Clinical and Immunological Insights into Oral Candidiasis

Background:Candida species are a group of coexistent microorganisms in the oral cavity that opportunistically cause disease in vulnerable people, including addicts. This study is aimed at identifying and determining the frequency of Candida species in the oral cavity of the addicts to inform the epidemiological panel and to warn to prevent the resistance of the species.Materials and Methods:In this study, sampling was done from the oral cavity of 83 addicts who referred to Addiction Treatment Centers in Isfahan, Iran, using moist sterile swab. The presence of yeast on the direct microscope slides of 58 samples was confirmed. To carry out culture and the primary identification, Sabouraud dextrose agar medium with chloramphenicol as well as HiCrome Candida agar medium was used. Isolates were identified by polymerase chain reaction (PCR) restriction fragment length polymorphism (using specific primers ITS1-ITS4 and MSP I enzyme) and Duplex PCR test (using specific primers CDU1-CDU2/CAL1-CAL2).Results:Out of 93 Candida isolates which had been isolated from 58 culture-positive samples of the oral cavity, Candida albicans (41.93%) were the most prevalent species, followed by Candida dubliniensis (24.73%), Candida glabrata (21.50%), Candida kefyr (8.60%), Candida tropicalis (2.15%), and Candida parapsilosis (1.07%), respectively. In 33 cases (56.90%), the presence of more than one Candida species was observed.Conclusion:Compared to the studies conducted on the oral cavity of healthy controls, smoking certain drugs can have a significant effect on the presence and frequency of Candida species, particularly C. dubliniensis and C. glabrata.

Oral thrush is commonly associated with HIV infection. The causative agent is a yeast strain that is originally a commensal of the oral cavity. Most species of the genus Candida that causes oral candidasis in HIV patients if not properly identified and treated with the drug of choice could result in resistant to the drugs and make treatment very difficult. This study was carried out to establsish the species spectrum of the common yeast(Candida albicans) associated with oral candidiasis in HIV patients on antiretroviral treatment in Abakaliki. A total of 240 samples were collected from HIV sero-positive males(64) and females(176) at the two hospitals. 40 control samples from HIV sero-negative persons were also collected. The samples were cultured on Sabouraud dextrose agar and Candida species were isolated and characterized using germ tube test and sugar fermentation tests. Out of the 240 subjects(HIV sero-positive patients) examined for oral candidiasis, the carriage rate of oral candidiasis were 12.5%(30/240). Candida albicans accounted for 80.00% in HIV sero-postive patients, followed by Candida pseudotropicalis(10.0%). More women, 21(8.75) had oral candidiasis than men 9(3.75%). HIV patients whether or not on drugs were predisposed to oral candidiasis. C. albicans(76.19%) is the commonest species associated with HIV infected patients on ART(Active Retroviral Therapy) followed by Candida pseudotropicalis(14.29%), Candida tropicalis(4.76%) and Candida parapsilosis(4.76%). Among the patients not on ART Candida albicans(88.89%) was most prevalent, followed by Candida guilliermondii(11.11%). C. albicans still remains the leading cause of oropharyngeal candidiasis in HIV infected persons within the study population. Constant identification of isolates of yeasts infecting HIV infected persons and the immune compromised will further enhance the appropriate treatment and minimize the spread emergence of antifungal resistance.

Background: The importance of epidemiological monitoring of yeasts involved in pathogenic processes is unquestionable due to the increase in trend of infections caused by various species of Candida over the last decade; so are the changes observed in species causing Candidiasis and empirical antifungal treatment.
 Aims and Objective: To speciate the clinically isolated Candida species by phenotypic methods and to estimate the antifungal susceptibility of the isolated species against fluconazole, ketoconazole, voriconazole, itraconazole by disc diffusion method.
 Materials and Methods: A cross-sectional study conducted in 2018 in the Department of Microbiology, J. N. Medical College, KAHER, Belagavi Karnataka. Ethical Clarence was obtained from institutional ethical committee J.N. Medical College.
 Results: Out of 59 Candida isolates, Candida tropicalis was the predominant species 41(69.49%), followed by Candida glabrata 5 (8.47%), Candida parapsilosis and Candida lusitaniae 4 (6.78%) respectively, Candidaguilliermondii and Candida kefyr 2 (3.39%) respectively and the least one was Candida krusei 1 (1.69%). Voriconazole showed the highest level of sensitivity whereas Itraconazole has shown the least sensitivity pattern by disk diffusion method. Out of 59 Candida species, 52 (88.13%) were sensitive to Voriconazole, 44 (74.57%) were sensitive to Fluconazole, 40 (67.79%) were sensitive to Ketoconazole and the least sensitivity was shown by Itraconazole 30 (50.84%). Candida krusei and Candida guilliermondii showed 100% sensitive to Fluconazole, Voriconazole, Ketoconazole and Itraconazole respectively.
 Conclusion: Non-albicans Candida species are being common isolates from cases of candidiasis. Candida tropicalis is the predominant isolate, followed by Candida glabrata, Candida lusitaniae, Candida parapsilosis, Candida guilliermondii, Candida kefyr and Candida krusei. Most of the isolates were sensitive to Voriconazole.

