Frequent detection of ‘azole’ resistant Candida species among late presenting AIDS patients in northwest Ethiopia

Abstract

BackgroundThe chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia.MethodsTwo hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method.ResultsThe colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent.ConclusionHIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.

Components of the Calcium-Calcineurin Signaling Pathway in Fungal Cells and Their Potential as Antifungal Targets

“…Azoles, especially fluconazole, have frequently been used in clinical practice due to their great efficacy in the prevention and treatment of Candida albicans infections and their reduced toxicity, but their use results in the emergence of drug resistance. Moreover, innately resistant species, such as non-albicans Candida species, are increasingly being isolated, which is a serious problem in the fight against fungal infections (11)(12)(13). Therefore, new antifungal drugs or new approaches for coping with invasive fungal infections are urgently needed (14).…”

Desenvolvimento de primers para identificação e diferenciação de espécies de Candida em secreção vaginal por PCR em tempo real (qPCR)

“…Os desafios vão desde a identificação do agente etiológico até a escolha do tratamento adequado, principalmente porque alguns isolados clínicos são resistentes aos antifúngicos (MULU et al, 2013 No Brasil, os dados epidemiológicos são escassos e estão inseridos em artigos científicos com dados parciais, pois não há um programa de notificação nacional de doenças fúngicas (GIACOMAZZI et al, 2016). No entanto, em 2016, Giacomazzi e colaboradores analisaram dados bibliográficos juntamente com dados coletados em hospitais brasileiros, estimando que mais de 3,8 milhões de pessoas sofrem com doenças fúngicas no país a cada ano, das quais 2,8 milhões têm como patógeno as leveduras do gênero Candida.…”

Exploring the thiazole scaffold for the identification of new agents for the treatment of fluconazole resistant Candida

“…Azoles, and in particular fluconazole (FLC), have been extensively used in clinical practice because of their great efficacy and low toxicity 3,9 . However, due to the excessive exposure to FLC, FLC-resistant C. albicans species have emerged 2,10,11 . In order to contrast this tendency, different efforts have been made to overcome the emergence of resistant fungi by using multi drugs therapy.…”

“…Over the past 20 years the incidence of invasive fungal infections and associated mortality have increased significantly as a consequence of the rising number of immunocompromised patients, the wide development of organ transplantation, tracheal intubation and endoscopic techniques, and the extensive application of broad-spectrum antibiotics, immunosuppressant drugs and corticosteroids 1,2 . In this respect, Candida albicans accounts for a large proportion of invasive fungal infections, placing itself at the first place as the major fungal pathogen in humans 3 .…”

“…In this respect, Candida albicans accounts for a large proportion of invasive fungal infections, placing itself at the first place as the major fungal pathogen in humans 3 . This organism, together with related Candida species, has become one of the commonest agents of hospital-acquired infection and in AIDS patients [2][3][4] . So far there are four classes of antifungal agents, (polyenes, 5-fluorocytosine, azoles and echinocandins) that can be used for the treatment of systemic infections [5][6][7][8] .…”