Background: Oropharyngeal candidiasis is a fungal infection in the mouth caused by Candida species. Oropharyngeal candidiasis is a major problem among hematologic malignancy patients. Objectives: The present study was designed to identify and evaluate antifungal susceptibility patterns of Candida spp. isolated from hematological malignancy patients with oral candidiasis. Methods: Samples were collected from the oral cavity of 138 patients and confirmed for oropharyngeal candidiasis by microscopic examination and fungal culture. Isolated Candida strains were identified by ITS-PCR. Hyphal wall protein 1 (HWP1) was amplified to differentiate the Candida albicans complex. In vitro antifungal susceptibility tests against fluconazole, amphotericin B, and caspofungin were performed according to CLSI M27-A3/S4. Results: The study enrolled 120 patients, including 74 (61.66%) females and 46 (38.33%) males. The mean age of affliction by fungal infections was 42 ± 8 years. Patients with acute myeloid leukemia (44%) comprised the majority of cases. The most commonly isolated species among patients were C. albicans (n = 110; 91.6%), C. glabrata (n = 8; 6.6%), and C. africana (n = 2; 2.8%). The overall resistance of C. albicans was 2.7% to fluconazole, and 1.8% to amphotericin B. Candida glabrata showed 12.5% resistance to amphotericin B. All Candida spp. isolates from patients were susceptible to caspofungin. Conclusions: Local information about the increasing resistance to fluconazole in both C. albicans and non albicans Candida species and their antifungal susceptibility is useful for deciding on antifungal prophylaxis and selecting the empirical therapy of cancer patients.
Background and Purpose: Oropharyngeal candidiasis (OPC) is a fungal infection of the oral cavity caused by the members of C. albicans complex. Although C. africana, as a part of the complex, is considered to be mostly responsible for the development of vulvovaginal candidiasis, it may be associated with a wider clinical spectrum. Case report: This report described two cases diagnosed with oral candidiasis during the receipt of treatment for malignancies. Conventional and molecular tests were performed on the samples collected from the patients’ oral cavities. The test results revealed C. africana as the causative agent of oral candidiasis. Furthermore, in vitro antifungal susceptibility test indicated the full susceptibility of all C. africana isolates to caspofungin. However, the data were also suggestive of the resistance against fluconazole and amphotericin B. Caspofungin was used as the main antifungal agent for the treatment of oral candidiasis, resulting in the improvement of thrush in patients. The resistance of C. africana to fluconazole and amphotericin B suggests the necessity of performing in vitro susceptibility testing on the isolates for the selection of appropriate antifungal agents. Conclusion: As the findings indicated, the achievement of knowledge regarding C. africana as an emerging non-albicans Candida species and its antifungal susceptibility profile is crucial to select antifungal prophylaxis and empirical therapy for oral candidiasis in cancer patients undergoing chemotherapy.
Immunocompromised patients, especially those hospitalized, are at higher risk for infection with opportunistic pathogens such as Stenotrophomonas maltophilia (S. maltophilia) which is a multidrug-resistant gram-negative bacillus and can cause a challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. A 71-year-old man with Hodgkin's lymphoma presented with severe respiratory symptoms of COVID-19 and was intubated upon admission and the initial standard treatment for COVID-19 was started for him. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia. According to that, the patient's intubation tube was removed and a tracheostomy was performed for him. Also, antibiotic treatment was replaced with Colistin and Co-trimoxazole drugs. Finally, after 31 days of hospitalization in the ICU and the aappropriate drug treatment, he was discharged with reduced symptoms and partial recovery. It should be noted that the occurrence of co-infection with multidrug-resistant pathogens such as S. maltophilia requires proper management to select appropriate treatment methods and drugs so that in addition to proper effectiveness, it does not lead to side effects and complications associated with COVID-19 disease.
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