IntroductionOral candidiasis is one of the most common opportunistic infection in HIV/AIDS patient and it is caused by Candida species. The low absolute CD4+T-lymphocyte count has traditionally been cited as the greatest risk factor for the development of Oral Candidiasis. The aim of this study was to identify Candida species isolated from the oral cavity of HIV/AIDS patients, to determine their in vitro antifungal susceptibility and to investigate the possible risk factors associated with oral candidiasis.MethodsThis was a hospital based cross sectional study that was carried out for a period of 3 months amongst HIV/AIDS patients in Kumba District Hospital, whether on HAART or not. Mouth swabs were collected from 378 participants using sterile cotton wool swabs and 5ml venous blood were collected for determination of CD4 cell. Candida species were isolated and identified. Antifungal sensitivity testing was performed using modified kirby-bauer susceptibility testing technique.ResultsCandida species were present in 42.86% of the samples and Candida albicans was the most prevalent (60.2%) amongst the six Candida isolates identified, followed by Candida glabrata (16.9%), Candida krusei (12.3%), Candida tropicalis (6.4%), Candida parapsilosis (2.3%) and Candida pseudotropicalis (1.8%). Pregnancy, oral hygiene and antibiotic usage were significantly associated with oral candidiasis in HIV/AIDS patients (P<0.05). Oral candidiasis was mostly frequent in HIV/AIDS patients between 21-40 years. A CD4 cell count less than 200 cells/μl was a significant risk factor for acquiring oral candidiasis in HIV/AIDS patients (P<0.001). Nystatin was the most sensitive drug (83.6%) meanwhile ketonazole was the most resistant drug (29.2%), followed by fluconazole (24.6%) to all oral Candida isolates.ConclusionOral Candida colonization occurs more frequently in HIV/AIDS patients and the is a need for the government to implement regular checks for opportunistic infections in HIV/AIDS patients, including oral candidiasis in HIV/AIDS patients to monitor disease progression and prevent subsequent complications such as candidemia and diarrhea.

Introduction: Oral candidiasis is the most common opportunistic infection of the oral cancer patients. Identification of Candida isolates and its susceptibility to antifungal agents will be helpful in the therapeutic management. Aim and Objective: To study the Genetic relatedness and antifungal susceptibility pattern of Candida isolates recovered from the oral cancer patients. Material and Methods: The present study was conducted in the Department of Microbiology at Santosh Medical College, Ghaziabad, U.P. &amp; VarunArjun Medical College &amp; Rohilkhand Hospital, Shahjahanpur, Uttar Pradesh. A total of 377 oropharyngeal cancer patients were selected for the study. The study was conducted from 2019 to 2021. Oropharyngeal swab was cultured by semi-quantitative method on Sabouraud dextrose agar (SDA) and Hi-Chrome agar and followed by identification and Antifungal susceptibility test. The Molecular characterization of Candida albicans and non albicans Candida isolates was performed by DNA extraction and PCR. Results: Out of the 377 oropharyngeal cancer cases, 292 (78.8%) were males and 85 (21.2%) females. The male: female ratio was 3.4:1. Of the 377 oral cancer cases, 152 (40.3%) cases were culture positive for Candida species. 191 isolates were recovered from oral cavity of the cancer patients with oral candidiasis. Isolates included Candida albicans (n = 42, 22.0%), Candida tropicalis (n = 36, 18.8%), Candida parapsilosis (n = 34, 17.9%), Candida dubliniensis (n= 30, 15.7%), Candida krusei (n= 30, 15.7%), Candida glabrata (n = 19, 9. 9%). 142 (74.3%) isolates were susceptible to miconazole followed by Ketoconazole 112 (58.6%), and of and Itraconazole 111 (58.1 %). Conclusion: The decreased effectiveness of antifungal drugs is a serious issue, especially in cancer patients. Hence, addition to emphasis on topical use of Miconazole application in the first stage of oral candidiasis in patients, using alternative systemic drugs such as Ketoconazole and Itraconazole may prove fruitful.

