of high biofilm-forming (HBF) Candida isolates. METHODS: For identification, carbohydrate fermentation, carbohydrate assimilation, and ChromAgar tests were used. Biofilm formation was assessed using crystal violet binding assay, while the susceptibility to antifungal agents was determined using ATBTM Fungus 3 test kits. RESULTS: The majority of Candida species were C. parapsilosis (31.3%; 31/99) and C. tropicalis (30.3%; 30/99). C. tropicalis was found to be the most frequently isolated species among all HBF Candida species. HBF Candida isolates were more frequently isolated from vaginal swab (35.7%; 10/28), tracheal aspirate (17.9%; 5/28), and urine (17.9%; 5/28). The majority of tested isolates were resistant to itraconazole and voriconazole, whereas no isolate was deemed resistant to 5-flucytosine. CONCLUSIONS: C. tropicalis displays the highest biofilm formation ability among all the Candida species evaluated, and HBF Candida isolates were more frequently seen in vaginal swab, tracheal aspirate, and urine samples. Our findings revealed that 5-flucytosine is the most efficient antifungal agent against HBF Candida isolates.

Peritonitis terciaria por Candida famata: infección por una levadura atípica / Tertiary peritonitis due to Candida famata: Infection by an atypical yeast

ResumenLa Candida famata es una levadura halotolerante, sobreproductora de vitamina B2, asociada infrecuentemente a infecciones en seres humanos, cuyo uso es común en procesos industriales. En nuestro servicio, se había detectado un único caso en el contexto de mediastinitis con un desenlace mortal. Se carecía de experiencia en cuanto al manejo de la infección por este agente. Posterior a una exhaustiva revisión bibliográfica, se demuestra la ausencia de reportes de infecciones por este agente en el contexto de la peritonitis terciaria. Se reporta el caso de un paciente de 37 años de edad que sufrió una herida de arma blanca en abdomen, y que después de múltiples complicaciones asociadas a este evento, desarrolló una peritonitis terciaria por C. famata; fue tratado satisfactoriamente con caspofungina y un abdomen abierto con terapia de presión negativa e instilación. Se espera que esta experiencia sirva de referente al detectar algún paciente con esta condición en el futuro.

AbstractCandida famata is a halotoleran, vitamin B2 overproducing yeast that is rarely associated with infections in humans, but is commonly utilized in industrial processes. In our service, it had been detected only once before in a patient with mediastinitis. The outcome of that infection was fatal. Not only were we unfamiliar with the management of infection by this agent, but after performing a thorough literary review, we were unable to find published reports of infections by this pathogen as the cause of tertiary peritonitis. We report the case of a 37 year old male who after suffering a stab wound to his abdomen and having multiple complications associated with this event, developed tertiary peritonitis by C. famata, that was treated with casponfungin and an open abdomen utilizing negative pressure wound therapy with instillation which yielded a satisfactory response to the therapy. This report may be of use in the event that clinicians are confronted with this condition in the future.

Isolation, Identification and Antifungal Susceptibility Testing of Candida species from Sepsis Patients from a rural based tertiary care and teaching hospital in Vadodara district, Gujarat

