Original Article

A six-year hospital-based surveillance study on burden of esophageal candidiasis in Gangtok, Sikkim

Abstract

Background and Objectives: Esophageal candidiasis once thought to be restricted amongst immunocompromised patients is being increasingly reported among non-immunocompromised individuals. It is debilitating and if not treated well may cause chronic long-lasting infections. The objective of this study was to identify the various species of Candida causing esophageal candidiasis and analyse their antifungal susceptibility pattern.
Materials and Methods: This was an observational, prospective study. Total of 108 patients who attended the Gastroenterology Department of Sir Thutob Namgyal Memorial Hospital, Govt of Sikkim, Gangtok, India between July 2012 – May 2018 were included in the study. They had complaints of upper gastrointestinal disturbances and chronic dyspeptic symptoms that required an endoscopy. Esophageal biopsy and brushings were taken and were transported to Microbiology Department. They were subjected to microscopic observation, fungal culture on Sabourauds dextrose agar. Preliminary species identification was done by chlamydospore formation and growth characteristics on CHROMagar Candida. Species confirmation and antifungal susceptibility testing was done on VITEK 2 system at Microbiology Department, Kasturba Medical College and Hospital, MAHE, Manipal, Karnataka, India.
Results: A total of 108 patients were screened among which 73 samples were positive for Candida species and species identification and antifungal susceptibility was performed. Forty fiveisolates were found to be C. albicans, 8 were C. glabrata, 4 were C. tropicalis, 3 were C. lusitaniae 2 were C. krusei, 2 were C. lipolyticaand 1 was C. parapsilosis. Eight isolates could not be identified and were recorded as Candida spp. C. albicans isolates were predominantly sensitive strain with susceptibility of 95% for both amphotericin B and fluconazole and 100% for caspofungin. C. glabrata showed high resistance to fluconazole with one isolate showing intermediate resistance to caspofungin.
Conclusion: Upper gastrointestinal symptoms even in non-immunocompromised patients need to be screened by endoscopy to rule out esophageal candidiasis. With the emergence of drug resistant non albicans Candida species diagnostic testing laboratories should include Candida species identification and antifungal susceptibility testing facility to provide effective patient care.

1. Repentigny LD, Lewandowski D, Jolicoeur P. Immunopathogenesis of oropharyngeal candidiasis in human immunodeficiency virus infection. Clin Microbiol Rev 2004; 17: 729-759.
2. Mohamed AA, Lu XL, Mounmin FA. Diagnosis and treatment of esophageal candidiasis: current updates. Can J Gastroenterol Hepatol 2019; 2019: 3585136.
3. Takahashi Y, Nagata N, Shimbo T, Nishijima T, Watanabe K, Aoki T, et al. Long-Term trends in esophageal candidiasis prevalence and associated risk factors with or without HIV infection: lessons from an endoscopic study of 80,219 patients. PLoS One 2015; 10(7): e0133589.
4. 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: 160-165.
5. Mushi MF, Ngeta N, Mirambo MM, Mshana SE. Predictors of esophageal candidiasis among patients attending endoscopy unit in a tertiary hospital, Tanzania: a retrospective cross-sectional study. Afr Health Sci 2018; 18: 66-71.
6. Maurya V, Srivastava A, Mishra J, Gaind R, Marak RSK, Tripathi AK, et al. Oropharyngeal candidiasis, and Candida colonization in HIV positive patients in northern India. J Infect Dev Ctries 2013; 7: 608-613.
7. Maninder J, Usha A. Isolation, characterization and antifungal susceptibility pattern of Candida species causing oropharyngeal candidiasis in HIV positive patients. J Commun Dis 2008; 40: 177-181.
8. Kliemann DA, Pasqualotto AC, Falavigna M, Giaretta T, Severo LC. Candida esophagitis: species distribution and risk factors for infection. Rev Inst Med Trop Sao Paulo 2008; 50: 261-263.
9. Kullberg BJ, Arendrup MC. Invasive candidiasis. N Engl J Med 2015; 373: 1445-1456.
10. Arastehfar A, Gabaldón T, Garcia-Rubio R, Jenks JD, Hoenigl M, Salzer HJ, et al. Drug-Resistant fungi: an emerging challenge threatening our limited antifungal armamentarium. Antibiotics (Basel) 2020; 9: 877.
11. Pristov KE, Ghannoum MA. Resistance of Candida to azoles and echinocandins worldwide. Clin Microbiol Infect 2019; 25: 792-798.
12. Ghannoum MA, Jurevic RJ, Mukherjee PK, Cui F, Sikaroodi M, Naqvi A, et al. Characterization of the oral fungal microbiome (mycobiome) in healthy individuals. PLoS Pathog 2010; 6(1): e1000713.
13. Naglik JR, Richardson JP, Moyes DL. Candida albicans pathogenicity and epithelial immunity. PLoS Pathog 2014; 10(8): e1004257.
14. Underwood JA, Williams JW, Keate RF. Clinical findings and risk factors for Candida esophagitis in outpatients. Dis Esophagus 2003; 16: 66-69.
15. Alsomali MI, Arnold MA, Frankel WL, Graham RP, Hart PA, Lam-Himlin DM, et al. Challenges to "classic" esophageal candidiasis: looks are usually deceiving. Am J Clin Pathol 2017; 147: 33-42.
16. Yakoob J, Jafri W, Abid S, Jafri N, Islam M, Hamid S, et al. Candida esophagitis: risk factors in non-HIV population in Pakistan. World J Gastroenterol 2003; 9: 2328-2331.
17. Ives NJ, Gazzard BG, Easterbrook PJ. The changing pattern of AIDS-defining illnesses with the introduction of highly active antiretroviral therapy (HAART) in a London clinic. J Infect 2001; 42: 134-139.
18. Detels R, Tarwater P, Phair JP, Margolick J, Riddler SA, Munoz A, et al. Effectiveness of potent antiretroviral therapies on the incidence of opportunistic infections before and after AIDS diagnosis. AIDS 2001; 15: 347-355.
19. Lamoth F, Lockhart SR, Berkow EL, Calandra T. Changes in the epidemiological landscape of invasive candidiasis. J Antimicrob Chemother 2018; 73 (Suppl-1): i4-i13.
20. Pahwa N, Kumar R, Nirkhiwale S, Bandi A. Species distribution and drug susceptibility of Candida in clinical isolates from a tertiary care centre at Indore. Indian J Med Microbiol 2014; 32: 44-48.
21. Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med 2015; 41: 285-295.
22. Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect 2014; 20 Suppl 6: 5-10.
23. Yang YL, Ho YA, Cheng HH, Ho M, Lo HJ. Susceptibilities of Candida species to amphotericin B and fluconazole: the emergence of fluconazole resistance in Candida tropicalis. Infect Control Hosp Epidemiol 2004; 25: 60-64.
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IssueVol 14 No 4 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v14i4.10247
Keywords
Candida; Candidiasis; Esophagitis; Antifungal; Endoscopy; Amphotericin B; Fluconazole; Caspofungin
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Gurung S, Sharma T, Rasaily S, Singh R, Prakash P. A six-year hospital-based surveillance study on burden of esophageal candidiasis in Gangtok, Sikkim. Iran J Microbiol. 2022;14(4):598-605.