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Mulu A, Kassu A, Anagaw B, Moges B, Gelaw A, Alemayehu M, Belyhun Y, Biadglegne F, Hurissa Z, Moges F, Isogai E. Frequent detection of 'azole' resistant Candida species among late presenting AIDS patients in northwest Ethiopia. BMC Infect Dis 2013; 13:82. [PMID: 23398783 PMCID: PMC3577436 DOI: 10.1186/1471-2334-13-82] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient's leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia. METHODS Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method. RESULTS The colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent. CONCLUSION HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.
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Affiliation(s)
- Andargachew Mulu
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Institute of Virology, Faculty of Medicine, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany
| | - Afework Kassu
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belay Anagaw
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beyene Moges
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aschalew Gelaw
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martha Alemayehu
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yeshambel Belyhun
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Biadglegne
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewdu Hurissa
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Feleke Moges
- Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emiko Isogai
- Department of Disease Control and Molecular Epidemiology, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
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