Prevalence, Antifungal Sucseptibility Patterns and Associated Factors of Candidia species among HIV Positive Individuals with Oropharyngeal Infections attending Mekelle Health Facilities of Tigrai, Northern Ethiopia

Abstract

Background: Oropharyngeal candidiasis (OPC) is the most common opportunistic infection encountered among human immunodeficiency virus infected patients and is considered as an independent predictor of immunodeficiency in patients with Acquired Immunodeficiency Syndrome (AIDS).Though Candida albican is the most frequently isolated species from the oropharyngeal lesions, the change in spectrum of Candida species as causative agent of oropharyngeal candidiasis and increased antifungal drug resistance among HIV infected individuals has made the identification of Candida species and determination of its drug resistance pattern is necessary for the routine patient care. Therefore, the aim of the study was to determine the the prevalence, antifungal susceptibility pattern and associated factors of Candida species among HIV positive individuals having oropharyngeal legions in Mekelle health Facilities of Tigray, Ethiopia Method: A cross-sectional study was conducted among 381 HIV positive individuals with oropharyngeal lesion from September 2017 to May 2018 Socio demographic and clinical data and oral swabs were collected from the study participants. Collected swab samples were transported to Microbiology laboratory, College of Health Sciences, Mekelle Universityand were cultured on to Sabouraud dextrose agar having chloramphenicol. All the isolates were characterized using germ tube and HiCrome Candida agar tests. The antifungal susceptibility patterns of all Candida species were determined using disk diffusion method and data were analyzed using STATA version 13.0. Result: Among the 381 study participants, the overall Candida species were isolated from 228(59.8%). A total of 240 Candidaspecies were isolated, of which C. albican was the most predominant 151(62.9%). Among the non-albican Candida species, the most predominant species were Candida glabrata 47(19.6%) followed by Candida tropicalis 26 (10.8%) and Candida krusei 16 (6.7%), and majority of theisolates were from HAART naïve 127(52.9%) and those on HAART were 113 (47.1%). Age group 40-49 years (p = 0.019), previous history of antifungal drug treatment (p=0.039), CD4 counts < 200 cells/mm3 (p=0.003), HAART naïve (p=0.000), body mass indices <15.9 kg/m2 (p=0.002), WHO clinical stage III (p=0.023) and TB co- infection (0.041) were found significantly associated with Candida species isolation. Of the isolates, 12.9% and 9.2% of were showed resistance to fluconazole and ketoconazole respectively. Least rate of resistance was found to nystatin, 0.8%. Conclusion: Nearly two-third (37.1%) of the Candida species that cause oropharyngeal legion among HIV positive individuals in the study area was non-candidia albicans. The non-candidia albicans groups showed an increasing resistance to fluconazole and ketoconazole, from the azole antifungal group Therefore, early identification of the etiologic agent and antifungal susceptibility testing for HIV positive patients should be done to improve treatment outcome and prevent the emergence of drug resistant.