Distributions and Antifungal Susceptibility of Candida Species from Mucosal Sites in HIV Positive Patients

Background: Mucocutaneous candidiasis (almost endogenous) is one of the most common manifestations of human immunodeficiency virus (HIV) infection. The aim of this study was the investigation of colonization patterns of Candida species, particularly C. dubliniensis, among mucosal sites of HIV-positive patients and determining corresponding in vitro susceptibility patterns to the antifungals.

Methods: From July 2006 to May 2008, specimens from the mucosal sites of 273 seropositive HIV patients were collected for Candida colonization. All isolates were identified by standard methods and carbohydrate assimilation patterns. Isolates phenotypically identified as C. albicans or C. dubliniensis were subjected to molecular identification. Susceptibility patterns of the isolated species to seven antifungal agents were determined using the broth microdilution method.

Results: The 359 samples from mucosal sites which consisted of 273 oral and 86 vaginal were collected and evaluated for Candida species distributions and their corresponding susceptibility patterns. The most commonly isolated species were: C. albicans (50%) followed by C. glabrata (21.4%), C. dubliniensis (13.3%, reported for the first time in Iran), C. krusei (9.8%), C. kefyr (3.1%), C. parapsilosis (1.6%), and C. tropicalis (0.8%). All species were sensitive to amphotencin B, ketoconazole, nystatin, voriconazole, and caspofungin. In some isolates, resistance to fluconazole and itraconazole was noted.

Conclusion: As demonstrated, resistance to fluconazole and itraconazole, the most frequent antifungals in use in the region suggests regular investigation into antifungal resistance in medical centers should be undertaken in order to promote the effective management of invasive candidiasis in HIV/AIDS patients.