Many ascomycete yeast species from the Candida genus are widely distributed in nature and act as common saprophytic constituents of the normal human microflora. However, some of these fungal species can also become opportunistic pathogens following a transition from a commensal to a pathogenic phase, induced by alterations in the host environment. Candida species thereby rarely trigger infection in healthy people, but take advantage of a locally or systematically impaired immune system to proliferate in the host and cause diseases termed ‘‘candidiasis.’’ Such fungal infections can be subdivided into three major groups: cutaneous (skin and its appendages), mucosal (oropharyngeal, esophageal, and vulvovaginal) and systemic (bloodstream infections, i.e., candidemia and other forms of invasive candidiasis [IC]). While superficial candidiasis (cutaneous and mucosal) is often observed in AIDS patients, oropharyngeal thrush and vaginitis are more frequently seen in immunocompetent infants and adult women, respectively. Candidemia and IC are common in cancer patients or in transplant individuals following immunosuppression. Candidiasis currently represents the fourth leading cause of nosocomial infections, at 8% to 10%, and mortality due to systemic candidiasis remains high, ranging from 15% to 35% depending on the infecting Candida species [1]. Although Candida albicans remains the most frequently isolated agent of candidiasis, non-albicans Candida (NAC) species now account for a substantial part of clinical isolates collected worldwide in hospitals. NAC species of particular clinical importance include Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei (synonym: Issatchenkia orientalis), as well as the less-prominent species Candida guilliermondii, Candida lusitaniae, Candida kefyr, Candida famata (synonym: Debaryomyces hansenii), Candida inconspicua, Candida rugosa, Candida dubliniensis, and Candida norvegensis (Table 1). A complementary set of about 20 opportunistic NAC species is also known, but exhibits lower isolation rates [2].

BackgroundOpportunistic infections due to Candida species occur frequently in cancer patients because of their inherent immunosuppression. The aim of the present study was to investigate the epidemiology of yeast species from the oral cavity of patients during treatment for oncological and haematological malignancies.MethodsMALDI-TOF was performed to identify yeasts isolated from the oral cavity of 350 cancer patients. Moreover, antifungal susceptibility testing was performed in according to CLSI guidelines (M27-A3).ResultsAmong 162 yeasts and yeast-like fungi isolated from the oral cavity of cancer patients, Candida albicans was the most common species (50.6%), followed by Candida glabrata (24.7%), Pichia kudriavzevii (Candida krusei (9.9%)), Candida tropicalis (4.3%), Candida dubliniensis (3.7%), Kluyveromyces marxianus (Candida kefyr (3.7%)) and Candida parapsilosis (1%). In addition, uncommon yeast species i.e., Saprochaete capitata, Saccharomyces cerevisiae, Clavispora lusitaniae (C. lusitaniae) and Pichia kluyveri (C. eremophila) were recovered from oral lesions. Oral colonization by C. albicans, non-albicans Candida species and uncommon yeasts were as follow; 55%, 44% and 1%, whereas oral infection due to C. albicans was 33.3%, non-albicans Candida species 60.6%, and uncommon yeasts 6.1%. Poor oral hygiene and xerostomia were identified as independent risk factors associated with oral yeast colonization. The overall resistance to fluconazole was 11.7% (19/162). Low MIC values were observed for anidulafungin for all Candida and uncommon yeast species.ConclusionsThis current study provides insight into the prevalence and susceptibility profiles of Candida species, including emerging Candida species and uncommon yeasts, isolated from the oral cavity of Iranian cancer patients. The incidence of oral candidiasis was higher amongst patients with hematological malignancies. The majority of oral infections were caused by non-albicans Candida species which were often more resistant to anti-fungal agents. Our findings suggest that anidulafungin should be used as antifungal of choice for prophylaxis in clinically high-risk patients with documented oral colonization or infection.

