English

Abstract

BACKGROUND: Difference in expression of virulence factors and in antifungal susceptibility among different Candida species has raised the need for species-level identification. Opportunistic infection is usually caused by Candida albicans, however, over the last decade reports of non-albicans Candida causing this infection is increasing. AIM: The present study was undertaken to assess the role of various Candida species as opportunistic pathogens in Human Immunodeficiency Virus (HIV) seropositive patients and testing their antifungal susceptibility pattern. METHODS AND MATERIAL : 100 clinical samples were obtained from HIV seropositive patients and 50 from HIV seronegative patients and were speciated by the conventional methods and also by HiCrome Candida Differential Agar (CHROM agar). Susceptibility testing of the isolates for Fluconazole and Itraconazole was performed by Macro broth dilution technique. RESULTS: Candida albicans was the commonest species isolated followed by C.dubliniensis, C.parapsilosis, C.tropicalis, C.krusei and C.glabrata. Antifungal susceptibility testing from HIV seronegative patients showed all Candida albicans and Candida tropicalis isolates were sensitive to both Fluconazole and Itraconazole. Candida krusei (1 isolate), Candida glabrata (1 isolate), Candida dubliniensis (3 isolate) showed resistance to Fluconazole and Candida parapsilosis (1 isolate) showed dose-dependent susceptibility with MIC = 16 μg/ml. Itraconazole resistance was observed for Candida krusei (1 isolate), Candida glabrata (1 isolate), with an MIC range of ≥1 mg/L. All other isolates, even which were resistant to Fluconazole were sensitive to Itraconazole. All Candida isolates from HIV seronegative patients were sensitive to both Fluconazole and Itraconazole. CONCLUSION: Increasing trend of Non albicans Candida species causing various invasive infections and their prevalence in a particular geographical area warrant the need of speciation of Candida species. The long-term use of azoles as prophylaxis for Invasive candidiasis can result in the selection of Candida isolates that are more resistant to azole therapy. The non albicans Candida species like C.glabrata and C. krusei are more resistant to Fluconazole and Itraconazole compared to C. albicans. Hence the antifungal susceptibility pattern plays an important role for successful treatment of Candidiasis. The use of Macrobroth dilution method using BHI broth technique will help in detecting the antifungal susceptibility pattern in a less equipped laboratory.