English

Abstract

INTRODUCTION : Infections caused by the yeasts of the genus candida are common in clinical practice. They may involve the mucous membranes and / or skin or spread internally to produce systemic infections. Superficial infections of the mucous membranes and skin are numerically most important but more serious involvement of the internal organs as in septicemia, endocarditis, meningitis, can also occur. Candida albicans is an oval yeast 2-6 x 3-9 μm in size, which can produce budding cells, pseudohyphae and true hyphae. The ability to simultaneously display several morphological forms is known as polymorphism. Although hyphae are likely to be produced during the process of tissue invasion, yeasts without hyphae may also occur in invasive disease, particularly in infections caused by non-albicans candida species. AIM AND OBJECTIVE OF THE STUDY : The term immunocompromised host is used to define a patient with impaired host defences who is at the risk of developing an opportunistic infection. This includes patients with immunodeficiency because of the disease perse such as patients with ‘Acquired Immune Deficiency Syndrome’ (AIDS) or induced iatrogenically as a result of chemotherapy. Susceptibility to infection is increased when normal host defence mechanisms are compromised by underlying disease states, therapeutic interventions or iatrogenic manipulations. Frequently all the three factors play a role in creating an immunocompromised state, in which infection is likely. Candida species are the most common cause of systemic fungal infections in the immunocompromised patients (Hawkins, 1984). This study has been designed, 1. To isolate, culture and subculture thereby identify the subspecies of candida from the mucosal lesions of immunocompromised individuals. 2. To study the age and sex distribution of immunosuppressed patients suffering from candidiasis. 3. To study the morphological pattern of lesions in the background of immunosuppression. 4. To identify the subspecies of candida causing various types of lesions in immunosuppressed patients. 5. To study the dose and duration of the immunosuppressive therapy that predisposed to candidasis. CONCLUSIONS : * Candidiasis is the commonest mycosis in patients on systemic immunosuppressive therapy and immunosuppressive status like HIV infection. * Majority of the affected victims of candidiasis, were in the age group between 31-50 years. Incidence of candidiasis was found to be more in male patients than female patients. (Males → 62%). (Females → 38%). However the age and sex distribution is also related to the patients screened. * Acute pseudomembranous glossitis was the commonest morphological type of the lesion encountered in this study (35%), to be followed by, chronic erythematous candidiasis (22%), Angular cheilitis (21%), acute erythematous glossitis (19%), balanoposthitis (2%) & Median rhomboid glossitis (1%). * Among the various immunosuppressive drugs taken into account for this study, Tab.Prednisolone was the commonest drug predisposing to candidiasis (28%) followed by Inj. Dexamethasone (22%). Thus systemic steroids accounted for 50% of drugs predisposing to candidosis, remaining 50% being contributed by cytotoxic drugs like methotrexate, cyclophosphamide, azathioprine etc; * Of all the various bullous dermatoses screened, pemphigus vulgaris was the commonest bullous disorder predisposing to candidosis (40%) followed by bullous pemphigoid (16.6%), Pemphigus foliaceus (8.3%), Dermatitis Herpetiformis (1.6%) and Pemphigus vegetans (5%). * Candida albicans was the commonest species isolated (52%). Other species isolated include, Candida tropicalis (22%), Candida glabrata (21%), Candida krusei (3%) and Candida dubliniensis (2%). * Patients with O+ve Blood group are considered to have high carriage of candidia species. * Even in HIV infected individuals, candida albicans was the commonest species isolated, in our study; candida dubliniensis is said to be exclusively common in the oral lesions of HIV patients, which however accounted only for (2%) in our study. Probably the sample size had still been larger. * The minimum time duration of systemic immunosuppressive therapy required for predisposition to oral candidosis was found to be 10 (Ten) days in our study in Non-HIV infected individuals, which was found to be still shorter in known cases of HIV infection (around 1 week); probably due to CD4 cell count depletion, and other associated opportunistic infections. * Inspite of heroic measures to avoid contaminants, and adhering to very strict aseptic protocols, it was found in our study that the maximum keeping time of primary candida culture in SDA with chloramphenicol and subcultures in Himedia CHROMagar was just 72 hours, after which saprophytic bacteria and various moulds and concomitant pathogens spoil the culture media.