Abstract
Oropharyngeal candidiasis is the most common fungal infection in hospitalized patients with acquired immune deficiency syndrome (AIDS). Its progression results in invasive infections, which are a significant cause of morbidity and mortality. This study aimed to quickly and accurately identify Candida spp. from oral mucosa of AIDS patients recruited at Presidente Vargas Hospital, in São Luís city, Brazil and to evaluate the sensitivity profile of these fungi to antifungals by using an automated system. Isolates were collected from oropharyngeal mucosa of 52 hospitalized AIDS patients, under anti-viral and antifungal therapies. Patients were included in research if they were HIV-positive, above 18 years of age and after obtaining their written consent. CHROMagar®Candida and the automated ViteK-2®system were used to isolate and identify Candida spp., respectively. Antifungal susceptibility testing was performed using the ViteK-2®system, complemented with the Etest®, using the drugs amphotericin B, fluconazole, flucytosine, and voriconazole. Oropharyngeal candidiasis had a high prevalence in these hospitalized AIDS patients (83%), and the most prevalent species was Candida albicans (56%). Antifungal susceptibility test showed that 64.7% of the Candida spp. were susceptible, 11.8% were dose-dependent sensitive, and 23.5% were resistant. All the Candida krusei and Candida famata isolates and two of Candida glabrata were resistant to fluconazole. Most of AIDS patients presented oropharyngeal candidiasis and C. albicans was the most frequently isolated species. The results showed high variability in resistance among isolated species and indicates the need to identify the Candida spp. involved in the infection and the need to test antifungal susceptibility as a guide in drug therapy in patients hospitalized with AIDS. This is the first relate about AIDS patients monitoring in a public hospital in São Luís concerning the precise identification and establishing of antifungal profile of Candida spp..
Highlights
In recent decades, the increasing incidence of fungal infections has been linked to patients with congenital or acquired immunodeficiency (Ortega et al, 2010; Junqueira et al, 2012; Li et al, 2013)
From 52 acquired immune deficiency syndrome (AIDS) patients participating in the study, 43 were positive for Candida
Using the automated Vitek-2 R Compact bioMérieux system, 51 isolates were identified as Candida spp., including 29 C. albicans (56%), 6 C. tropicalis (12%), 6 C. krusei (12%), 4 C. glabrata (8%), 2 C. famata (4%), 2 C. parapsilosis (4%), and 2 C. guilliermondii (4%) (Table 1)
Summary
The increasing incidence of fungal infections has been linked to patients with congenital or acquired immunodeficiency (Ortega et al, 2010; Junqueira et al, 2012; Li et al, 2013). Candida albicans is the most frequently isolated species in humans (Delgado et al, 2009; Hise et al, 2009; Junqueira et al, 2012; Li et al, 2013). There has been a significant increase in the prevalence of infections caused by species of Candida other than C. albicans such as C. krusei, C. tropicalis, C. glabrata, C. guilliermondii, and C. parapsilosis (Sant’Ana et al, 2002; Li et al, 2013; Kaur et al, 2016). The severity of the disease, associated with debilitating conditions of patients, causes prolonged hospital stays and higher hospital costs, generating a major public health problem (Back-Brito et al, 2009)
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