Emergence Of Non-albicans Candida Research Articles

Species of Yeasts Identified from Different Clinical Samples Addis Ababa, Ethiopia

Background Currently, fungal diseases in humans are among the most problematic illnesses. This is the result of an increase in opportunistic fungal infections caused by a rise in the number of immune-compromised patients. Particularly, yeasts are the most common cause of fungal infections leading to a range of superficial types to life-threatening invasive infections. The aim of this study is to determine the species distribution of yeasts particularly of Candida species recovered from different clinical samples. Method A cross sectional study was conducted from January 2018 to September 2018 in Addis Ababa, Ethiopia. Specimen from Oropharyngeal, nail, eye’s cornea, and vaginal were collected from patients with signs and symptoms of infections. Identification was performed by using a YST card through VITEK 2 compact system. All data were coded, double-entered and analyzed using SPSS version 20. Result 174 yeasts were recovered of which 51.1% were Candida albicans, 43.1% were nonalbicans Candida species and 5.7% were yeasts other than Candida species. Eighteen (18) different types of yeast species were identified from different clinical samples. All recognized yeast is considered as a causative agent of fungal infection in previously reported data worldwide. Conclusion C. albicans remaining the predominant species, but the emergence of non-albicans Candida and other than candida species have increased. Thus, more studies on Candida prevalence are needed throughout country.

Species Distribution, Antifungal Susceptibility, and Molecular Epidemiology of Candida Species Causing Candidemia in a Tertiary Care Hospital in Bangkok, Thailand.

Candida species represent a common cause of bloodstream infection (BSI). Given the emergence of non-albicans Candida (NAC) associated with treatment failure, investigations into the species distribution, fungal susceptibility profile, and molecular epidemiology of pathogens are necessary to optimize the treatment of candidemia and explore the transmission of drug resistance for control management. This study evaluated the prevalence, antifungal susceptibility, and molecular characteristics of Candida species causing BSI in a tertiary-level hospital in Bangkok, Thailand. In total, 54 Candida isolates were recovered from 49 patients with candidemia. C. tropicalis was the most prevalent species (33.3%), followed by C. albicans (29.6%). Most Candida species were susceptible to various antifungal agents, excluding C. glabrata and C. tropicalis, which had increased rates of non-susceptibility to azoles. Most C. glabrata isolates were non-susceptible to echinocandins, especially caspofungin. The population structure of C. albicans was highly diverse, with clade 17 predominance. GoeBURST analysis of C. tropicalis revealed associations between genotype and fluconazole resistance in a particular clonal complex. The population structure of C. glabrata appeared to have a low level of genetic diversity in MLST loci. Collectively, these data might provide a fundamental database contributing to the development of novel antifungal agents and diagnostic tests.

Neonatal sepsis due to non-albicans Candida species and their susceptibility to antifungal agents: first report from Bangladesh

