Introduction: Candidiasis is an opportunistic infection which occurs due to indiscriminate and prolonged use of broadspectrum antimicrobials, corticosteroids, immunosuppressive agents, diabetes mellitus, Human Immunodeficiency Virus (HIV), chronic renal failure, haemodialysis, renal transplantation or indwelling urinary catheter. Recently, Non-albicans Candida (NAC) species have replaced Candida albicans and emerged as an important opportunistic pathogens exhibiting decreased susceptibility to commonly used antifungal agents. Early speciation of Candida isolates along with their antifungal susceptibility testing not only will restrict the empirical use of antifungal agent but also greatly influence the treatment options for the clinicians. Aim: To speciate Candida isolates from various clinical specimens and to determine their antifungal susceptibility pattern. Materials and Methods: This study was a cross-sectional study carried out in the Mycology Section, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India, from September 2016-August 2018. Candida isolates were identified using standard microbiological procedures, and speciation was done following conventional and HiCrome differential media. Antifungal susceptibility testing was determined by using Clinical and Laboratory Standards Institute (CLSI) disk diffusion method. Data analysis was done using descriptive statistics and Chi-square test. Results: A total of 100 isolates were identified from different clinical specimens, which included 43 (43%) from sputum, 34 (34%) from urine, in majority. Highest age was 92 years and lowest age was one year from whom the isolates were detected and females (57%) outnumbered males (43%) patients. Predominant Candida isolates were Candida albicans (44%), Candida tropicalis (32%). Among the azoles, the most sensitive agent was voriconazole (86%) and least was ketoconazole (56%), 81% of the total isolates were found sensitive to amphotericin B. Conclusion: The present study demonstrated that NAC spp. have surpassed Candida albicans and there is an increase in the resistance of the Candida isolates to commonly used antifungal agents. Therefore, this study highlights the need for speciation of Candida isolates upto species level and to determine the antifungal susceptibility pattern to decrease the morbidity and mortality of the patients.
BACKGROUND Onychomycosis is a fungal infection of the nails. It is caused by dermatophytes, non-dermatophytes and yeasts. In spite of improved personal hygiene and living condition, it continues to persist and poses a major clinical challenge regarding its treatment due to its chronicity. The present study was conducted to identify the fungi causing onychomycosis in our region. MATERIALS AND METHODS This descriptive study was carried out in the Department of Microbiology at a tertiary healthcare centre in Manipur from August 2016 to August 2017. A total of 166 cases of clinically diagnosed cases of onychomycosis were taken up for study. After disinfecting the nails with 70% alcohol, collected nail samples were subjected to 20% KOH and culture was done on Sabouraud's Dextrose Agar (SDA) with chloramphenicol. Identification of the isolates was done by microscopic and macroscopic examination. RESULTS Out of 166 samples KOH is positive in 54 samples (32.54%), of which culture is positive in 30 samples (18.07%) and 24 is culture negative (14.45%). Total culture positivity is seen in 52 samples (31.32%), of which 30 samples (18.07%) is KOH positive and 22 samples (13.25%) is KOH negative. Females are predominantly affected (64.45%). F: M is 1.8: 1. Most affected age group is 21-30 yrs. (30.12%). Candida species are the commonest species isolated (46.15%) and non-albicans Candida are more predominant (30.76%) followed by dermatophytes (28.84%). Trichophyton rubrum is the commonest dermatophyte isolated (15.38%). CONCLUSION The study showed the genus Candida as the main pathogen causing onychomycosis in our region. So, clinical onychomycosis should be confirmed both by KOH and fungal culture to prescribe specific antifungal drugs for optimal outcome.
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