Non-albicans candidemia in cancer patients as an increasing health problem: A comprehensive review and meta-analysis

Objective: To evaluate the prevalence of Candida species in cancer patients with candidemia around the world, and to identify related risk factors and their antifungal resistance, with an emphasis on non-albicans Candida species (NACs). Methods: The published papers related to the subject were systematically searched in databases of MEDLINE (including PubMed), Web of Science, Scopus, Science Direct, and Google Scholar between the 1 st January 2000 and 21 st April 2021. Results: Among the 4 546 records, 69 studies met the inclusion criteria. The pooled prevalence of NACs in cancer patients with candidemia was 62% (95% CI 58%-67%; I 2 =94.85%, P=0.00). Based on type of cancer, the pooled prevalence of NACs in hematologic and solid cancer patients were 68% (95% CI 65%-70%) and 52% (95% CI 49%-54%), respectively. Among NACs, Candida (C.) parapsilosis was the most frequently isolated organism followed by C. tropicalis and C. glabrata. In addition, the therapeutic usage of antibiotics was found as the most common risk factor, accounting for 85% (95% CI 81%-89%) and central venous catheter accounting for 69% (95% CI 62%-77%). Conclusions: The incidence of Candida bloodstream infections among cancer patients is a growing concern, especially when the etiologic agents of candidemia tend to shift towards NACs.

Oral colonization by Candida species and associated factors in HIV-infected patients in Ahvaz, southwest Iran / 한국역학회지

Objectives@#Oropharyngeal candidiasis is one of the most common opportunistic fungal infections among human immunodeficiency virus (HIV)-infected individuals. The most common cause is Candida albicans, followed by non-albicans Candida. This study aimed to identify colonized Candida species in HIV-infected patients from Ahvaz, Iran. Additionally, the relationships between immunity-related factors, lifestyle, and colonization of Candida spp. were studied. @*Methods@#Oral swabs were taken from 201 HIV-positive patients referred for consultations at the Behavioral Modification Center. Oral Candida colonization was detected using culture-based and molecular assays. Data were assessed by descriptive statistics and analyzed to investigate the correlation between Candida colonization and various factors, including the CD4+ cell count and viral load. @*Results@#It was found that 43.8% of patients were positive for Candida. The most common species was C. albicans (48.0%), followed by non-albicans Candida isolates, including C. dubliniensis, C. glabrata, C. tropicalis, C. parapsilosis, C. guilliermondii, C. kefyr, and C. krusei. Colonization of Candida spp. in patients was associated with a CD4 count ≤200 cells/mm3 (odds ratio [OR], 4.62; p<0.05), history of shared injections (OR, 6.96; p<0.001), and sex (OR, 3.59; p<0.05). @*Conclusions@#The results of this study showed that C. albicans was the dominant pathogen. The risk factors for colonization of Candida spp. were a CD4 count ≤ 200/mm3 , a history of shared injections, and sex. Other factors with potential relationships include viral load, age, and opportunistic infections, but further investigations are needed.

Oral colonization by Candida species and associated factors in HIV-infected patients in Ahvaz, southwest Iran / 한국역학회지

Objectives@#Oropharyngeal candidiasis is one of the most common opportunistic fungal infections among human immunodeficiency virus (HIV)-infected individuals. The most common cause is Candida albicans, followed by non-albicans Candida. This study aimed to identify colonized Candida species in HIV-infected patients from Ahvaz, Iran. Additionally, the relationships between immunity-related factors, lifestyle, and colonization of Candida spp. were studied. @*Methods@#Oral swabs were taken from 201 HIV-positive patients referred for consultations at the Behavioral Modification Center. Oral Candida colonization was detected using culture-based and molecular assays. Data were assessed by descriptive statistics and analyzed to investigate the correlation between Candida colonization and various factors, including the CD4+ cell count and viral load. @*Results@#It was found that 43.8% of patients were positive for Candida. The most common species was C. albicans (48.0%), followed by non-albicans Candida isolates, including C. dubliniensis, C. glabrata, C. tropicalis, C. parapsilosis, C. guilliermondii, C. kefyr, and C. krusei. Colonization of Candida spp. in patients was associated with a CD4 count ≤200 cells/mm3 (odds ratio [OR], 4.62; p<0.05), history of shared injections (OR, 6.96; p<0.001), and sex (OR, 3.59; p<0.05). @*Conclusions@#The results of this study showed that C. albicans was the dominant pathogen. The risk factors for colonization of Candida spp. were a CD4 count ≤ 200/mm3 , a history of shared injections, and sex. Other factors with potential relationships include viral load, age, and opportunistic infections, but further investigations are needed.