Esophageal Candidiasis: Causative Species and their Antifungal Susceptibility Pattern in Hospital of Western U.P.
Etiology of esophageal candidiasis and its resistance pattern
Esophageal candidiasis is more commonly presented in persons with immunocompromised conditions but it can also be seen in immunocom- petent patients. There has been an epidemiological shift towards the predominance of candida spp. other than C.albicans such as C. glabrata parapsilosis, C. krusei, C. tropicalis, C. dubliensis etc. accounting for more than 50% of the Candida infections. The rampant misuse of antifungals has increased the antifungal resistance among C.albicans as well as non-albicans species and poses a challenge to clinicians for the management of such cases. The current study was aimed to understand the isolation of various Candida spp. in patients diagnosed with esophageal candidiasis attending a tertiary care center in western U.P. and to analyse its association with various predisposing factors. This study also extends to determine the susceptibility pattern of the isolated candida spp. against different antifungal agents. The study was conducted for 3 years in the hospital of western U.P. North India from July 2017 to June 2020. Candidial esophagitis was suspected when in endoscopy, whitish plaques are seen attached to the mucosa and these plaques were collected using biopsy forceps and sent to the microbiology laboratory for its fungal culture and speciation. In the current study, 60.1% were Candida albicans while 39.9% were other candida spp. Among NAC, the commonest species was C. parapsilosis (14.1%) followed by C. dubliensis (9.2%), C. glabrata (8.6%), C. tropicalis (4.9%) and C. krusei (3.1%). All isolates were found sensitive to AmphotericinB, however 3.1% of the isolates were resistant to Voriconazole and 7.4% to fluconazole. Fluconazole resistance is a serious issue as it is considered the drug of choice in cases with esophageal candidiasis. Such studies help clinicians to select appropriate antifungals for these patients and reduces patient’s morbidity and mortality.
2. Knoke M, Bernhardt H. The first description of an oesophageal candidosis by Bernhard von Langenbeck in 1839. Mycoses. 2006;49(4):283–287. Available from: https://dx.doi.org/10. 1111/j.1439-0507.2006.01237.x.
3. Choi JH, Lee CG, Lim YJ, Kang HW, Lim CY, Choi JS. Prevalence and risk factors of esophageal candidiasis in healthy individuals: a single center experience in Korea. Yonsei Med J. 2013;54(1):160–165. Available from: https://dx.doi.org/10. 3349/ymj.2013.54.1.160.
4. Olmos MA, Araya V, Concetti H, Ramalho J, Piskorz E, Pérez H, et al. Oesophageal candidiasis: clinical and mycological analysis. Acta Gastroenterol Latinoam. 2005;35:211–219.
5. Cortés C, Oksenberg D, Afani A, Defilippi C, Madrid AM. Clinical and immunological study of 10 immunocompe- tent patients with esophageal candidiasis. Rev Med Chil. 2004;132:1389–94. Available from: https://doi.org/10.4067/ s0034-98872004001100008.
6. Kasapidis P, Kokkinou E. Experience with Candida esophagi- tis in young patients without predisposing factors. Gut. 1997;41:509–522.
7. Olmos MA, Araya V, Concetti H, Ramalho J, Piskorz E, Pérez H, et al. Oesophageal candidiasis: clinical and mycological analysis. Acta Gastroenterol Latinoam. 2005;35:211–219.
8. Wilheim AB, de Barros Miranda-Filho D, Nogueira RA, de Melo Rêgo RS, de Magalhães Lima K, Pereira LMMB. The resistance to fluconazole in patients with esophageal candidiasis. Arquivos de Gas- troenterologia. 2009;46(1):32–37. Available from: https://dx.doi.org/10.1590/s0004-28032009000100011.
9. Miceli MH, Díaz JA, Lee SA. Emerging opportunistic yeast infections. Lancet Infect Dis. 2011;11(2):142–151. Available from: https://dx.doi.org/10.1016/s1473-3099(10)70218-8.
