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Open Access Highly Accessed Research article

Frequent detection of ‘azole’ resistant Candida species among late presenting AIDS patients in northwest Ethiopia

Andargachew Mulu12*, Afework Kassu1, Belay Anagaw1, Beyene Moges1, Aschalew Gelaw1, Martha Alemayehu1, Yeshambel Belyhun1, Fantahun Biadglegne1, Zewdu Hurissa3, Feleke Moges1 and Emiko Isogai4

Author Affiliations

1 Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

2 Institute of Virology, Faculty of Medicine, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany

3 Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

4 Department of Disease Control and Molecular Epidemiology, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan

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BMC Infectious Diseases 2013, 13:82  doi:10.1186/1471-2334-13-82

Published: 12 February 2013

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.

Keywords:
Candida species diversity; In vitro susceptibility; Late presenters; Northwest Ethiopia