A study on speciation and antifungal susceptibility pattern of Candida isolates from HIV patients with oropharyngeal candidiasis and correlation with CD4 count

Abstract

INTRODUCTION : Infection with Human Immunodeficiency Virus (HIV) and its end stage Acquired Immunodeficiency Syndrome (AIDS) is the major public challenge of Modern times, with over 25 million persons already dead and over 30 million Living with HIV / AIDS, the majority of whom are without access to therapy. Opportunistic infection continue to cause morbidity and mortality in Patients with human immunodeficiency virus infection throughout the world. Although the incidences of opportunistic infections have been reduced Around the globe by Highly Active Anti Retroviral Therapy (HAART), the situation remains the same in most developing countries including India. This is due to the fact that some patients do not have access to the treatment and others do not have sustained response to antiretroviral drugs for multiple reasons including poor adherence, drug toxicities, drug interactions or initial acquisition of a drug resistant strains. Oropharyngeal candidiasis is the most common opportunistic infection Observed in AIDS patients, occurring in an estimated 80 to 95% of these patients when the CD4 T lymphocyte counts are below 200 cells /mm3. Increased retroviral replication and an associated decline in immune defences render these patients more susceptible to oropharyngeal candidiasis. Considering the above the facts, the present study was conducted to determine the species distribution and antifungal susceptibility profiles of the Candida isolates from HIV patients with Oropharyngeal Candidiasis. AIMS AND OBJECTIVES : 1. To isolate Candida species from HIV patients with oropharyngeal Candidiasis. 2. To speciate the Candida isolates. 3. To determine the antifungal susceptibility pattern of the isolates by disk diffusion and microbroth dilution method. 4. To find out the correlation of various Candida isolates and their antifungal susceptibility pattern to the CD4 count of the patients. MATERIALS AND METHODS : Statistical analysis were carried out using statistical package for Social sciences and Epi- software by statistician .The proportional data of this cross sectional study were tested using Pearson’s Chi Square Analysis test and Binomial Proportion test. Study group includes 150 HIV positive patients presenting with clinical picture of oral candidiasis. Inclusion Criteria: 1. HIV positive patients: Seropositivity status of the patients were determined as per NACO guidelines. 2. Patients with clinical picture of candidiasis on the oral /pharyngeal mucosa. 3. Patients above 18 years of age group. 4. Both Males and Female were included in the study. 5. Not on any antifungals or corticosteroids 30 days prior to the study. Patients were included in the study only after getting informed written consent. All patients satisfying the inclusion criteria were only once documented and were assigned serial numbers. Patients were interviewed by structured questionnaire and their hospital records were used to know about the previous episodes of Oropharyngeal Candidiasis, use of any antifungal agents and past medical conditions.Oropharyngeal specimens were collected by firmly swabbing the lesion site with two steile cotton swabs under strict aseptic precautions. Samples were transported immediately to the laboratory and subjected to various mycological tests. Blood was collected in EDTA vacutainer tubes from each patients for enumeration of their CD4 count using BD FACS Counter. CONCLUSION : In conclusion, Candida albicans is the most frequently isolated species from HIV seropositive patients with primary as well as recurrent Candidiasis. Non- albicans Candida species are emerging as important pathogens with increasing rates of azole resistance and with increased immunosuppression. Since oral candidiasis may be considered as indirect marker of immunosuppression in HIV patients, regular oral check up of these patients could be an indicator of immunosuppression. Further the increasing rates of resistance particularly among the non- albicans Candida spp. emphasizes the need for speciation and determination of antifungal susceptibility pattern of the oral candida isolates from HIV patients with oropharyngeal candidiasis.