Abstract
BackgroundGastrointestinal candidiasis is the most predominant opportunistic human mycosis, especially in diabetic patients. There is a global increase in antifungal resistance coupled with a rarity of information on antifungal susceptibility profiles in Uganda.ObjectiveThis study aimed to determine the occurrence and antifungal susceptibility of gastrointestinal candidiasis in diabetic patients.MethodsStool and fasting blood specimens were obtained from randomly sampled consenting patients with diabetes mellitus at St. Francis Hospital Nsambya in Kampala, Uganda to determine Candida infection, fasting blood glucose and glycated haemoglobin levels. Susceptibility testing was performed on Muller Hilton agar supplemented with 2% glucose and 0.2 µg of methylene blue, using the E-test diffusion method.ResultsAmong the 241 patients included in the analyses, the overall prevalence of gastrointestinal candidiasis was 15.4% (n = 37). Candida albicans (62.16%, n = 23) was the predominant species, followed by Candida glabrata (18.92%, n = 7), Candida tropicalis (8.11%, n = 3), Candida krusei (5.41%, n = 2) and Candida dublinensis (5.41%, n = 2). Resistance was observed with miconazole (48.65%), clotrimazole (18.92%) and fluconazole (8.11%). No resistance to itraconazole and nystatin was observed. Gastrointestinal candidiasis was associated with poor glucose control (p ≤ 0.001), prior use of antibiotics (p ≤ 0.001), antifungals (p ≤ 0.001) and corticosteroids (p ≤ 0.001) and was more common among female patients (p = 0.01).ConclusionOccurrence of gastrointestinal candidiasis was relatively low among our participants, and infection was associated with poor glucose control, female sex and use of antifungals, antibiotics and corticosteroids.
Highlights
Candida species reside in the human gastrointestinal tract as part of the body’s microbiota
This study found that 87% of C. albicans isolates were fluconazole-susceptible
Prevalence of gastrointestinal candidiasis was relatively low among the participants of this study
Summary
Candida species reside in the human gastrointestinal tract as part of the body’s microbiota. Due to changes in host environment (such as immunosuppression, metabolic imbalances and dysbiosis), they can proliferate as opportunistic pathogens.[1,2] They are the predominant cause of opportunistic human mycoses, and are capable of causing superficial as well as invasive mycoses.[3] Candida proliferation, especially with heavy growth, within the gut may result in diarrhoea and abdominal discomfort.[4,5]. Patients with diabetes mellitus (DM) are susceptible to intestinal candidiasis,[6,7] due to the effects of the hyperglycaemic state on the immune system such as dysfunction in the microbicidal activity, chemotaxis and the phagocytosis ability of the neutrophils.[8] there is increased death of leukocytes and decreased response to moderators of inflammation such as histamine and bradykinin among DM patients,[9] resulting in a reduction in the capability of their immune systems to combat gastrointestinal infections.
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