Abstract
Drug-resistant Candida species in HIV-infected patients are the result of the selective pressure of currently used azoles. In the course of screening for active plant products against drug-resistant Candida species, we paid special attention on the effects of commonly available herbal plants. A total of 123 oral Candida isolates which were previously isolated from 172 HIV-infected patients were included in this study. In vitro antifungal susceptibility to fluconazole (FCZ), itraconazole (ITZ) and amphotericin B (AMB) was evaluated using Clinical and Laboratory Standard Institute (CLSI) guidelines. Antifungal potency of garlic, neem, Aloe, Calendula, Citrus, mint, tea and ginger extracts were tested against drug-resistant isolates. Out of 123 isolates, 26.8% were resistant to FCZ, 21.9% to ITZ and 8.1% to AMB. All drug-resistant isolates tested, were completely inhibited by garlic and neem leaves extracts with minimum fungicidal concentration (MFC) of 0.781 and 1.562 mg/ml, respectively. Aloe and Calendula extracts were also found to be effective with MFC of 3.125 mg/ml each. The observed growth inhibition zones and minimum inhibitory concentrations (MICs) showed that the isolates exhibited susceptibility. Our results provided scientific justification for the use of garlic, neem, Aloe and Calendula extracts in health products and herbal remedies against multidrug-resistant candidiasis. Key words: Oral lesions, antifungal susceptibility, drug resistant, herbal, Candida albicans.
Highlights
Oral candidiasis (OC) is the most frequent human immunodeficiency virus (HIV) infection-associated oral disease and can act as a marker for immunosuppression (Moura et al, 2006; Chunchanur et al., 2009; Merçon et al, 2009; Moura et al, 2010; Thompson et al, 2010)
In the 1990s, there was a significant increase in the prevalence of drug-resistant fungal infections due to Candida species in patients hospitalized for mucosal or systemic diseases
The frequency of isolation of Candida isolates in Group 1 was: Candida albicans
Summary
Oral candidiasis (OC) is the most frequent human immunodeficiency virus (HIV) infection-associated oral disease and can act as a marker for immunosuppression (Moura et al, 2006; Chunchanur et al., 2009; Merçon et al, 2009; Moura et al, 2010; Thompson et al, 2010). Fluconazole (FCZ) is frequently used for the treatment of mucocutaneous candidiasis in patients with. In the 1990s, there was a significant increase in the prevalence of drug-resistant fungal infections due to Candida species in patients hospitalized for mucosal or systemic diseases. The widespread application of FCZ or related azole antifungal is postulated to promote selection of resistant subpopulations by shifting colonization to more naturally resistant species, such as Candida krusei or Candida glabrata. In India, despite the numerous reports of isolation of azole resistant strains of Candida species from patients with refractory mucosal candidiasis, only a few longitudinal prospective studies have evaluated the antifungal susceptibility of Candida isolates recovered from HIV-infected patients receiving long-term therapy with azole (Gautam and Garg, 2013a).
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