Spectrum of Opportunistic Fungal Infections in HIV/AIDS Patients in Tertiary Care Hospital in India

Abstract

HIV related opportunistic fungal infections (OFIs) continue to cause morbidity and mortality in HIV infected patients. The objective for this prospective study is to elucidate the prevalence and spectrum of common OFIs in HIV/AIDS patients in north India. Relevant clinical samples were collected from symptomatic HIV positive patients (n = 280) of all age groups and both sexes and subjected to direct microscopy and fungal culture. Identification as well as speciation of the fungal isolates was done as per the standard recommended methods. CD4+T cell counts were determined by flow cytometry using Fluorescent Activated Cell Sorter Count system. 215 fungal isolates were isolated with the isolation rate of 41.1%. Candida species (86.5%) were the commonest followed by Aspergillus (6.5%), Cryptococcus (3.3%), Penicillium (1.9%), and Alternaria and Rhodotorula spp. (0.9% each). Among Candida species, Candida albicans (75.8%) was the most prevalent species followed by C. tropicalis (9.7%), C. krusei (6.4%), C. glabrata (4.3%), C. parapsilosis (2.7%), and C. kefyr (1.1%). Study demonstrates that the oropharyngeal candidiasis is the commonest among different OFIs and would help to increase the awareness of clinicians in diagnosis and early treatment of these infections helping in the proper management of the patients especially in resource limited countries like ours.

Spectrum of Fungal Isolates in Different Clinical Samples

“…In these areas also, C. albicans is the major isolate followed by C. tropicalis. Similar observations were also made by Kaur et al 4 In our study, it was seen that C. albicans was the most common isolate from total samples followed by C tropicalis among the yeasts which is supported by the findings of others. 2,4,5 Globally, the incidence of C. albicans is in a declining trend and incidence of the non-albicans Candida are on the rise.…”

“…It was observed that all the isolates from endotracheal aspirates are Candida. This finding corroborates with the observation of Kaur R et al and Dorko E et al 4,13 The pus samples collected from superficial wounds, like burn wounds and bed sores, showed mainly the growth of Candida, whereas the sample collected from deep wounds or sinuses mostly showed filamentous fungi belonging to the dematiaceous group. These results are in agreement with the findings of Dowd SE et al 13 Samples from unopened abscess cavities and surgical sites showed no growth of fungi.…”

“…Similar finding is also described by other studies. 3,4 From the genital tract, oropharynx and faeces samples, Candida is the sole isolate as it is a member of the microbial flora of these regions. In these areas also, C. albicans is the major isolate followed by C. tropicalis.…”

“…Indiscriminate use of antibiotics has led to the suppression of the local microflora, which has helped in the growing incidence of fungal infections. 4,5,6 Besides this, fungi pose a difficult situation from the clinicians' point of view because of non-availability of proper laboratory facilities, limited number of antifungals available, their side effects and the long duration of treatment needed to eradicate the infection. As most of these fungi are ubiquitous and freeliving in the environment it is very difficult on the part of the laboratory to prove the cause effect relationship between the fungus and the disease they are attributed to.…”

Spectrum of opportunistic infections with correlation to CD4 counts in newly diagnosed HIV seropositive cases

“…Other fungi isolated from HIV patients were Aspergillus sp, from respiratory tract infections. The prevalence of respiratory infections was 49% in our study with mostly bacterial pathogens (74) and fungal pathogens (20) and Pneumocystis jiroveci pneumonia (PCP) was observed in 6 cases. Most of the studies in India reported PCP among CD4 counts <50cells/µl, in our study the mean CD4 count among these cases was 35.8 (1-154) cells/µl.…”