Candidal vulvovaginitis causes extreme discomfort and affects the well being of women. The aim of this study was to determine the prevalence of Candida infections among women attending gynaecological clinic at the Komfo Anokye Teaching Hospital (KATH) in Kumasi and the antifungal susceptibility patterns of the Candida species isolated. A total of 186 high vaginal swabs (HVS) were collected from women suspected of having candidal vulvovaginitis between March and June 2009. Wet mount preparations in potassium hydroxide (KOH) and Gram-stained smears were performed directly on specimens. Cultures for Candida species were done using sabouraud dextrose agar (SDA) (Oxoid, UK) at room temperature (25 - 28&#186;C). Antifungal susceptibility of the Candida species to amphotericin B, fluconazole and itraconazole was assessed using the ATB FUNGUS 3 test kits (bioMerieux, Marcy-l&#8217;Etoile, France). Of the 186 HVS cultured, 39 yielded Candida species giving Candida prevalence in HVS during the study period as 21%. Candida species isolated from HVS specimens were Candida albicans (n=19, 48.7%), Candida glabrata (n=7, 17.9%), Candida tropicalis (n=4, 10.3%) and Candida dubliniensis (n=4, 10.3%). Other species isolated were Candida sake (n=2, 5.1%), Candida krusei (n=2, 5.1%) and Candida parapsilosis (n=1, 2.6%). Susceptibility of the isolates to antifungal agents ranged from 66.7% to 87.2% with MICs ranging from &#8804; 0.125mg/l to 8mg/l. Amphotericin B was the best performing antifungal agents with sensitivity of 87.2%.

Background:Candida species are opportunistic pathogens that can cause local or systemic invasive infections in patients hospitalized in intensive care units (ICUs). The present study aimed to rapidly and precisely identify Candida species, especially Candida auris, from patients hospitalized in high-risk units using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique.Materials and Methods:In this study, 136 clinical samples were prospectively collected from different organs of patients hospitalized in high-risk units recruited from three tertiary care training hospitals in Isfahan. Direct microscopic analysis using potassium hydroxide 10% followed by culturing on Sabouraud dextrose agar and CHROMagar culture media was primarily used to screen Candida species. Molecular detection of clinical isolates was mainly done using the PCR-RFLP method. Then, all the isolates were subjected to confirmatory diagnosis again through amplification of the C. auris-specific PCR.Results:Candida albicans was the most prevalent isolate (48.8%), followed by Candida glabrata (17.6%), Candida tropicalis (16.1%), Candida parapsilosis (6.6%), Candida krusei (5.8%), Candida famata (4.4%), Candida kefyr (2.9%), and Candida guilliermondii (1.4%). Therefore, the prevalence of non-albicans Candida species was higher than C. albicans isolates. No C. auris isolates were identified among 136 patients. However, according to the positive control, C. auris had no restriction enzyme cleavage site for MspI, and its PCR and digestion products were the same size (401 bp).Conclusions:The simple and reliable PCR-RFLP assay used in the study has the potential to identify rare yeasts such as C. auris. It can reduce turnaround times and costs if applied in developing countries.

Introduction: The threat of Invasive fungal infections has been increasing in the contemporary health care scenarios, with candidal infections being the most common. Candidal bloodstream infections (BSIs) account for one?fourth of the nosocomial BSIs. Candida albicans once the most common has now been replaced by nonalbicans Candida (NAC), accounting for majority of cases of candidal infections. The knowledge and understanding of specific risk factors, epidemiology, prophylactic measures, and outcomes with relation to speciation are changing rapidly. Emergence of antifungal resistance is a cause of concern. With this background, a retrospective study was undertaken. Aims and Objectives: To isolate Candida spp. from blood cultures of patients with clinically diagnosed or suspected septicemia; to determine incidence of candidemia; to identify and speciate Candida isolates and carry out the antifungal susceptibility test. Materials and Methods: This retrospective study was conducted at the Department of Microbiology, CMC and Hospital, Ludhiana from January 2014 to December 2020. Blood cultures received during this period by BACTEC automated culture system; Becton Dickinson were included in the study. The positive blood culture bottles were cultured on Sabouraud dextrose agar. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline (CLSI). Results: A total of 396 out of 52, 066 blood cultures were culture positive for Candida species. Therefore the overall prevalence rate of isolation of Candida species was 0.76% in our study. The incidence of blood stream infection caused by Non albicans Candida species (72.98%) was higher than Candida albicans (27.02%). Among NAC spp. Candida tropicalis (28.28%) was the most common, followed by Candida parapsilosis (18.94%), Candida glabrata (11.87%), Candida krusei (9.09%), and Candida gullermondii (4.30%) and Candida dubliniensis (0.5%). Candida spp. demonstrated higher resistance to azole group of antifungal agents, as compared to amphotericin B. Resistance was significantly higher among NAC spp. , Itraconazole, Clotrimazole, Fluconazole, Ketoconazole and Amphotericin B- 46.37%, 42.21% 39.10%, 34.60%, and 4.15%, respectively. Conclusion: Species-level identification of Candida and their antifungal sensitivity testing should to be performed to achieve better clinical result and to select an appropriate and effective antifungal therapy. High resistance to antifungal agents is an alarming sign to the healthcare professionals.

