Isolation of Candida Species from Gastroesophageal Lesions among Pediatrics in Isfahan, Iran: Identification and Antifungal Susceptibility Testing of Clinical Isolates by E-test

Salehi, Fatemeh; Esmaeili, Mehran; Mohammadi, Rasoul

Isolation of Candida Species from Gastroesophageal Lesions among Pediatrics in Isfahan, Iran: Identification and Antifungal Susceptibility Testing of Clinical Isolates by E-test

Document Type : Original Article

Authors

¹ Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Candida species can become opportunistic pathogens causing local or systemic invasive infections. Gastroesophageal candidiasis may depend on the Candida colonization and local damage of the mucosal barrier. Risk factors are gastric acid suppression, diabetes mellitus, chronic debilitating states such as carcinomas, and the use of systemic antibiotics and corticosteroids. The aim of this study is collection and molecular identification of Candida species from gastroesophageal lesions among pediatrics in Isfahan, and determination of minimum inhibitory concentration (MIC) ranges for clinical isolates. Materials and Methods: A total of 200 patients underwent endoscopy (130 specimens from gastritis and 70 samples from esophagitis) were included in this study between April 2015 and November 2015. All specimens were subcultured on sabouraud dextrose agar, and genomic DNA of all strains was extracted using boiling method. Polymerase chain reaction and DNA sequencing of the ITS1-5.8SrDNA-ITS2 region were used for the identification of all Candida strains. MIC ranges were determined for itraconazole (ITC), amphotericin B (AmB), and fluconazole (FLU) by E-test. Results: Twenty of 200 suspected patients (10%) were positive by direct microscopy and culture. Candida albicans was the most common species (60%) followed by Candida glabrata (30%), Candida parapsilosis (5%), and Candida kefyr (5%). MIC ranges were determined for FLU (0.125–8 μg/mL), ITC (0.008–0.75 μg/mL), and AmB (0.008–0.75 μg/mL), respectively. Conclusion: Every colonization of Candida species should be considered as a potentially factor of mucocutaneous candidiasis and should be treated with antifungal drugs.

Keywords

References

1.	Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag 2014;10:95-105.
2.	Nishimura S, Nagata N, Shimbo T, Asayama N, Akiyama J, Ohmagari N, et al. Factors associated with esophageal candidiasis and its endoscopic severity in the era of antiretroviral therapy. PLoS One 2013;8:e58217.
3.	Papon N, Courdavault V, Clastre M, Bennett RJ. Emerging and emerged pathogenic Candida species: Beyond the Candida albicans paradigm. PLoS Pathog 2013;9:e1003550.
4.	Maccallum DM. Hosting infection: Experimental models to assay Candida virulence. Int J Microbiol 2012;2012:363764.
5.	Silva GA, Bernardi TL, Schaker PD, Menegotto M, Valente P. Rapid yeast DNA extraction by boiling and freeze-thawing without using chemical reagents and DNA purification. Braz Arch Biol Technol 2012;55:319-27.
6.	Zarrinfar H, Kaboli S, Dolatabadi S, Mohammadi R. Rapid detection of Candida species in bronchoalveolar lavage fluid from patients with pulmonary symptoms. Braz J Microbiol 2016;47:172-6.
7.	Mohammadi R, Ataei B. Candidiasis in pediatrics; identification and In vitro antifungal susceptibility of the clinical isolates. Iran J Ped Hematol Oncol 2016;6:43-51.
8.	Saleem N, Ijaz S, Lodhi O. Esophageal candidiasis in a patient with uncontrolled diabetes mellitus and recurrent abdominal pain, symptomatic or incidental? A case report and brief literature review. J Med Cases 2015;6:523-6.
9.	Komeno Y, Uryu H, Iwata Y, Hatada Y, Sakamoto J, Iihara K, et al. Esophageal candidiasis as the initial manifestation of acute myeloid leukemia. Intern Med 2015;54:3087-92.
10.	Yan L, Yang C, Tang J. Disruption of the intestinal mucosal barrier in Candida albicans infections. Microbiol Res 2013;168:389-95.
11.	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;54:160-5.
12.	Mimidis K, Papadopoulos V, Margaritis V, Thomopoulos K, Gatopoulou A, Nikolopoulou V, et al. Predisposing factors and clinical symptoms in HIV-negative patients with Candida oesophagitis: Are they always present? Int J Clin Pract 2005;59:210-3.
13.	Underwood JA, Williams JW, Keate RF. Clinical findings and risk factors for Candida esophagitis in outpatients. Dis Esophagus 2003;16:66-9.
14.	Naito Y, Yoshikawa T, Oyamada H, Tainaka K, Morita Y, Kogawa T, et al. Esophageal candidiasis. Gastroenterol Jpn 1988;23:363-70.
15.	Mohammadi R, Abdi S. Molecular identification of Candida species isolated from gastro-oesophageal candidiasis in Tehran, Iran. Gastroenterol Hepatol Bed Bench 2015;8:288-93.
16.	Vermeersch B, Rysselaere M, Dekeyser K, Rasquin K, De Vos M, Elewaut A, et al. Fungal colonization of the esophagus. Am J Gastroenterol 1989;84:1079-83.
17.	Vazquez JA. Optimal management of oropharyngeal and esophageal candidiasis in patients living with HIV infection. HIV AIDS (Auckl) 2010;2:89-101.
18.	Kodsi BE, Wickremesinghe C, Kozinn PJ, Iswara K, Goldberg PK. Candida esophagitis: A prospective study of 27 cases. Gastroenterology 1976;71:715-9.
19.	Barrett JP, Vardulaki KA, Conlon C, Cooke J, Daza-Ramirez P, Evans EG, et al. A systematic review of the antifungal effectiveness and tolerability of amphotericin B formulations. Clin Ther 2003;25:1295-320.
20.	Ostrosky-Zeichner L, Marr KA, Rex JH, Cohen SH. Amphotericin B: Time for a new “gold standard”. Clin Infect Dis 2003;37:415-25.
21.	Chen SC, Sorrell TC. Antifungal agents. Med J Aust 2007;187:404-9.
22.	Teseng YH, Lee WT, Kuo TC. In-vitro susceptibility of fluconazole and amphotericin B against Candida isolates from women with vaginal candidiasis in Taiwan. J Food Drug Anal 2005;13:12-6.
23.	Saporiti AM, Gómez D, Levalle S, Galeano M, Davel G, Vivot W, et al. Vaginal candidiasis: Etiology and sensitivity profile to antifungal agents in clinical use. Rev Argent Microbiol 2001;33:217-22.
24.	Bauters TG, Dhont MA, Temmerman MI, Nelis HJ. Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. Am J Obstet Gynecol 2002;187:569-74.
25.	Citak S, Ozçelik B, Cesur S, Abbasoglu U.In vitro susceptibility of Candida species isolated from blood culture to some antifungal agents. Jpn J Infect Dis 2005;58:44-6.
26.	Swinne D, Watelle M, Van der Flaes M, Nolard N.In vitro activities of voriconazole (UK-109, 496), fluconazole, itraconazole and amphotericin B against 132 non-albicans bloodstream yeast isolates (CANARI study). Mycoses 2004;47:177-83.
27.	Sabatelli F, Patel R, Mann PA, Mendrick CA, Norris CC, Hare R, et al. In vitro activities of posaconazole, fluconazole, itraconazole, voriconazole, and amphotericin B against a large collection of clinically important molds and yeasts. Antimicrob Agents Chemother 2006;50:2009-15.

Advanced Biomedical Research