Background: Sepsis is a global problem causing substantial morbidity and mortality to the patients afflicted with it. Moreover sepsis due to fungal infections, especially, the Candida infections has increased in the recent times due to increase in patients with immunocompromised conditions. They are the normal commensal of the oral cavity, GIT and the mucosal surfaces in the body as well as the pathogens leading to colonization and also infection. Though Candida albicans is the most commonly isolated fungal pathogen from clinical samples, gradually non-albicans Candida species are becoming predominant pathogens. The increased use of anti-fungal agents for treatment and also for prophylaxis especially in ICU patients has lead to development of resistance against commonly used anti-fungal agents in the treatment like various azoles. Thus this study was carried out to identify different Candida species from specimens of clinically diagnosed sepsis patients and their antifungal susceptibility pattern which can be utilized for better management of sepsis patients. Objectives: The objectives of this study were to isolate and identify the species of Candida from different samples of clinically diagnosed sepsis patients and to determine the susceptibility pattern of the Candida species isolates against the commonly used anti-fungal agents from the clinical samples of sepsis patients from a rural based tertiary care and teaching hospital. Khara R, Lakhani SJ, Vasava S. Isolation, Identification and Antifungal Susceptibility Testing of Candida species from Sepsis Patients from a rural based tertiary care and teaching hospital in Vadodara district, Gujarat. IAIM, 2017; 4(7): 151- 160. Page 152 Materials and methods: A total of 100 Candida species were isolated from different samples of clinically diagnosed sepsis patients. These were identified on the basis of gram stain of the samples, colony morphology on Saboraud’s Dextrose agar and HiCrome also germ tube and chlamydospore formation. The antifungal susceptibility testing was done according to CLSI M44-A2 for yeasts. Results: A total of 100 (14.26%) Candida species were isolated out of the total 701 isolates from 1136 different samples cultured from clinically diagnosed sepsis patients. Of these, 53% were C. albicans, 37% C. non-albicans, 6% C. glabrata and 4% C. tropicalis. Also 35% were obtained from blood, 20% from catheterized urine, 19% from sputum, 14% from non-catheterized urine, 7% from ET (Endotracheal) tips/secretions and the smaller percentage from other specimens. The antifungal testing showed a higher resistance to most of the antifungal agents tested with 80% towards clotrimazole, 77% to ketoconazole and 63% to fluconazole and 62% towards itraconazole. However, 80% of Candida species were susceptible to amphotericin B followed by 33% to fluconazole and 80% were susceptible-dose-dependent to nystatin. Conclusion: The findings of our study suggest that Candida species are an important pathogen causing various infections in our patients leading to sepsis as well as a higher resistance to most of the antifungal agents tested poses a real challenge in the management of patients with sepsis due to Candida. Thus routine identification using HiCrome Media and antifungal susceptibility testing by disc diffusion method for yeasts will help in better management of sepsis due to Candida infections.

Fern extracts potentiate fluconazole activity and inhibit morphological changes in Candida species

Objective To investigate the antifungal activity of the fern species Lygodium venustum (L. venustum) and Pityrogramma calomelanos (P. calomelanos) against Candida albicans and Candida tropicalis strains. Methods The microdilution method was used to evaluate the antifungal activity, as well as the modulating effects of ethanolic extracts of these plants in combination with fluconazole. The minimum inhibitory concentration (MIC), minimum fungicide concentration and morphological changes were also determined. Results The extract obtained from L. venustum presented a MIC > 8 192 μg/mL, while the extract obtained from and P. calomelanos presented a MIC = 8 192 μg/mL, indicating that they present weak antifungal activity. However, combination of the extracts with Fluconazole potentiated the antifungal activity of this drug. At different experimental conditions, such as concentration of the extract and type of strain, the extracts inhibited hyphae and pseudohyphae formation, indicating that these fern species can affect the morphology of the fungi. Conclusions The extracts obtained from the fern species L. venustum and P. calomelanos dose not present significant antifungal activity. However, P. calomelanos potentiates the activity of fluconazole and both extracts inhibits the morphological changes in Candida species, indicating that they have potential pharmacological activity as modulators of fungal biology. Therefore, novel studies are required to characterize the interference of these extracts in the virulence and pathogenicity of Candida species as well as the potential of fern species to treat fungal infections.

