Speciation of Candida and antifungal susceptibility from oral thrush cases in people living with HIV and its correlation with CD4 count and viral load in a tertiary care hospital: a cross-sectional study

C. H. Aruna Kumari; D. Satyanarayana Murthy; Siva Kalyani; B. Nirmala Grace; A. Durga Rani; P. V. Prasanna Kumar; S. Rukmini; Rajesh

doi:10.18203/2320-6012.ijrms20251648

Authors

C. H. Aruna Kumari Department of Microbiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
D. Satyanarayana Murthy Department of Microbiology, Sri Venkateshwara Medical College, Tirupati, Andhra Pradesh, India
Siva Kalyani Department of Microbiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
B. Nirmala Grace Department of Microbiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
A. Durga Rani Department of Microbiology, Government Medical College, Machilipatnam, Andhra Pradesh, India
P. V. Prasanna Kumar Department of Microbiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
S. Rukmini Department of SPM, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
Rajesh Department of Microbiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251648

Keywords:

Oral candidiasis, Candida species, Antifungal susceptibility testing, CD4 count, Viral load

Abstract

Background: Oropharyngeal candidiasis (OPC) is the most common opportunistic infection observed in Human immunodeficiency virus (HIV) seropositive patients. It has been perceived that low CD4 counts and high plasma HIV RNA levels, both significantly correlate with oral candidiasis in HIV patients. Aim was to determine the antifungal susceptibility testing of the Candida isolates by disc diffusion method.

Methods: The present study is a cross-sectional study that included 100 clinical samples processed for speciation of Candida isolates by using standard mycological techniques and antifungal susceptibility of the Candida isolates was done by using disc diffusion method and minimum inhibitory concentration (MIC’s) was done by ‘E’ strip test for fluconazole resistant isolates. CD4 count was estimated by using flow cytometry method and viral load was estimated by using real time PCR, Abbott M2000SP and correlated with oral thrush.

Results: Out of 100 Candida isolates, C. albicans 84 (84%) was the predominant species followed by C. krusei 7 (7%), C. glabrata 6 (6%), C. tropicalis 3 (3%). Among the antifungals used in this study, the most sensitive agent was voriconazole 99 (94.4%) and the least was itraconazole 59 (19.6%). CD4 count was less than 200 cells/μl in 45 (45%). Viral load varied from 1,62409 to 58 copies/ml of blood in the patients with oral thrush with significant association.

Conclusions: To conclude, though C. albicans was the common species, the emergence of non-albicans Candida species and the increasing rate of azole resistance, emphasizes the need for speciation and determination of susceptibility pattern to provide appropriate treatment for HIV patients with oral candidiasis.

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References

Gottfredsson M, Cox GM, Indridason ÓS, de Almeida GMD, Heald AE, Perfect JR. Association of plasma levels of human immunodeficiency virus type 1 RNA and oropharyngeal Candida colonization. J Infect Dis. 1999;180(2):534-7. DOI: https://doi.org/10.1086/314887

Nicolatou-Galitis O, Velegraki A, Paikos S, Economopoulou P, Stefaniotis T, et al. Effect of PI-HAART on the prevalence of oral lesions in HIV-1 infected patients. A Greek study. Oral Dis. 2004;10(3):145-50. DOI: https://doi.org/10.1046/j.1601-0825.2003.00994.x

Liu X, Liu H, Guo Z, Luan W. Association of asymptomatic oral candidal carriage, oral candidiasis and CD4+ lymphocyte count in HIVpositive patients in China. Oral Dis. 2006;12(1):41-4. DOI: https://doi.org/10.1111/j.1601-0825.2005.01155.x

Crowe S-M, Carlin JB, Stewart KI, Lucas CR, Hoy JF. Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV infected persons. J Acquire Immune Defici Syndr. 1994;4(8):770-6.