Background and objectives: Frequency of neonatal sepsis in Neonatal Intensive Care Units (NICU) has been increasing worldwide over the last decades. The emergence of non-albicans Candida (NAC) species and their resistance to common antifungal agents become an important preventive and therapeutic issue. The present study was undertaken to find out the role of NAC species in neonatal sepsis/candidemia in the NICUs of hospitals of Dhaka city. The susceptibility pattern of NAC species to antifungal agents was also determined.
 Materials and methods: Suspected cases of neonatal sepsis admitted in NICU of four tertiary care hospitals of Dhaka city, from March to December 2018 were enrolled. In this cross sectional study, blood samples were collected from neonates with suspected sepsis for culture. Identification of Candida species was done by carbohydrate (CHO) assimilation tests using swab auxanographic technique, CHO impregnated yeast nitrogen base plate method (YNB), microtiter plate based miniaturized method and by HiCromeTM Candida Differential Media. Susceptibility of the isolated Candida species to antifungal agents was determined by disk diffusion (DD) and by minimum inhibitory concentration (MIC) methods. MIC was determined by broth microdilution method using RPMI 1640 and trypticase soy broth (TSB).
 Results: In the present study, NAC species were isolated from 39.7% neonates. C. tropicalis was the predominant species (81.0%) followed by C. parapsilosis (12.1%), C. auris (5.2%) and C. dubliniensis (1.7%). Isolated NAC species were 98.3% sensitive to voriconazole. Sensitivity to fluconazole, ketoconazole, itraconazole, and clotrimazole was 3.5%, 15.5%, 86.2% and 56.9% respectively by DD method. All the isolates (100%) were sensitive to miconazole and nystatin. All the C. tropicalis, C. auris and C. dubliniensis were sensitive to amphotericin B and anidulafungin. One and four C. parapsilosis were found resistant to amphotericin B and anidulafungin respectively. The MIC results obtained by using RPMI 1640 and TSB as growth medium were concordant suggesting that TSB media was a good alternative to expensive RPMI 1640.
 Conclusion: The advent of NAC species merits attention as they are highly resistant to most of the azoles. Therefore, speciation of Candida in neonatal candidemia is essential to institute appropriate antifungal therapy.
 Ibrahim Med. Coll. J. 2020; 14(2): 19-26

Emergence of Non-albicans Candida in Type 2 Diabetes Mellitus patients attending a tertiary care centre, Gujarat

Emergence of Non-albicans Candida in Type 2 Diabetes Mellitus patients attending a tertiary care centre, Gujarat

Identification of candida albicans and nonalbicans candida resistant species in tobacco users and oral squamous cell carcinoma patients: Comparison of HiCrome agar and automated VITEK 2 system.

Introduction:Candida is most common fungal pathogen in the immunocompromised and medically ill patients. Higher prevalence of Candida albicans has been reported in tobacco users and oral squamous cell carcinoma (OSCC) patients which may be due to immunosuppression. Recently, emergence of nonalbicans candida (NAC) species resistant to conventional antifungal treatment has been observed that requires accurate identification of organisms at species level for reduction of progression of suspicious oral lesions toward malignancy.Aims and Objectives:To detect and compare the prevalence of C. albicans and NAC species smokeless tobacco chewers, histopathologically confirmed oral squamous cell carcinoma patients and the normal individuals. Effectiveness of automated Vitek 2 system in comparison to HiCrome agar color media in the identification of the candida species was also evaluated.Methodology:One hundred and fifty patients (90 males, 60 females) aged between 20 and 76 years were divided into three groups: Group I individuals with habit of chewing Gutka, and betel quid/pan masala with or without tobacco, Group II individuals with clinically and histopathologically confirmed oral squamous cell carcinoma and Group III comprised of controls. Salivary samples were cultured on HiCrome agar color media and results were compared with those of Vitek 2 system in the accurate identification of candida species. Data were statistically analyzed and Chi-square test was used to estimate the effectiveness of color and Vitek method in the identification of candida species in all the three groups. P < 0.05 was considered to be statistically significant.RESULTS:HiCrome agar color method identified six candida isolates C. albicans, Candida tropicalis, Candida krusei and Candida glabrata isolates in all the three groups, with 0.00 unidentified organisms (P = 0.00001) whereas VITEK 2 system identified five isolates of candida; C. albicans, Candida famat, Candida ciferri, Candida gulleri, C. tropicalis, unidentified organisms were observed in 26% of subjects. Further confirmation by supplemental tests indicated the presence of two or three organisms of different species/or subspecies with low reactivity biopattern. Higher incidence of opportunistic infections was seen in Group II OSCC patients (P = 0.00001).Conclusion:The results suggested that there is shift toward NAC species, with higher species diversity in OSCC patients followed by gutka, betel quid/pan masala with or without tobacco users. Conventional agar media culture methods of species identification should be used in conjunction with automated Vitek 2 method for better control of candida-associated oral cancer.