10. Bohme A, Ruhnke M, Buchheidt D, Karthaus M, Einsele H, Guth S, et al. Treatment of fungal infections in hematology and oncology guidelines of the infectious disease working party (AGIOF) of the German Society of Hematology and Oncology (DGOH). Ann Hematol. 2003;82(2):133–173. Available from: https://doi.org/10.1007/s00277-003-0767-1.
11. Vazquez JA. Invasive oesophageal candidiasis: current and developing treatment options. Drugs. 2003;63:971–
89. Available from: https://doi.org/10.2165/00003495- 200363100-00004.
12. Golia S, Reddy KM, Karjigi KS, Hittinahalli V. Speciation of Candida using chromogenic and cornmeal agar with the determination of fluconazole sensitivity. Al Ameen J Med Sci. 2013;6(2):163–169.
13. Achkar JM, Fries BC. Candida Infections of the Genitourinary Tract. Clin Microbiol Rev. 2010;23(2):253–273. Available from: https://dx.doi.org/10.1128/cmr.00076-09.
14. Bennett C; 1995.
15. Naito Y, Yoshikawa T, Oyamada H, Tainaka K, Morita Y, Kogawa T, et al. Esophageal candidiasis. Gastroenterologia Japonica. 1988;23(4):363–370. Available from: https://dx.doi. org/10.1007/bf02779203.
16. Underwood JA, Williams JW, Keate RF. Clinical findings and risk factors for Candida esophagitis in outpatients*. Dis Esophagus. 2003;16(2):66–69. Available from: https://dx.doi. org/10.1046/j.1442-2050.2003.00305.x.
17. Takahashi Y, Nagata N, Shimbo T, Nishijima T, Watanabe K, Aoki T. Long-Term Trends in Esophageal Candidiasis Prevalence and Associated Risk Factors with or without HIV Infection: Lessons from an Endoscopic Study of 80,219 Patients. PLoS ONE. 2015;10(7):133589. Available from: https://doi.org/10.1371/journal.pone.0133589.
18. Lakshmy J, Katragadda R, Balaji J. Speciation and antifungal susceptibility of esophageal candidiasis in cancer patients in a tertiary care hospital in South India. J Med Allied Sci. 2016;6(1):29. Available from: https://dx.doi.org/10.5455/jmas. 214436.
19. Nadagir SD, Chunchanur SK, Halesh LH, Yasmeen K, Chandrasekhar MR, Patil BS. Significance of isolation and drug susceptibility testing of non-Candida albicans species causing oropharyngeal candidiasis in HIV patients. Southeast Asian J Trop Med Public Health. 2008;39(3):492–95.
20. Baradkar VP, Kumar S. Species identification ofCandidaiso- lates obtained from oral lesions of HIV infected patients. Indian
J Dermatol. 2009;54(4):385. Available from: https://dx.doi.org/ 10.4103/0019-5154.57622.
21. Sajith KG, Dutta AK, Sahni RD, Esakimuthu S, Chacko A. Is empiric therapy with fluconazole appropriate for esophageal candidiasis? Indian J Gastroenterol. 2014;33(2):165–168. Available from: https://dx.doi.org/10.1007/s12664-013-0439- 6.
22. Badarinarayanan G, Gowrisankar R, Muthulakshmi K. Esophageal candidiasis in non-immune suppressed pa-tients in a semi-urban town. Mycopathologia. 2000;149(1):1–4. Available from: https://doi.org/10.1023/a:1007245919761.
23. Mandal B. Study the growth kinetics of pediococcus acidilactici with estimation of kinetic parameters and applied in large scale pediocin production. Asian J Pharm Clin Res. 2016;9:130. Available from: https://dx.doi.org/10.22159/ajpcr.2016.v9i5. 12753.
24. Maninder J, Usha AJ. Isolation, characterization and antifungal susceptibility pattern of Candida species causing oropharyngeal candidiasis in HIV positive patients. Commun Dis. 2008;40(3):177–81.
Copyright (c) 2021 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.