Species distribution and antifungal susceptibility of Candida spp. isolated from superficial candidiasis in outpatients in Iran.
OBJECTIVE
Candidiasis is the most prevalent fungal infection affecting human and animals all over the world. This study represents the epidemiological aspects of superficial candidiasis in outpatients and in vitro antifungal susceptibility of etiologic Candida species.


METHODS
Clinical samples were taken from 173 patients including skin and nail scrapings (107; 61.8%), vaginal discharge (28; 16.2%), sputum (20; 11.6%), oral swabs (7; 4.0%), bronchoalveolar lavage (6; 3.5%) and 1 specimen (0.6%) of each eye tumor, gastric juice, urine, biopsy and urinary catheter and confirmed as candidiasis by direct microscopy, culture and histopathology. Susceptibility patterns of the isolated Candida species were determined using the disk diffusion and broth microdilution methods.


RESULTS
Among 173 Candida isolates, C. albicans (72.3%) was the most prevalent species followed by C. parapsilosis (11.5%). Other identified species were C. glabrata, C. krusei, C. tropicalis, C. guilliermondii, C. intermedia and C. sake. Majority of the Candida isolates were susceptible to fluconazole (95.4%) followed by 5-flucytosine (89.6%), voriconazole (78.6%) itraconazole (48.0%) and ketoconazole (42.8%). Caspofungin was the most potent antifungal drug against C. albicans (MICs; 0.062-1 μg/mL), ketoconazole for C. parapsilosis and C. tropicalis (MICs; 0.031-0.25 μg/mL) and itraconazole for C. krusei, C. glabrata and C. guilliermondii (MICs; 0.031-1 μg/mL).


CONCLUSIONS
This study reinforces the significance of superficial candidiasis as an important fungal infection with multiple clinical presentations. Our results further indicate that susceptibility testing to commonly used antifungals is crucial in order to select the appropriate therapeutic strategies which minimize complications while improving patients' life.
Department of Medical Mycology, Pasteur Institute of Iran, 13164 Tehran, Iran. Electronic address: mrab442@yahoo.com.
M
M
Razzaghi-Abyaneh
Department of Medical Mycology, Pasteur Institute of Iran, 13164 Tehran, Iran.
G
G
Sadeghi
Department of Medical Mycology, Pasteur Institute of Iran, 13164 Tehran, Iran.
E
E
Zeinali
Department of Medical Mycology, Pasteur Institute of Iran, 13164 Tehran, Iran.
M
M
Alirezaee
Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, 14115-331 Tehran, Iran.
M
M
Shams-Ghahfarokhi
Medicinal Chemistry Laboratory, Pasteur Institute of Iran, 13164 Tehran, Iran.
A
A
Amani
Laboratory of Arboviruses and Viral Hemorrhagic Fevers, Pasteur Institute of Iran, 13164 Tehran, Iran.
R
R
Mirahmadi
Department of Medical Mycology, Pasteur Institute of Iran, 13164 Tehran, Iran.
R
R
Tolouei
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016533:Mycological Typing Techniques; D010045:Outpatients / Q000706:statistics & numerical data; D055815:Young Adult
D000935:Antifungal Agents
Antifongiques; Antifungal drugs; Broth microdilution; CHROMagar Candida; Candida species; Candidiasis; Candidose; Diffusion des disques; Disk diffusion; Espèces de Candida; Microdilution