Fern extracts potentiate fluconazole activity and inhibit morphological changes in Candida species

Objective:To investigate the antifungal activity of the fern species Lygodium venustum (L.venustum) and Pityrogramma calomelanos (P.calomelanos) against Candida albicans and Candida tropicalis strains.Methods:The microdilution method was used to evaluate the antifungal activity,as well as the modulating effects of ethanolic extracts of these plants in combination with fluconazole.The minimum inhibitory concentration (MIC),minimum fungicide concentration and morphological changes were also determined.Results:The extract obtained from L.venustum presented a MIC ＞ 8192 μtg/mL,while the extract obtained from and P.calomelanos presented a MIC =8192 μtg/mL,indicating that they present weak antifungal activity.However,combination of the extracts with Fluconazole potentiated the antifungal activity of this drug.At different experimental conditions,such as concentration of the extract and type of strain,the extracts inhibited hyphae and pseudohyphae formation,indicating that these fern species can affect the morphology of the fungi.Conclusions:The extracts obtained from the fern species L.venustum and P.calomelanos dose not present significant antifungal activity.However,P.calomelanos potentiates the activity of fluconazole and both extracts inhibits the morphological changes in Candida species,indicating that they have potential pharmacological activity as modulators of fungal biology.Therefore,novel studies are required to characterize the interference of these extracts in the virulence and pathogenicity of Candida species as well as the potential of fern species to treat fungal infections.

Influence of concentrations of CaCl2 on hemolytic activity of candida strains / 口腔疾病防治

Objective@# To investigate the influence of different concentrations of CaCl2 on the hemolytic activity of candida strains. @*Methods @#A total of 25 candida strains were selected, including 21 candida strains recovered from clinical specimens, and 4 reference strains of C. albicans (ATCC 90028) (American Type Culture Collection, Manassas, VA, USA), C. glabrata (ATCC 90030), C. krusei (ATCC 6258), and C. tropicalis (ATCC 13803) respectively. CaCl2 was added at concentrations of 0%, 0.5%, 1% and 2.5 g % (wt/vol). Plates were cultured at 37 ℃ in a 5% CO2 atmosphere for 24-72 h, and the hemolytic index (Hi) was analyzed. @*Results @#comparsions of the hemolytic indices among the groups treated with 0.5% CaCl2 (Hi = 2.247 ± 0.079), 1% CaCl2 (Hi = 2.013 ± 0.092), 2.5% CaCl2 (Hi = 2.150 ± 0.066) and the control (Hi = 2.749 ± 0.103) reached statistical significance (P < 0.001). @*Conclusion@#CaCl2 may produce a decrease activity in the hemolysis of candida species.

Species distribution and antifungal susceptibility patterns of Candida isolates from a public tertiary teaching hospital in the Eastern Cape Province, South Africa

Candida species are the leading cause of invasive fungal infections, and over the past decade there has been an increased isolation of drug resistant Candida species. This study aimed to identify the species distribution of Candida isolates and to determine their unique antifungal susceptibility and resistance patterns. During a cross-sectional study, 209 Candida isolates (recovered from 206 clinical samples) were collected and their species distribution was determined using ChromAgar Candida. The Vitek-2 system (Biomerieux, South Africa) was used to determine minimum inhibitory concentrations (MICs) to azoles (fluconazole, voriconazole), echinocandins (caspofungin, micafungin), polyenes (amphotericin B) and flucytosine. Four species of Candida were isolated, of which C. albicans was the most frequent, isolated in 45.4% (95/209) of the isolates, followed by C. glabrata: 31.1% (65/209). The MICs of the different antifungal drugs varied amongst the species of Candida. From the 130 isolates tested for MICs, 90.77% (112/130) were susceptible to all antifungal drugs and 6.9% (9/130) of the isolates were multi-drug resistant. C. dubliniensis (n=2) isolates were susceptible to all the above mentioned antifungal drugs. There was no significant difference in species distribution amongst clinical specimens and between patients' genders (P>0.05). An increase in MIC values for fluconazole and flucytosine towards the resistance range was observed. To our knowledge, this is the first report on surveillance of Candida species distribution and antifungal susceptibility at a public tertiary teaching hospital in Eastern Cape, South Africa.