Candida species is observed as the most common cause of 'Opportunistic Mycoses' worldwide. Candida species is a member of normal flora of skin, mouth, vagina, and stool. Infections caused by Candida species are in general referred to as Candidiasis. Vaginal Candidiasis is a fungal or yeast infection of the vulva and/or vagina, which causes a smelly, thick, white-yellow discharge, which might be accompanied by itching, burning and swelling. It can also can make walking, urinating or sex very painful. The Genus Candida includes around 154 species. While Candida albicans is the most abundant and significant species; importantly, there has been a recent increase in infections due to non-albicans Candida species along with increasing drug resistance. The present study includes isolation of Candida species from the patients suffering from vaginal candidiasis followed by identification and differentiation between different Candida species by their morphological studies, microbiological analysis and biochemical activities, which are: C. albicans, C. tropicalis, C. glabrata & C. krusei. The present study also includes a comparative study of anti-microbial activities of commercially available anti-fungal drugs as well as 22 novel chemically synthesized 1% DMSO soluble compounds (belonging to Azoles) by “Disc Diffusion Method” according to NCCLS Guidelines. Out of which 5 compounds were found to be remarkably effective, especially AntiC-15 was found to be the most potent and excellent among all; which exhibits its inhibitory effects against some drug resistant isolates also. It is sent for further study in order to use it at commercial level. INTRODUCTION Candida species is yeast and the most common cause of opportunistic mycoses worldwide. It is also a frequent colonizer of human skin and mucous membranes. Candida species is a member of normal flora of skin, mouth, vagina, and stool. Infections caused by Candida species are in general referred to as Candidiasis. The clinical spectrum of Candidiasis is extremely diverse. Almost any organ or system in the body can be affected. Candidiasis may be superficial and local or deep-seated and disseminated. Candidiasis is mostly an endogenous infection, arising from overgrowth of the fungus inhabiting in the normal flora. However, it may occasionally be acquired from exogenous sources such as catheters or prosthetic devices or by personto-person transmission such as Oral Candidiasis in neonates of mothers with Vaginal Candidiasis or Endophthalmitis following corneal transplantation from an infected donor. Vaginal Candidiasis is a fungal or yeast infection of the vulva and/or vagina. It causes a smelly, thick, white-yellow discharge that might be accompanied by itching, burning and swelling. It can also can make walking, urinating or sex very painful. The Genus Candida includes around 154 species. Among these, very few are most frequently isolated in human infections. While Candida albicans is the most pathogenic and most commonly encountered species among all due to its ability to adhere to host tissues, produce aspartyl Effects of chemically synthesized Azole compounds on Clinical isolates of Vaginal Candidiasis, in comparison with commercially available anti-fungal drugs 2 of 6 proteases & phospholipase enzymes and transformation from yeast to hyphal phase, which are the major determinants of its pathogenicity. Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei and Candida lusitaniae are also isolated as causative agents of Candidiasis. Importantly, there has been a recent increase in infections due to non-albicans Candida species along with increasing drug resistance. For the same, the present study also includes a comparative study of anti-microbial activities of commercially available anti-fungal drugs as well as 22 newer chemically synthesized 1% DMSO soluble compounds (belonging to Azoles). MATERIAL & METHODS STUDY GROUP The study group includes different patients suffering from Vaginal Candidiasis with varying degree of severity. SPECIMEN COLLECTION: Vaginal Swab

