Genotyping, antifungal susceptibility, enzymatic activity, and phenotypic variation in Candida albicans from esophageal candidiasis

Abstract

Background Esophageal candidiasis is the most frequent form of esophagitis. The pathogenicity of Candida spp. is related to a combination of microbial factors, hydrolytic enzyme secretion and phenotypic switching. This study was designed to investigate esophageal candidiasis, antifungal activity, enzymatic activity patterns, phenotyping, and genotyping profiles of Candida albicans species. Methods Nine hundred thirty‐three visited patients were evaluated, and esophageal biopsies from patients were included in this study during 2019–2020. Direct smear, Gram staining, and culture on CHROMagar were performed for each sample. Isolated species were identified with conventional procedures and PCR‐RFLP. Susceptibility to antifungals was determined according to CLSI guidelines. ABC typing, phenotype switching, hemolysin, proteinase, phospholipase, and esterase activity were also determined with the appropriate protocols. Results Twenty‐three (2.5%) patients (mean age 55.2 years) were diagnosed with esophageal candidiasis. The species isolated were 19(82.6%) C. albicans, 3(13.1%) C. glabrata, and 1(4.3%) C. tropicalis. Genotype A (57.9%) was the predominant type in C. albicans isolates. 50% of C. albicans isolates exhibited a white phenotype. A high level of phospholipase (47.4%), hemolysin (68.4%), and proteinase activity (36.8%) was observed in the C. albicans isolates. Only three C. glabrata isolates displayed non‐wild type susceptibility to voriconazole and itraconazole. Conclusion This study shows that C. albicans are still the most frequent isolates from patients with esophageal candidiasis. The predominance of genotype A, the white phenotype, and strong hemolysin activity may indicate a high prevalence of pathogenicity in these isolates. Sensitivity to antifungal drugs was greatest for amphotericin and fluconazole.

Molecular Identification and Antifungal Susceptibility Patterns of Candida Species Isolated from Candidemia Patients in Yasuj, Southwestern Iran

“…However, the incidence of candidemia in published reports from the US and Europe was lower than in our study (19,20). Amphotericin B is one of the main antifungal drugs with broad-spectrum uses in systemic mycosis (22). However, 40.7% of our patients were not treated with antifungal drugs.…”

ABC typing and extracellular enzyme production of Candida albicans isolated from Candida vulvovaginitis

“…Also, Jafarian et al reported that genotype C was the predominant genotype among oropharyngeal C . albicans isolates followed by B and A, 20 whereas genotype A was accounted as the major genotype among urinary C . albicans isolates in the Gharaghani et al report.…”

Nausea and vomiting caused by candida esophagitis in an elderly frail patient

“…Most patients with esophageal candidiasis have coexisting oral candidiasis, 6 but the absence of the latter does not exclude the diagnosis as illustrated by this patient. Candida esophagitis usually responds well to antifungal therapy 8 . Amphotericin syrup was effective in this patient, but alternative medication could include fluconazole, itraconazole, voriconazole, and caspofungin 8,9 .…”

“… 8 Amphotericin syrup was effective in this patient, but alternative medication could include fluconazole, itraconazole, voriconazole, and caspofungin. 8 , 9 Some of these drugs have significant side effects including drug interactions. This case suggests that nausea and vomiting are caused by candida esophagitis in an elderly frail patient and that antifungal drugs could improve these symptoms and the quality of life of the patient.…”

“…Candida esophagitis usually responds well to antifungal therapy 8 . Amphotericin syrup was effective in this patient, but alternative medication could include fluconazole, itraconazole, voriconazole, and caspofungin 8,9 . Some of these drugs have significant side effects including drug interactions.…”