Emergence of non albicans Candida in a tertiary care hospital of north In-dia

Introduction: Over past few years, a dramatic increase in the incidence of infections caused by Candida species is seen, which has been attributed to increased number of immunocompromised patients, widespread use of broad spectrum antibiotics, long term use of corticosteroids and immunosuppressive drugs, prolonged hospital stay and use of advanced life support systems Aims and Objectives:To determine the incidence of Candida infections among patients admitted to a tertiary care teaching hospital of north India, characterise Candida isolates upto to specie level and also to evaluate presence of any drug resistance among these strains. Material and Methods:Present study was a hospital based prospective study carried out in the Department of Microbiology, of a tertiary care hospital in north India, over a period of one year from June 2016 to May 2017. For all Candida isolates obtained from various clinical samples, identification to the species level and anti-fungal susceptibility testing was done by automated Vitek 2 compact system (Biomerieux). Results were interpreted as per CLSI guidelines. Results:A shift of trends from Candida albicans to non albicans Candida was observed as out of total 56 isolates, the number of Candida albicans isolates was 16 (28.6%) and non-albicans Candida was 40 (72.4%). Anti-fungal susceptibility test results showed high susceptibility to Voriconazole and Amphotericic B. Only 5.35% (3/56) of Candida isolates showed resistance. Conclusions: Since non albicans Candida has emerged as an important nosocomial pathogen and these species are intrinsically resistant to some of the commonly used anti fungal drugs so anti-fungal susceptibility should be routinely performed to improve the treatment outcomes, for the benefit of the patient. Keywords: Candida albicans, Shift, non albicans Candida, Anti fungal susceptibility testing

Bioregulatory Role of Wickerhamomyces anomalus Killer Toxin against Pathogenic Members of the Genus Candida

Objectives: Candida species are endogenous fungus causing both mucosal and invasive infections. With the increasing rate of non-albicans Candida infections with varying susceptibilities, early and accurate species identification would help the clinician in befitting therapeutic management. So the interest in natural products secreted by a fungus Wickerhamomyces anomalus itself as an antimicrobial agent against pathogenic Candida species has evaluated in the present study. Methods: A total of 336 Candida species isolated from various clinical samples were included in the study. Candida identification, antifungal susceptibility was done by standard procedures. The environmental yeast killer toxin Wickerhamomyces anomalus was purified and the killer toxin assay against Candida species was done by standard procedures. Results: The predominant Candida species were Candida albicans (31%), but the emergence of non-albicans Candida also noted with 69%. Total antifungal resistance was 117 (35%) with fluconazole resistance in Candida albicans 13 (13%) and in non-albicans Candida were 50 (21%). The characterization of W. anomalus toxin has revealed that it is a glycoprotein of having 42.6 kDa active at pH 5.5 and temperatures 250 C. Candida isolates showed 292 (87%) sensitivity to the killer toxin. Conclusions: The study emphasizes the need for rapid and precise speciation and antifungal susceptibility of Candida isolates for effective treatment and management strategies.Our study proved the antifungal ability of W. anomalus and this resource can be used for alternative treatment of candidiasis with further assessments. J Microbiol Infect Dis 2019; 9(3):155-160.

PREDICTORS OF CANDIDEMIA IN PEDIATRIC PATIENTS (0–12 YEARS) ADMITTED IN A TERTIARY CARE HOSPITAL OF NORTHERN INDIA

Background: Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The emergence of non-albicans Candida (NACs) species with lesser susceptibility to antifungals has added to the woes of clinicians. Objectives: The objectives of the study were to determine the clinical and laboratory predictors and microbiological profile of candidemia in pediatric patients. Materials and Methods: This is a hospital-based, prospective, and cross-sectional study conducted in the pediatric department of a tertiary care hospital. A total of 250 children aged 0–12 years with risk factors for fungal sepsis were enrolled. Demographic details, clinical, and laboratory parameters were noted and samples were sent for culture. Cultures yielding growth of Candida were included in the study, and antifungal susceptibility performed. Associations were assessed using Chi-square test first and then through logistic regression models. Results: Among the 250 patients with risk factors for fungal sepsis, 47 patients (18.8%) with culture proven candidemia were identified. Predictors of candidemia among neonates were prematurity (&lt;30 weeks), prolonged ventilation (&gt;72 h), and thrombocytopenia. Among pediatric patients, prolonged steroid intake, Candida isolation from sites other than blood and persistent neutropenia, were significantly associated with the candidemia. NAC species were the predominant isolates (78.7%). Conclusion: Candidemia should be suspected in premature neonates requiring prolonged ventilation with unexplained thrombocytopenia. Among pediatric patients, prolonged steroid intake, Candida isolation from sites other than blood and persistent neutropenia are predictors of candidemia.

