Oropharyngeal candidiasis among HIV seropositive patients in Chennai, South India: An evaluation of Polymerase chain reaction-Restriction Fragment Length polymorphism for speciation and Antifungal drug resistance

Abstract

CONTEXT: Oropharyngeal candidiasis is a common opportunistic manifestation of HIV/acquired immunodeficiency syndrome. Non-albicans Candida and drug-resistant strains are on the rise leading to treatment difficulties. AIMS: The present study aims to speciate, perform antifungal susceptibility, and also to evaluate the significance of antifungal drug resistance by correlating the prior exposure to Fluconazole and CD-4 counts. SETTINGS AND DESIGN: This was a cross-sectional study. MATERIALS AND METHODS: A total of 115 HIV patients with clinical evidence of oropharyngeal candidiasis were included in the study. Two swabs were collected from the lesions. Speciation and antifungal susceptibility by microbroth dilution method for fluconazole, itraconazole, and amphotericin B were done as per the standard microbiological techniques. Polymerase chain reaction and restriction fragment length polymorphism (PCR and RFLP) were performed for speciating the Non-albicans candida. The association between prior exposure to Fluconazole, CD-4 counts, and antifungal resistance was assessed (Fisher's exact test, Chi-square test P RESULTS: Among the 115 patients, 60 (52.17%) showed culture positivity for Candida species. Candida albicans 35 (56.45%) was the predominant species isolated followed by Candida tropicalis 12 (19.30%). PCR RFLP produced specific products for 19 of the non albicans Candida. A resistance of 17 (27.41%) and 18 (29.00%) was seen to fluconazole and itraconazole, respectively. A significant association was observed between prior exposure to Fluconazole and drug resistance (P = 0.0201).The correlation between CD-4 counts and antifungal resistance was not statistically significant (P = 0.595). CONCLUSION: Antifungal susceptibility testing should be performed routinely along with species-level identification whether it is the first or recurrent episode of oral candidiasis and therapy should be modified accordingly to prevent the morbidity and mortality.