Abstract
Objective:Fungal urinary tract infections due to Candida have increased significantly in recent years. Our research objective was to study Candida species in urine samples of patients with urinary tract infections (UTIs) associated with obstructive uropathy and to investigate the virulence factors of the isolated Candida.Methods:Patients were divided into two groups: Group I (cases): 50 patients with UTIs and obstructive uropathy. Group II (control): 50 patients with UTIs but with no functional or anatomical obstruction of their urinary tract. Clinical histories and physical examinations, together with laboratory investigations of urine samples were carried out in all patients in this study. Mid stream urine samples were examined microscopically and by fungal cell culture. The isolated Candida species were identified by analytical profile index (API). Candida Virulence factors were determined for the isolated Candida. The susceptibility to fluconazole was evaluated.Results:This study revealed an overall isolation rate of 27% of Candida species among all patient groups. The rate was 36% in cases, and 18% in controls, a difference found to be statistically significant (P<0.05). By API, C.albicans was detected in 44% of Candida species in cases, and in 33% in controls. While C.glabrata was detected in 28% of Candida species in cases, and in 22% in controls. C.tropicalis was detected in 17% of Candida species in cases, and in 22% in controls. Both C.krusei and C.kyfr were detected in 5.5% of Candida species in cases, and in 11% in controls. In terms of virulence factors the study showed that 11 out of 27 (40.5%) of Candida isolates were biofilm positive by tube adherence. Phospholipase activity was demonstrated in 12 out of 27 (44.5%) of Candida isolates. Secretory aspartic proteinase activity was demonstrated in 13 out of 27 (48%) of the Candida isolates.Conclusion:Candida is an important cause of UTIs and obstructive uropathy is a major predisposing factor.
Highlights
Community acquired urinary tract infections (UTIs) are a frequent problem worldwide and are caused by microbial invasion to different tissues of the urinary tract.[1]
Candida species were identified by analytical profile index (API) Candida
All known Candida species are capable of causing UTIs
Summary
Community acquired urinary tract infections (UTIs) are a frequent problem worldwide and are caused by microbial invasion to different tissues of the urinary tract.[1] Fungi are a portion of the microbial population that may contribute as fungal uropathogens in UTIs. Over the last year, the incidence of fungal UTIs due to Candida has increased significantly.[1] The increased incidence of fungal infections in patients suffering from urinary tract infections associated with obstructive uropathy as well as the emergence of azole antifungal drug resistance justifies an immediate need to investigate mechanisms of Candida species pathogenicity and their relationship to drug resistance.[2]. Secreted aspartyl proteinases (SAPs) are extracellular proteolytic enzymes that play a central role in Candida pathogencity. SAPs carry out a number of specialized functions during the infection process, which facilitates their adhesion and tissue invasion.[3] Phospholipases are another group of enzymes that contribute to the pathogencity of C. albicans by damaging host-cell membranes, and facilitating fungal invasion of host tissues.[4]
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