Background: New chemotherapeutics are urgently required to treat Candida infections caused by drug-resistant strains. Methods: The effects of 16 1,10-phenanthroline (phen)/1,10-phenanthroline-5,6-dione/dicarboxylate complexed with Mn(II), Cu(II) and Ag(I) were evaluated against ten different Candida species. Results: Proliferation of Candida albicans, Candida dubliniensis, Candida famata, Candida glabrata, Candida guilliermondii, Candida kefyr, Candida krusei, Candida lusitaniae, Candida parapsilosis and Candida tropicalis was inhibited by three of six Cu(II) (MICs 1.52-21.55μM), three of three Ag(I) (MICs 0.11-12.74μM) and seven of seven Mn(II) (MICs 0.40-38.06μM) complexes. Among these [Mn2(oda)(phen)4(H2O)2][Mn2(oda)(phen)4(oda)2].4H2O, where oda=octanedioic acid, exhibited effective growth inhibition (MICs 0.4-3.25μM), favorable activity indexes, low toxicity against Vero cells and good/excellent selectivity indexes (46.88-375). Conclusion: [Mn2(oda)(phen)4(H2O)2][Mn2(oda)(phen)4(oda)2].4H2O represents a promising chemotherapeutic option for emerging, medically relevant and drug-resistant Candida species.

Candida albicans is the species most frequently isolated from oral specimens, but the recovery of other Candida species such as Candida dubliniensis is increasing. Differentiation of C. dubliniensis from C. albicans requires special tests and both species are misidentified in some studies. CHROM-Pal (CH-P) is a novel chromogenic medium used in our laboratory for differentiation between C. albicans and C. dubliniensis on the basis of colony colour and morphology, and chlamydospore production. The performance of CH-P and CHROMagar Candida (CAC) was compared for primary isolation and presumptive identification of yeasts from oral specimens from human immunodeficiency virus (HIV)-infected and uninfected individuals. The identification of Candida species on both media was compared with two reference identification methods (API ID 32 C and multiplex PCR). A total of 137/205 oral swabs (66.8 %) plated onto CH-P and CAC media were positive by culture and resulted in the growth of 171 isolates of Candida species on CH-P, whilst only 159 isolates grew on CAC. C. albicans was the most frequently isolated species in both groups of patients, followed by Candida parapsilosis in the HIV-negative group, and by C. dubliniensis in the HIV-infected group. The other Candida species isolated were Candida guilliermondii, Candida glabrata, Candida krusei, Candida tropicalis, Candida famata, Candida rugosa, Candida kefyr, Candida pelliculosa and Candida pulcherrima. The sensitivity and specificity for identifying C. albicans, C. krusei, C. tropicalis and C. dubliniensis on CH-P were over 98.5 %, always equal to or higher than those obtained when CAC was used. CH-P is a simple reliable medium for primary isolation and presumptive identification of yeast isolates from oral samples. The ability of CH-P to discriminate between C. dubliniensis and C. albicans was significantly higher (P <0.05) than that of CAC.

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to > or = 60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologic cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 microg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 microg/ml) and for the C. krusei isolates (MIC > 32 microg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 microg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologic surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles.

Candida is normal flora of human skin, mouth, vagina, colon and causes mycosis worldwide. Candida causes oral thrush, vaginitis and other potentially life-threatening diseases. This study assesses anticandidal potential of essential oils against Candida species isolated from clinical samples obtained from Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra. On the basis of morphological characterization on Sabouraud dextrose agar, CHROMagar, Germ tube test and biochemical characterization, Candida species identified as Candida albicans, Candida krusei, Candida glabrata, Candida parapsilosis. Clove, thyme, cinnamon and eucalyptus essential oils with concentrations of 6.2, 12.5, 25, 50 and 100 μg/ml were used to study their anticandidal activity. C. albicans demonstrated zone of inhibition (ZOI) 29, 20, 32, 29 mm, Candida krusei 25, 25, 30, 21 mm, Candida glabrata 24, 22, 31, 32mm,Candida parapsilosis 33,31,33, 29mm towards clove, thyme, cinnamon and eucalyptus oil (each at 100 μg/ml) respectively which are highest ZOI as compared with antifungal agent Amphotericin-B, which showed 16, 13, 12, 8 mm against C. albicans, C. krusei, C.glabrata and C. parapsilosis respectively. All Candida spp. produced biofilms and enzyme lipase. This study will facilitate the development of novel broad-spectrum key molecules against a range of Candida species.