Dupont B, Denning DW, Marriot D, Sugar A, Vivani MA, Srisanthana T. Mycosis and AIDs patients. J Med Mycol. 1992;32(1):19-28. DOI: https://doi.org/10.1080/02681219280000731

Calvet HM, Yeaman MR, Filler SG. Reversible fluconazole resistance in Candida albicans: a potential in vitro model. Antimicrob Agents Chemother. 1997;41(3):535-9. DOI: https://doi.org/10.1128/AAC.41.3.535

Colombo AL, Da Matta D, De Almeida LP, Rosas R. Fluconazole susceptibility of Brazilian Candida isolates assessed by a disk diffusion method. J Infect Dis. 2002;6:118-23. DOI: https://doi.org/10.1590/S1413-86702002000300003

Mulu A, Kassu A, Anagaw B, Moges B, Gelaw A, Alemayehu M, et al. Frequent detection of azole resistant Candida species among late presenting AIDS patients in northwest Ethiopia. BMC Infectious Dis. 2013;13:82. DOI: https://doi.org/10.1186/1471-2334-13-82

Gugnani HC, Becker K, Fegeler W, Basu S, Chattopadhya D, Baveja U, et al. Oropharyngeal carriage of Candida species in HIV-infectedpatients in India. Mycoses. 2003;46(8):299-306. DOI: https://doi.org/10.1046/j.1439-0507.2003.00896.x

Nugraha AP, Ernawati DS, Parmadiati AE, Soebadi B, Triyono EA, Prasetyo RA, et al. Prevalence of Candida species in oral candidiasis and correlation with CD4+ count in HIV/AIDS patients at surabaya, Indonesia. J Int Dental Med Res. 2018:11(1):81-5.

Franker CK, Lucartorto FM, Johnson BS, Jacobson JJ. Characterization of the mycoflora from oral mucosal surfaces of some HIV-infected patients. Oral Surg Oral Med Oral Pathol. 1990;69(6):683-7. DOI: https://doi.org/10.1016/0030-4220(90)90348-V

Hemachandra C, Jeer M, Kundapur A. Identification of Candida species isolated from oropharyngeal candidiasis of human immunodeficiency virus infected patients. Int J Med Microbiol Trop Dis. 2019;5(1):57-62 DOI: https://doi.org/10.18231/2581-4761.2019.0013

Shyamala R, Parandhekar PK. Identification and Invitro azole resistance of Candida species isolated from Oropharyngeal Candidiasis in HIV infected patients. Int J Curr Microbiol App Sci. 2014;3(10):816-22.

Anwar KP, Malik A, Subhan KH. Profile of candidiasis in HIV infected patients. Iran J Microbiol. 2012;4:2049.

Maheshwari M, Kaur R, Chadha S. Candida Species Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India. J Pathog. 2016;2016:6204804. DOI: https://doi.org/10.1155/2016/6204804

Chinnappan JAI, Lakshmipriya N, Umadevi U. Distribution of Candida Species with Antifungal Susceptibility Isolated from Oral Thrush in People Living with HIV/AIDS and its Correlation with CD4 Count. Curr Res HIV: CRHA-122. 2000;4(1):1-4.

Jayacharan AL, Katragadda R, Ravinder T, Vajravelu L, Manoranjan L, Hemalatha S, et al. Antifungal susceptibility pattern among Candida species: An evaluation of disc diffusion and micro broth dilution method. J Microbiol Infect Dis. 2018;8(3):97-101. DOI: https://doi.org/10.5799/jmid.458457

White TC, Hollemann S, Dy F, Mirels LF, Stevens DA. Resistance mechanisms in clinical isolates of Candida albicans. Antimicrobial Agents Chemother. 2002;46:1704-13. DOI: https://doi.org/10.1128/AAC.46.6.1704-1713.2002

Shwetha DC, Venkatesha D. Identification and antifungal susceptibility of Candida species isolated from various clinical samples at a tertiary care hospital. Int J Curr Microbiol App Sci. 2021;10(03):527-32.

Talukdar A, Barman R, Sarma A, Krishnatreya M, Sharma J, Kataki A. Fungal profile and antifungal susceptibility pattern of candidiasis in esophageal cancer patients. J Cancer Res Ther. 2020;16:209. DOI: https://doi.org/10.4103/jcrt.JCRT_581_18

Costa CR, De Lemos JA, Passos XS, de Araújo CR, Cohen AJ, Souza LK, et al. Species distribution and antifungal susceptibility profile of oral Candida isolates from HIVinfected patients in the antiretroviral therapy era. Mycopathologia. 2006;162(1):45-50. DOI: https://doi.org/10.1007/s11046-006-0032-y

Usha A, Maninder J, Neerja J. Immunosuppression level in HIV-positive patients with oropharyngeal candidiasis: Indian J Med Microbiol. 2009;27(2):174-5. DOI: https://doi.org/10.4103/0255-0857.49442