P350 Oropharyngeal candidiasis in HIV infected patients: associated risk factors and antifungal susceptibility testing of candida species by disc diffusion method

Abstract

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesTo isolate and identify Candida species by the standard microbiological method.To estimate the frequency of oral Candidiasis according to age, sex, and other factors [CD4 + count, ART, tobacco consumption, diabetes, upper respiratory tract infection (URTI), recent antibiotic consumption] in HIV-positive patients.To determine the Antifungal Susceptibility pattern of the Candida species by Disc Diffusion Method.MethodologyA hospital-based cross-sectional study was conducted for 6 months in the Department of Microbiology of Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Teku, Nepal. A total of 408 HIV-positive patients attending the ART center of the hospital of different age and sex were included in the study. Study variables like CD4 + count, tobacco consumption, diabetes, URTI, and recent antibiotic consumption were noted.Standard microbiological guidelines were followed for the oral swab collection and transportation. Specimen was seeded on SDA agar plates (SDA with chloramphenicol and cycloheximide). Preliminary identification of the Candida was done on the basis of colony characteristics, gram staining, and germ tube test. Further for the speciation of Candida species, HiCrome™ Candida Differential Agar (HImedia, India) was applied where on the basis of coloration and colony morphology speciation was done. Similarly, Cornmeal Agar (Dalmau plate culture technique) and sugar Fermentation test were applied to confirm the Candida species.Muller-Hinton agar supplemented with 2% glucose and 0.5 μg/ml methylene blue dye (GMB) medium was used to perform the antifungal susceptibility testing of Candida isolates. Antifungal susceptibility testing (AST) of isolates was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) M44-A document. Candida albicans ATCC 90028 was taken as the reference strain. All the data were entered in Microsoft excel and Chi-square was used to find out the association between the frequency of oral candidiasis and study variables.ResultsAmong 408 studied subjects, 225 (55.1%) were males and 183 (44.9%) were females. Of the participants, 116 (28.4%) had regular tobacco smoking habit, diabetes 10 (2.5%), URTIs 30 (7.4%), antibiotic consumption 44 (10.8%) and ART use 394 (96.6%). The CD4 + cell count of respondents ranged from 12 - 2425 cells/mm³. Candida albicans 53 (81.5%) was the most frequently encountered species followed by C. tropicalis 3 (4.6%), C. krusei 2 (3.1%), C. glabrata 1 (1.5%) and 6 (9.2%) other Candida species. A total of 26 patients had CD4+ ≤200 cells/mm3 and 39 patients had CD4+ >200 cells/mm3. There was no significant association in the occurrence of oral candidiasis among males and females (P = .966), tobacco consumption (P = .051), ART use (P = .188), diabetes (P = .722). Whereas, there was a significant association between oral Candida carriage and CD4 + cell count ≤ 200 cells/mm3 (P <.001), URTI (P = .029), and recent antibiotic consumption (P = .002). Amphotericin B was the most potent antifungal followed by voriconazole, itraconazole, and conversely fluconazole the most resistant.Conclusion Candida albicans was the common species isolated in our study. Candida Chrome Agar can be used as a routine media for rapid identification and Candida speciation. AST needs to be done routinely to know the susceptibility pattern of isolates and initiate proper treatment of patients. Since oral yeast colonization was associated with low CD4 + count (<200 cells/mm3). Thus, oral lesions can serve as early markers for HIV infection.