title: Frequent detection of 'azole' resistant Candida species among late presenting AIDS patients in northwest Ethiopia.
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.
  
  
  CONCLUSIONS
  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.
authors: Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. andargachewmulu@yahoo.com
authors: Andargachew
authors: A
authors: Mulu
authors: Afework
authors: A
authors: Kassu
authors: Belay
authors: B
authors: Anagaw
authors: Beyene
authors: B
authors: Moges
authors: Aschalew
authors: A
authors: Gelaw
authors: Martha
authors: M
authors: Alemayehu
authors: Yeshambel
authors: Y
authors: Belyhun
authors: Fantahun
authors: F
authors: Biadglegne
authors: Zewdu
authors: Z
authors: Hurissa
authors: Feleke
authors: F
authors: Moges
authors: Emiko
authors: E
authors: Isogai
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy / Q000209:etiology*; D002180:Candidiasis, Oral; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D026141:Drug Resistance, Multiple, Fungal; D005002:Ethiopia; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
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