Abstract

Candida species are opportunistic fungal pathogens which are often isolated from immunocompromised individuals. Candida albicans is the most frequently isolated species in both superficial and invasive candidiasis. Non-albicans species are equally striving in their pathogenic ability, but it is noticed that C. albicans continues to exert its relevance as the leading cause of candidiasis. This is confirmed by this case report finding, from the traditional laboratory culture-based phenotypic methods to molecular diagnostic methods and finally DNA sequencing. Antifungal susceptibility pattern was performed using E-test strip to determine the minimum inhibitory concentrations (MICs) of eight antifungal agents from the three main classes against C. albicans isolate. The MIC results were read at 24 and 48 h incubation according to Clinical and Laboratory Standards Institute (CLSI) guidelines. The results indicate susceptibility of C. albicans to amphotericin B with MIC value of 0.47 µg/mL, anidulafungin with MIC of 0.32 µg/mL; micafungin with MIC of 0.94 µg/mL and caspofungin with MIC of 0.125 µg/mL. The isolate was found to be resistant to all the four azole derivatives tested: fluconazole MIC ≥256 µg/mL; itraconazole, posaconazole and voriconazole with MIC values ≥32 µg/mL, indicating that the isolate may be azole resistant strain. Determination of the susceptibility pattern of this isolate is paramount for effective management of the case. Use of any echinocandins derivatives may be of help in the treatment of such fluconazole resistant strain. Here, we report a case of interdigital space infection (between 4th and 5th digits) due to C. albicans in a 41 year old African man. Key words: Candida albicans, E-test, interdigital, African, superficial.

Highlights

  • Non-albicans species are striving in their pathogenic ability, but it is noticed that C. albicans continues to exert its relevance as the leading cause of candidiasis

  • We report a case of interdigital space infection due to C. albicans in a 41 year old African man

  • The success of C. albicans in causing cutaneous candidiasis is based on its ability to thrive in many environmental factors by exploring many pathogenic mechanisms to facilitate its survival

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Summary

Introduction

The success of C. albicans in causing cutaneous candidiasis is based on its ability to thrive in many environmental factors by exploring many pathogenic mechanisms to facilitate its survival. These mechanisms include; yeast–to–hyphae transition; biofilm formation, sensing and thigmotropistic growth; presence of adhesion molecules; secretion of enzymes e.g. hydrolases and phenotypic switching among others. Other important factor is the genetic predisposition that makes the skin more susceptible to candida infection, e.g. autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), popularly known as polyglandular autoimmune syndrome type 1 (PAS-1) caused as a result of mutations in autoimmune regulator gene (AIRE) (Kämpe et al, 2018). Ketoconazole and fluconazole were used as topical and oral treatment respectively, prior to clinical diagnosis, though the infection is not yet resolved

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