Trend of Prevalence and Antifungal Drug Resistance of Candida Species Isolated from Candidemia Patients at a Tertiary Care Hospital During Recent Two Decades / 대한임상미생물학회지

BACKGROUND: Candidemia has increased with an increasing number of people in the high risk group and so has become more important. This study was conducted to investigate the isolation rate of Candida species from candidemia patients and the change in rate of antifungal resistance. METHODS: At a single tertiary care hospital, 1,120 blood cultures positive for Candida species from 1997 to 2016 were investigated according to date of culture, gender, age, and hospital department. RESULTS: During the investigation period, the number of candidemia patients increased from 14 in 1997 to 84 in 2016. The most common organism identified during the two decades was Candida albicans (40.8%), followed by Candida parapsilosis (24.1%), Candida tropicalis (13.2%), and Candida glabrata (12.8%). C. glabrata was relatively common in females (45.5%) compared to males. The age group 40-89 years was more frequently infected than other age groups, and the most frequent isolates according to age group were C. albicans in neonate (66.7%), C. parapsilosis in 1-9-year-olds (41.7%), and C. glabrata in those aged ≥60 years (range; 13.3%–20.0%). According to the visited departments, C. albicans, C. glabrata, and Candida haemulonii were more common in medical departments, while C. parapsilosis was more common in surgical departments. In the antifungal susceptibility test, a rising trend of azole resistance among C. albicans and C. glabrata was observed in recent years. CONCLUSION: In this study, it was confirmed that the isolation rate of Candida species in blood is different by age, gender, and hospital department, and the distribution of isolated Candida species changed over time. The resistance patterns of antifungal agents are also changing, and continuous monitoring and proper selection of antifungal agents are necessary.

Candida glabrata among Candida spp. from environmental health practitioners of a Brazilian Hospital

Abstract The incidence of the species Candida albicans and non-albicans Candida was evaluated in a Brazilian Tertiary Hospital from the environment and health practitioners. In a 12-month period we had a total positivity of 19.65% of Candida spp. The most recurring non-albicans Candida species was C. glabrata (37.62%), generally considered a species of low virulence, but with a higher mortality rate than C. albicans. Subsequently, C. parapsilosis (25.74%) and C. tropicalis (16.86%) were the second and third most commonly isolated species. Considering the total samples collected from the emergency room and from the inpatient and the pediatric sector, 19.10% were positive for Candida spp., with the predominance of non-albicans Candida species (89.42%). The high percentage of positivity occurred in the hands (24.32%) and the lab coats (21.88%) of the health care assistants. No sample of C. albicans presented a profile of resistance to the drugs. All the non-albicans Candida species presented a decreased susceptibility to miconazole and itraconazole, but they were susceptible to nystatin. Most of the isolates were susceptible to fluconazole and amphotericin B. As expected, a high resistance rate was observed in C. glabrata and C. krusei, which are intrinsically less susceptible to this antifungal agent. The contamination of environmental surfaces by Candida spp. through hand touching may facilitate the occurrence of Candida infections predominantly in immunocompromised patients. In addition to that, the antifungal agents used should be carefully evaluated considering local epidemiologic trends in Candida spp. infections, so that therapeutic choices may be better guided.

Species distribution & antifungal susceptibility pattern of oropharyngeal Candida isolates from human immunodeficiency virus infected individuals.

