Abstract
BackgroundThe chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia.MethodsTwo hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method.ResultsThe colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent.ConclusionHIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.
Highlights
The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species
The widespread these antifungal agents have been followed by an increase in antifungal resistance and by a noticeable shift toward non albicans species with relative resistance to fluconazole and itraconazole [7] and there have been reports of emergence of resistance to antifungal agents in human immunodeficiency virus (HIV)/AIDS patients with Oropharyngeal candidiasis (OPC) [8,9,10,11,12,13]
C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177)
Summary
The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. The introduction of highly active antiretroviral therapy (HAART) has dramatically reduced the incidence of opportunistic infections among HIV-positive people who have received the drugs, OPC with a shift in the spectrum of Candida species remains the most frequent HIV-associated oral lesion in most developing countries, including Ethiopia [2,5], where access to HAART is still limited. The high incidence of mucosal and deep seated forms of candidiasis has resulted in the use of systemic antifungal agents, especially fluconazole and itraconazole [6] The widespread these antifungal agents have been followed by an increase in antifungal resistance and by a noticeable shift toward non albicans species with relative resistance to fluconazole and itraconazole [7] and there have been reports of emergence of resistance to antifungal agents in HIV/AIDS patients with OPC [8,9,10,11,12,13]. The resistance of Candida isolates to currently available antifungal drugs is a highly relevant factor because it causes important implications for morbidity and mortality
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