Prevalence of non albicans candida species in a tertiary care hospital

Prevalence of non albicans candida species in a tertiary care hospital - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/j.ijmr.2019.060, Indian Journal of Microbiology Research-Indian J Microbiol Res

Correlation between antifungal consumption and the distribution of Candida species in different hospital departments of a Lebanese medical Centre

BackgroundIn recent years, there has been a significant increase in the incidence of fungal infections attributed to Candida species worldwide, with a major shift toward non-albicans Candida (NAC). In this study, we have described the distribution of Candida species among different hospital departments and calculated the antifungal consumption in our facility. We also correlated the consumption of certain antifungals and the prevalence of specific Candida species.MethodsThis was a retrospective review of all the Candida isolates recovered from the computerised microbiology laboratory database of Makassed General Hospital, a tertiary care centre in Beirut, Lebanon, between January 2010 and December 2015. Data on antifungal consumption between January 2008 and December 2015 were extracted from the hospital pharmacy electronic database. We used Spearman’s coefficient to find a correlation between Candida species distribution and antifungal consumption.ResultsBetween 2008 and 2015, we observed that the highest antifungal consumption was in the haematology/oncology department (days of therapy/1000 patient days = 348.12 ± 85.41), and the lowest was in the obstetrics/gynaecology department (1.36 ± 0.47). In general, the difference in antifungal consumption among various departments was statistically significant (P < 0.0001). Overall, azoles were the most common first-line antifungals in our hospital. Echinocandins and amphotericin B were mostly prescribed in the haematology/oncology department. As for Candida species distribution, a total of 1377 non-duplicate isolates were identified between 2010 and 2015. A non-homologous distribution of albicans vs. non-albicans was noted among the different departments (P = 0.02). The most commonly isolated NAC was Candida glabrata, representing 14% of total Candida species and 59% of NAC. Candida famata (9% of NAC), Candida parapsilosis (3.6% of NAC) and Candida krusei (3% of NAC) were recovered unequally from the different departments. The total antifungal consumption correlated positively with the emergence of NAC. The use of azoles correlated positively with Candida glabrata, while amphotericin B formulations correlated negatively with it. None of these correlations reached statistical significance.ConclusionDifferent Candida species were unequally distributed among different hospital departments, and this correlated with consumption of antifungals in respective departments, highlighting the need for antifungal stewardship.

Correlation between antifungal consumption and distribution of Candida spp. in different departments of a Lebanese hospital.

Recently there has been a significant increase in the incidence of fungal infections attributed to Candida species worldwide, with a major shift toward non-albicans Candida (NAC). Herein, we described the distribution of Candida species among different departments in a Lebanese hospital and calculated the antifungal consumption in this facility. We, then, correlated the consumption of antifungals and the prevalence of Candida species. This was a retrospective study of Candida isolates recovered from the hospital microbiology laboratory database between 2010 and 2015. Data on antifungal consumption between 2008 and 2015 were extracted from the hospital pharmacy database. Spearman's coefficient was employed to find a correlation between Candida species distribution and antifungal consumption. The highest antifungal consumption was seen in the haematology/oncology department (days of therapy/1000 patient days = 348.12 ± 85.41), and the lowest in the obstetrics department (1.36 ± 0.47). The difference in antifungal consumption among various departments was statistically significant (p < 0.0001). Azoles were the most common first-line antifungals. A non-homologous distribution of albicans vs. non-albicans was noted among different departments (p = 0.02). The most commonly isolated NAC was Candida glabrata, representing 14% of total isolates and 59% of NAC. The total antifungal consumption correlated positively with the emergence of NAC. The use of azoles correlated positively with Candida glabrata, while amphotericin B formulations correlated negatively with it. None of these correlations reached statistical significance. Different Candida species were unequally distributed among different hospital departments, and this correlated with consumption of antifungals in respective departments, highlighting the need for antifungal stewardship.