Background & objectives: The changing spectrum of Candida species in causation of oropharyngeal candidiasis and their antifungal susceptibility pattern among the HIV infected individuals has made the identification to species level mandatory and detection of drug resistance necessary for patient care. The present study was carried out to determine the species distribution and antifungal susceptibility profile of oral Candida isolates colonizing or infecting both HIV seropositive and seronegative individuals. Methods: A case-control study was conducted including 141 consecutive, non-repeat HIV-seropositive individuals and an equal number of sex and age matched HIV-seronegative control. Speciation of the oropharyngeal Candida isolates was done using standard yeast identification protocol. Antifungal susceptibility testing was done by the disk-diffusion method as well as by Fungitest method. Results: From the 59 culture positive HIV seropositive cases, 61 Candida isolates were recovered; Candida albicans (n=47, 77.0%), C. dubliniensis (n=9, 14.7%), C. parapsilosis (n=2, 3.2%), C. glabrata (n=2, 3.2%), and C. famata (n=1, 1.6%). Candida colonization in HIV-seropositive individuals was significantly higher than that of HIV-seronegative (control) group. Antifungal susceptibility testing revealed (n=6, 9.3%) C. albicans isolates resistant to voriconazole and fluconazole by disk-diffusion method whereas no resistance was seen by Fungitest method. Interpretation & conclusions: C. albicans was the commonest Candida species infecting or colonizing HIV seropositive individuals. Oropharyngeal Candida isolates had high level susceptibility to all the major antifungals commonly in use. Increased level of immunosuppression in HIV-seropositives and drug resistance of non-albicans Candida species makes identification and susceptibility testing of Candida species necessary in different geographical areas of the country.

Study of systemic fungal infections in renal transplant recipients

Background: Despite technical, immunological, and therapeutic advances in the field of renal transplantation, infections remain a major barrier to successful outcome. Fungal infections (14%) after renal transplantation, despite a lower incidence than bacterial and viral infections, remain a major cause of morbidity and mortality. This study was conducted to assess the impact of invasive fungal infections in our renal transplant recipients. Aim: To study the clinical profile, risk factors for acquiring fungal infections, its outcome and the factors influencing outcome in living and deceased donor renal transplant recipients. Materials and methods: Renal transplant recipients both cadaveric and living-related during the time period between August 2008 and May 2011 admitted with systemic fungal infections in nephrology ward were included in the study. Data gathered included age, sex, date of transplantation, date of diagnosis, fungal pathogen, organs affected by infection, treatment and patient outcome. Microsoft excel 2007, Binomial and Student t tests were used for statistical analysis. Observation: Twenty two patients were diagnosed with systemic fungal infections during this period. The mean age of the study patients was 35.55 years. The male to female ratio was 1.75:1.Candida species (62%) are the commonest organisms causing fungal infection. Fungal infections commonly occurred in gastrointestinal tract (GIT), lung and urinary tract, each 22%. Fifty percent of patients with fungal infections expired. Graft loss occurred in 41% of patients. Conclusion: The mortality rate was 50%. Bone marrow suppression {Leukopenia (50%)} and hypoalbuminemia (59%) contributed to high mortality. Overall immunosuppression should be monitored periodically and kept at optimal level just enough to avoid rejection, thereby avoiding opportunistic infections.

Emergence of non-albicans Candida species and antifungal resistance in intensive care unit patients

Objective: To evaluate the epidemiology of candidiasis and the antifungal susceptibility profile of Candida species isolated from the intensive care unit (ICU) patients. Methods: The study used a qualitative descriptive design. Relevant samples depending on organ system involvement from 100 ICU patients were collected and processed. Identification and speciation of the isolates was conducted by the biochemical tests. Antifungal susceptibility testing was carried out as per CLSI-M27-A3 document. Results: Ninety Candida isolates were isolated from the different clinical samples:urine (43.3%), tracheal aspirate (31.1%), urinary catheter (12.2%), endotracheal tube (7.8%), abdominal drains (3.3%), sputum (2.2%). The incidence of candidiasis caused by non-albicans Candida (NAC) species (63.3%) was higher than Candida albicans (36.7%). The various NAC species were isolated as: Candida tropicalis (41.1%), Candida glab-rata (10%), Candida parapsilosis (6.7%), Candida krusei (3.3%) and Candida kefyr (2.2%). The overall isolation rate of Candida species from samples was 53.3%. Anti-fungal susceptibility indicated that 37.8%and 7.8%of the Candida isolates were resistant to fluconazole and amphotericin B, respectively. Conclusions: Predominance of NAC species in ICU patients along with the increasing resistance being recorded to fluconazole which has a major bearing on the morbidity and management of these patients and needs to be further worked upon.