Molecular identification and antifungal susceptibility pattern of Candida species isolated from HIV infected Patients with candisiasis

Abstract

Background and Purpose: Opportunistic fungal infections have been on a growingtrend since the last two decades. Among the opportunistic fungal agents, Candidaspecies, Cryptococcus neoformans, and Aspergillus fumigatus account for most of thelife-threatening infections in immunocompromised individuals. Regarding this, thepresent study aimed to investigate the molecular identification and antifungalsusceptibility pattern of Candida species isolated from HIV-infected patients.Materials and Methods: This study was conducted on 80 clinical samples collectedfrom HIV-infected patients with suspected candidiasis referring to Tagore MedicalCollege and Hospital, Rathinamangalam and Government Hospital of ThoracicMedicine, in Chennai, India, for 18 months (i.e., May 2016-December 2017). Phenotypicand molecular identification was accomplished using internal transcribed spacer region 1(ITS1) and ITS4 primers. The antifungal susceptibility pattern of the isolates against fourantifungal agents was also determined by both disk diffusion and broth dilution methods.Results: In the present study, the prevalence of candidiasis was obtained as 75% (n=60).Candida tropicalis was the predominant identified species. All the emerging species(i.e., Kodamaea ohmeri, Hanseniaspora opuntiae, and C. orthopsilosis) were identifiedthrough molecular identification since the phenotypic identification was inconclusive. Interms of the susceptibility pattern, 63.3% and 18.3% of the isolates were resistant tofluconazole and voriconazole, respectively. Candida albicans was also found to beresistant to amphotericin B.Conclusion: Molecular assay led to the identification of K. ohmeri, H. opuntiae, and C.orthopsilosis, which were multidrug-resistant. This study highlighted the need for theprompt and timely identification of clinical yeast isolates given the emergence of manyrare species and their capability of causing life-threatening infections and outbreaks. Inthe laboratories where molecular diagnostic methods are not available, alternativeservices of reference laboratories can be utilized as cost-effective measures. With regardto the growing prevalence of antifungal drug resistance, antifungal susceptibility testingshould be made mandatory for effective patient management.

Factors associated with the isolation of Candida Spp. from the oral microbiota of people living with HIV

“…[37] According to the present research, all isolated Candida species produce phospholipases, with C. albicans having the strongest Pz activity, corroborating the findings of another study that described phospholipae production in 61.42% of C. albicans isolates, in addition the majority were considered as strong producers. [37] Our findings regarding Pz [17,30,39,40] and hemolytic activities [21,39] in PLHIV are consistent with the findings of several previous studies.…”

“…In this process, the formation of white glabrous colonies with creamy aspect and texture and a smooth surface was observed during morphological observation. [17] After growth, Candida species were identified using the CHROMagar Candida Medium microbiological method. With the inclusion of chromogenic substrates, the colonies presented with certain characteristics, that is, Candida albicans, Candida tropicalis, and Candida krusei colonies presented a different coloration.…”

Kodamaea ohmeri infections in humans: A systematic review

“…Among the 35 studies on K ohmeri infections, 30 (85.7%) reported fungemias, accounting for 36 patients out of 44 (81.8%) in total 3,4,7–34 . A concomitant infection was present in 22.2% (8 out of 36 fungemias), namely infective endocarditis (IE) in 11.1% (4 cases), 31–34 skin and soft tissue infection (SSTI) in 5.6% (2 cases), 16,21 disseminated infection with involvement of the spleen, urinary tract and lower respiratory tract in 2.8% (1 case), 8 and lower respiratory tract infection in 2.8% (1 case) 29 .…”

“…membranaefaciens and is frequently mistaken for Candida , as they belong to the same family 1,2 . It has been isolated from environmental sources, such as sand, pools, seawater and fruits, while the last decades it is recognised as a rare pathogen that causes life‐threatening infections in humans 2–4 …”

An alarming rise of non-albicans Candida species and uncommon yeasts in the clinical samples; a combination of various molecular techniques for identification of etiologic agents

“…Increasing of non-albicans Candida species is due to the improved laboratory diagnosis, previous exposure to polyene and azole agents, use of indwelling medical devices, malignancies, growing number of immunocompromised patients, and long-term immunosuppressive and cytotoxic therapy in organ transplant recipients and cancer patients (9,18). It is usually believed that azole agents excess NAC infections, which may be associated with irrelevant treatment of bacterial or cryptococcal infections in AIDS patients (19).…”