Estimation of biofilm, proteinase & phospholipase production of the Candida species isolated from the oropharyngeal samples in HIV-infected patients.

Background & objectives:Candida, the most common opportunistic infection in acquired immunodeficiency syndrome (AIDS), attributes its pathogenicity to its virulence factors, mainly the biofilms, the proteinases and the phospholipases. There is a significant interplay of these factors during the HIV infection. This study was aimed to estimate the biofilm, proteinase and phospholipase production in Candida species isolated from the oropharyngeal samples in the HIV-infected patients.Methods:A total of 126 consecutive HIV-positive patients were screened for Candida growth using oropharyngeal swabs. Identification was done by Gram staining, germ tube test, chlamydospore identification, chromagar and biochemical tests on Vitek 2. Biofilm production was observed on Sabouraud's dextrose broth with glucose, phospholipase production in egg yolk agar medium and proteinase production in bovine serum albumin agar medium.Results:Of a total of 126 patients, 53 (42.06%) showed Candida growth: Candida albicans (n=46, 86.8%) was most common followed by the non-albicans Candida (NAC) (n=7, 13.93%). Of a total 33 (62.3%) biofilm positive isolates, significant production was observed in the NAC species (P <0.05). C. albicans reported the highest phospholipase (n=37/41, 90.24%) and proteinase (n=37/43, 86%) activities in a total of 41 (77%) phospholipase positive and 43 (81.1%) proteinase positive isolates.Interpretation & conclusions:Although C. albicans was the most common Candida species identified in HIV positive patients, the emergence of NAC was of special concern. Virulence factors such as biofilms, proteinases and phospholipases were noted in both these groups. Further research is required for better understanding of the pathogenic role of Candida species so as to aid in therapeutic interventions.

“Emergence of Non albicans Candida as potential pathogen --- Change in spectrum poses therapeutic challenge”

“Emergence of Non albicans Candida as potential pathogen --- Change in spectrum poses therapeutic challenge”

Micafungin treatment and eradication of candiduria among hospitalized patients.

In high-risk patients, candiduria may be associated with the development of urinary tract infections (UTI) and invasive candidiasis. The triazole antifungals achieve good urine concentrations, but their use is limited by the emergence of non-albicans Candida spp. with low-triazole susceptibility. The echinocandins remain fungicidal against many azole-resistant Candida spp., but low urine concentrations limit their use. We examined the rates of candiduria elimination in micafungin-treated patients. This retrospective analysis evaluated consecutive patients with candiduria (1/2008-4/2011) who were treated with micafungin (100mg/day) and had post-micafungin urine cultures. Patients were deemed to have either candiduria or UTI and were assessed for short-term (within 2weeks post-micafungin) and long-term (>1month post-micafungin) urine sterilization. Thirty-three patients meeting our inclusion criteria were identified. Of these, 16 (48%) were diagnosed with a Candida UTI. A total of 25 patients (76%) had Foley catheters, which were replaced in 11 (44%) cases. The majority of patients had Candida albicans (39%), but Candida krusei and Candida glabrata (33%) were also isolated. Eight patients (24%) were immunocompromised, and 29 (88%) received broad-spectrum antibiotics. Rates of urine sterilization during micafungin treatment, 2weeks after micafungin, and>1month after micafungin were 81, 78, and 75%, respectively. Among hospitalized patients with candiduria, micafungin administration was frequently associated with both short- and long-term urine sterilization. This was observed among patients with or without Foley removal and among those with Candida albicans, as well as non-albicans Candida spp.

