Speciation and antifungal susceptibility of esophageal candidiasis in cancer patients in a tertiary care hospital in South India

Abstract

Background Esophagealcandidiasis is the most common opportunistic infection in patients with altered immunity such as HIV infection, cancer patients on chemotherapy and radiotherapy. Neutropenia,irradiation and chemotherapy will facilitate deeper mucosal invasion of candida leading onto esophageal candidiasis. Empirical treatment of esophageal candidiasis without antifungal susceptibility testing will lead to the emergence of drug resistant species increasing the morbidity and mortality associated with cancer. Aim: The present study aims to study the frequency of esophageal candida in individuals with cancer, species level identification and Antifungal susceptibility pattern for fluconazole, Itraconazole and Amphotericin B by Microbroth dilution method. Methods: Scrapings of whitish appearing lesions were obtained from a total of thirty five cases of endoscopically identified esophageal candidiasis were obtained from patients with cancer. Identification of the candida isolates were done by cultivation in Sabouraud dextrose agar, Gram staining, germ tube test, colony morphology in Chrom agar and corn meal agar, sugar assimilation and fermentation tests. Antifungal susceptibility was done by Microbroth dilution method for Fluconazole,Itraconazole and Amphotericin B. Results: We found that Candida albicans was the predominant species isolated followed by Candida tropicalisand Candida glabrata. Sensitivity rates were 91.7%, 94% and 100% for fluconazole, Itraconazole and Amphotericin B by Microbroth dilution method. Conclusion: Species level identification of candida isolated from esophageal candidiasis and their Antifungal sensitivity testing should be performed for early identification ofResistant strains and for promptly treating the cases there by preventing the dissemination of infection in case of immunocompromisedindividuals. Further the susceptibility pattern will facilitate therapeutic guidance especially in individuals prone to relapse.