The very nature of infectious diseases has undergone profound changes in the past few decades. Fungi once considered as nonpathogenic or less virulent are now recognized as a primary cause of morbidity and mortality in immunocompromised and severely ill patients. Candida spp. are among the most common fungal pathogens. Candida albicans was the predominant cause of candidiasis. However, a shift toward non-albicans Candida species has been recently observed. These non-albicans Candida species demonstrate reduced susceptibility to commonly used antifungal drugs. In the present study, we investigated the prevalence of non-albicans Candida spp. among Candida isolates from various clinical specimens and analysed their virulence factors and antifungal susceptibility profile. A total of 523 Candida spp. were isolated from various clinical specimens. Non-albicans Candida species were the predominant pathogens isolated. Non-albicans Candida species also demonstrated the production of virulence factors once attributed to Candida albicans. Non-albicans Candida demonstrated high resistance to azole group of antifungal agents. Therefore, it can be concluded that non-albicans Candida species have emerged as an important cause of infections. Their isolation from clinical specimen can no longer be ignored as a nonpathogenic isolate nor can it be dismissed as a contaminant.

The incidence of invasive candidiasis has increased over the past few decades. Although Candida albicans remains by far the most common species encountered, in recent years shift towards non-albicans Candida species like Candida tropicalis is noted. Here in this study we determined the virulence factors and antifungal susceptibility profile of 125 C. tropicalis isolated from various clinical specimens. Biofilm formation was seen in 53 (42.4%) isolates. Coagulase production was noted in 18 (14.4%) isolates. Phospholipase enzyme was the major virulent factor produced by C. tropicalis isolates. A total of 39 biofilm forming isolates showed phospholipase activity. Proteinase activity was demonstrated by 65 (52%) isolates. A total of 38 (30.4%) isolates showed haemolytic activity. Maximum isolates demonstrated resistance to fluconazole. Fluconazole resistance was more common in C. tropicalis isolated from blood cultures. Antifungal resistance was more in isolates possessing the ability to produce phospholipase and biofilm. C. tropicalis exhibit a great degree of variation not only in their pathogenicity but also in their antifungal susceptibility profile. The identification of virulence attributes specific for each species and their correlation with each other will aid in the understanding of the pathogenesis of infection.

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BACKGROUND:Candidemia remains as one of the major cause of morbidity and mortality in health care setting. Over the last two decades, the proportion of blood stream infection (BSI) due to non-albicans Candida (NAC) species has increased. Several NAC spp. are inherently resistant to commonly used antifungal drugs. The increased isolation rates of NAC spp. and a gradual shift in the antifungal susceptibility profile underlines the need of early and accurate diagnosis of infecting Candida spp. along with antifungal susceptibility testing for selecting the most appropriate antifungal agent for therapy. AIM: The Aim of the present study was to investigate the distribution pattern of Candida spp. isolated from candidemia patients and evaluate its antifungal susceptibility pattern. SETTING AND DESIGN: The present study was conducted in the department of Microbiology for a period of six years (January 2006 to December 2011) which included, 194 Candida spp. isolated from the cases of candidemia. MATERIALS AND METHODS: Candida isolates were speciated by conventional techniques and HiCandida identification kit. Antifungal susceptibility test was performed using two disc diffusion methods. Clinical details and risk factors were recorded and analyzed. RESULTS AND CONCLUSIONS: Isolation of NAC spp. was significantly higher than Candida albicans. The most important risk factor associated with candidemia was intensive care unit stay, followed by diabetes and HIV infection. Azole resistance was more in NAC species as compared to C. albicans. The early and accurate diagnosis of infecting Candida spp. along with antifungal susceptibility testing plays a pivotal role in preventing morbidity and mortality associated with Candida BSI. Disc diffusion technique for antifungal susceptibility using glucose methylene blue Mueller-Hinton (GM-MH) agar was found to be simple, cost effective and sufficiently accurate for the routine testing of antifungal susceptibility of Candida spp. in resource constrained microbiology laboratories.

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The germ tube production in serum is a rapid method for identification of Candida.