Echinocandin Susceptibility Profile of Fluconazole Resistant Candida Species Isolated from Blood Stream Infections.

Over the last two decades, Candida blood stream infections (BSIs) have been increasingly reported from various parts of the world. Recent studies on invasive candidiasis have documented the emergence of non albicans Candida (NAC) species as major pathogens. Candida spp. belonging to NAC group often demonstrate intrinsic or acquired or both resistance to fluconazole which is the most readily available and prescribed cost effective antifungal agent. Echinocandins are recent addition to antifungal armamentarium and are now increasingly used as first line drugs for treatment and management of candidemia. The aim of this study was to determine echinocandin susceptibility profile of fluconazole resistant Candida Spp. isolated from BSIs. Predominance of NAC spp was noted. C. glabrata followed by C. krusei and C. parapsilosis demonstrated high resistance to fluconazole. Echinocandins demonstrated good activity against all Candida spp. As species distribution of Candida isolates varies greatly by country and by different health care setups within the country, species identification and antifungal susceptibility results are often useful to guide the selection of empiric treatment and design of local therapeutic guidelines. On the basis of antifungal susceptibility profile of the isolates, caspofungin can be suggested as a useful antifungal drug for the treatment of candidemia due to fluconazole resistant species.

English

Candida is one of the most frequently encountered opportunistic fungi that cause infection in humans. The pathogenesis of Candida is complex and probably varies with each infection. This study was conducted to understand the prevalence of Candida from various clinical specimens of patients and to show the emergence of Non albicans Candida in clinical samples. This study also focused on the antifungal susceptibility which guides the clinicians to treat the infection effectively. METHODS: Clinical samples were collected from outpatients and inpatients of Government General Hospital, Kurnool over a period of one year from March2008 to June2009. Isolation, culture, speciation of Candida was done by using standard methods. Antifungal susceptibility testing was done by disc diffusion technique against amphotericin B, nystatin, fluconazole and clotrimazole. RESULTS: Candida manifests in various sites depending on the predisposing factors and immune status of the person. In this study we found the association of Candida with various predisposing factors (Pregnancy, Oral contraceptive pills's, Immune suppression, Diabetes). This study observed the dominance of non-albicans Candida (51%) in the clinical samples over Candida albicans (49%). The maximum antifungal susceptibility was observed against amphotericin B in both the albicans and non-albicans Candia, but non-albicans Candida showed maximum resistance to azoles. CONCLUSION: Candida albicans was the most predominant species (49%) isolated in various clinical samples. There was an increase in the prevalence of non albicans Candida in this study. Among the nonalbicans Candida (51%) Candid tropicalis was the commonest species isolated. Candida albicans showed maximum susceptibility to amphotericin B and maximum resistance to azoles was seen in nonalbicans Candida.

Emergence of Non-albicans Candida in urine of diabetic patients at Gwalior (M.P.), India

The frequent occurrence of Candida infections in patients with diabetes mellitus has been recognized for many years and is thought to be more prevalent among these individuals. The objective of the study was to focus on the isolation of non- albicans Candida in urine of diabetic patients. A total of 80 samples in urine of diabetic patients treated in hospitals, clinics and nursing homes and from pathological laboratories at Gwalior (M.P.), India were recruited for the study. Among the diabetic patients 62.5 % (50/80) had Candida infections. The major Candida species isolated were Candida tropicalis 34% (17) followed by C. albicans 30% (15), C. parapsilosis 16% (08), C. glabrata 14% (07) and C. krusei 6% (03). This study indicates that non- albicans Candida are also emerging in urine of diabetic patients.

Emergence of non-albicans Candida among candidal vulvovaginitis cases and study of their potential virulence factors, from a tertiary care center, North India

The purpose of this study was to determine the prevalence of various Candida species and study some of their virulence factors among thevulvovaginal candidiasis(VVC)patients. The study was conducted in a Tertiary Care University Hospital in North India. This study was carried out prospectively for a period of 1 year. High vaginal swabs (HVSs) were collected from women in childbearing age group attending the gynecology and obstetrics out-patient departments with the complaints suggestive of vulvovaginitis. Samples were plated on Sabouraud's dextrose agar slope. Candida spp. isolated was further speciated based on microscopy, biochemical tests and culture characteristics on special media. Virulence factors of these strains were determined by biofilm formation and phospholipase activity. A total of 464 HVS from 232 patients with the complaints of vulvovaginitis were included in this study. Following laboratory workup, 71 specimens were positive for genus Candida (30.6%). Further speciation showed 32.4% as Candida albicans, 45.07% Candida parapsilosis and 22.53% of Candida glabrata. Biofilm production was shown by 50 candidal strains (70.4%) and phospholipase activity was given by 41 candidal strains (57.74%). Our study suggests increasing prevalence of non-albicans Candida among the VVC cases along with their virulence factors. Therefore, we recommend that microbiological investigation upto species level should be mandatory to determine the emergence of non-albicans Candida as a major cause of VVC.

Emergence of Candida spp. and exploration of natural bioactive molecules for anticandidal therapy –status quo

The opportunistic yeast pathogen Candida albicans and the emerging non-albicans Candida spp. cause life-threatening infections in immuno-compromised patients, leading to an increase in mortality rate. At present, the emergence of non-albicans Candida spp. causes serious infections that are difficult to treat the human populations worldwide. The available, synthetic antifungal drugs show high toxicity to host tissues causing adverse effects. Many metabolites of terrestrial and marine plants, microbes, algae, etc., contain a rich source of unexplored novel leads of different types, which are under use to treat various diseases. Such natural drugs are less expensive and have lower toxicity to host tissues. The patent search on identified and potential anticandidal-lead molecules, from various patent databases, has been described in this review. Furthermore, this article consolidates the trends in the development of anticandidal drug discovery worldwide. Most of the investigations on natural, bioactive molecules against candidiasis are in various phases of clinical trials, of which, two drugs Caspofungin acetate and Micafungin sodium were approved by the U.S. FDA. In conclusion, the exploration of drugs from natural resources serves as a better alternative source in anticandidal therapeutics, having great scope for drug discovery in the future.

Emergence of Nonalbicans Candida in Neonatal Septicemia and Antifungal Susceptibility: Experience from a Tertiary Care Center

Aims:To know the distribution and antifungal susceptibility pattern of Candida species in neonatal septicemia cases.Materials and Methods:In a prospective analysis blood samples from 825 clinically suspected cases of neonatal septicemia, collected aseptically, were cultured to look for the role of Candida spp. in septicemia. Candida isolates were speciated by germ tube test, Hi-CHROME agar, sugar fermentation, and sugar assimilation tests using standard protocol. All the Candida isolates were tested for antifungal susceptibility to fluconazole by the Disk Diffusion (DD) method and broth micro dilution-minimum inhibitory concentration (BMD-MIC) method using NCCLS guidelines.Results:Isolation rate of Candida from neonatal septicemia cases was 8.1%. Most common isolate was C. tropicalis (61.19%), followed by C. albicans (19.40%), C. glabrata (11.94%), C. parapsilosis (5.97%) and C. guillermondii (1.49%). Low birth weight and previous antibiotic prophylaxis was found in 100% cases. Crude mortality rate was 50.1%. By DD method, 95.53% of the Candida isolates were sensitive to fluconazole. A discrepancy between DD method and BMD-MIC method was noted in 4.47% strains. One isolates each of C. tropicalis, C. albicans, and C. glabrata showed discrepancy.Conclusion:Nonalbicans Candida has emerged as an important cause of neonatal septicemia. Routine susceptibility testing of Candida isolates by DD method should be confirmed by BMD-MIC method. Fluconazole can be used as empirical therapy for neonatal candidemia at our center.