Distribution and antifungal susceptibility profiles of candida species isolated from dermatomycosis patients

Year 2024, Volume: 7 Issue: 3, 290 - 295, 27.05.2024

Mine Aydın Kurç Ayşe Demet Kaya Gamze Erfan Şule Albayrak

https://doi.org/10.32322/jhsm.1448006

Abstract

Aims: Superficial mycoses are the most common dermatological diseases worldwide, and the causes are becoming increasingly resistant to antifungal agents used in treatment. The aim of our study was to identify the yeast species causing superficial mycoses and determine their susceptibilities to some antifungal agents.
Methods: Skin and nail scraping samples obtained from 726 patients with suspected superficial fungal infection were collected and examined by direct microscopy and culture. Isolates were identified by conventional methods and API ID32 C (Biomeriux, France) commercial kits. The minimum inhibitory concentrations (MIC) of isolates against itraconazole, miconazole, nystatin, and terbinafine antifungals were determined by microdilution method.
Results: A total of 59 yeasts were isolated from the samples. The most frequently isolated species were Candida glabrata (n=31, 52.54%), Candida guillermondii (n=9, 15.25%), and Candida albicans (n=7, 11.86%). In terms of infection sites, the most common involvement was observed in the foot (n=39, 66.1%) and nails (n=16, 27.1%). In terms of their antifungal susceptibilities, the highest resistance was detected against terbinafine (35.6%) and itraconazole (33.9%). Multidrug resistance was observed among strains of the Candida species (n=17, 28.8%).
Conclusion: The most striking results of this study can be summarized as high rates of Candida glabrata isolation, increase in resistance rates, and a prevalence of 28.8% multidrug resistance. This data once again emphasize the importance of isolation, identification, and antifungal susceptibility testing in the diagnosis and effective treatment of superficial mycoses.

Keywords

Superficial mycoses, Candida sp, Antifungal Susceptibility, Multidrug resistance

Ethical Statement

The study was carried out with the permission of Tekirdağ Namık Kemal University Faculty of Medicine Ethical Evaluation Commission (Date: 29.12.2012, Decision No: 2012/05/01/05).

Supporting Institution

This research was funded by Namık Kemal University Scientific Research Projects Coordination Unit

Project Number

grant number NKUBAP.00.20.AR.12.05.

References

• Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses. 2008;51(Suppl 4):2-15.
• Buil JB, Meijer EF, Denning DW, Verweij PE, Meis JF. Burden of serious fungal infections in the Netherlands. Mycoses. 2020; 63(6):625-631.
• Kaushik N, Pujalte GG, Reese ST. Superficial fungal infections. Prim Care. 2015;42(4):501-516. Song Y, Li R. Superficial fungal infections. In: Song Y, Li R, eds. Molecular Medical Microbiology. 3rd ed. Academic Press: 2024: 2895-2904.
• Metin A, Dilek N, Bilgili SG. Recurrent candidal intertrigo: challenges and solutions. Clin Cosmet Investig Dermatol. 2018; 11:17585.
• Pfaller MA, Andes DR, Diekema DJ, et al. Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the prospective antifungal therapy (PATH) registry 2004-2008. PLoS One. 2014; 9(7):e101510.
• Almeida LMMD, Souza EADF, Bianchin DB, Svidzinski TIE. Resposta in vitro de fungos agentes de micoses cutâneas frente aos antifúngicos sistêmicos mais utilizados na dermatologia. Ana Brasil Dermatol. 2009;84(3):249-255.
• Magagnin CM, Stopiglia CDO, Vieira FJ, et al. Perfil de suscetibilidade a antifúngicos de dermatófitos isolados de pacientes com insuficiência renal crônica. Ana Brasil Dermatol. 2011;86(4):694-701.
• Pereira PA, Vieira ES, Charles FC, et al. Superficial and cutaneous mycoses, epidemiology, virulence, susceptibility profile to antifungals and their infections: A literature review of the last twenty years. Int J Pharm Biologic Sci. 2021;11(1):176-187.
• Tümbay E. Mantar Laboratuarında Uygulanan Yöntemler. In: Tümbay E. Pratik Tıp Mikolojisi. Bilgehan Basımevi:1983.
• Larone DH. Medically Important Fungi: A Guide to Identification. 5th Edition. ASM Press: 2011.
• CLSI. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Third Informational Supplement. CLSI document M27-S3. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.
• CLSI. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Third Informational Supplement. CLSI document M27-S4. Wayne, PA: Clinical and Laboratory Standards Institute; 2012.
• Fothergill AW. Miconazole: a historical perspective. Expert Rev Anti Infect Ther. 2006;4(2):171-175.
• St-Germain G, Laverdiere M, Pelletier R, et al. Epidemiology and antifungal susceptibility of bloodstream Candida isolates in Quebec: report on 453 cases between 2003 and 2005. Can J Infect Dis Med Microbiol. 2008;19(1):55-62.
• Orasch C, Marchetti O, Garbino J, et al. Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerland. Clin Microbiol Infect. 2014;20(7):698-705.
• Taghipour S, Rezaei-Matehkolaei A, Mahmoudabadi AZ. Antifungal susceptibility profiles of Candida species isolated from Ahvaz Jundishapur educational hospitals. Jundishapur J Microbiol. 2018; 11(11):e78851.
• Martinez KDV, Pereira PA, Nascimento CGSD, et al. Identificação do perfil dos agentes etiológicos causadores de micoses superficiais cutâneas no sul do Brasil. Scientif Electr Arch Rondonópolis (MT). 2020;13(9):85-90.
• Dias MFRG, Quaresma-Santos MVP, Bernardes-Filho F, Amorim AGDF, Schechtman RC, Azulay DR. Update on therapy for superficial mycoses: review article part I. Ana Brasil Dermatol. 2013;88(5):764-774.
• Zareshahrabadi Z, Totonchi A, Rezaei‐Matehkolaei A, et al. Molecular identification and antifungal susceptibility among clinical isolates of dermatophytes in Shiraz, Iran (2017‐2019). Mycoses. 2021;64(4):385-393.
• Diongue K, Diallo MA, Ndiaye M, et al. Champignons agents de mycoses superficielles isolés à Dakar (Sénégal): Une étude rétrospective de 2011 à 2015. J Mycolog Méd. 2016;26(4):368-376.
• Sellami A, Sellami H, Makni F, et al. Childhood dermatomycoses study in Sfax hospital, Tunisia. Mycoses. 2008;51(5):451-454.
• Panasiti V, Devirgiliis V, Borroni RG, et al. Epidemiology of dermatophytic infections in Rome, Italy: a retrospective study from 2002 to 2004. Med Mycol. 2007;45(1):57-60.
• Chiacchio ND, Madeira CL, Humaire CR, Silva CS, Fernandes LHG, Reis ALD. Superficial mycoses at the Hospital do Servidor Público Municipal de São Paulo between 2005 and 2011. Ana Brasil Dermatol. 2014;89(1):67-71.
• Ergin Ç, Ergin Ş, Yaylı G, Baysal V. Süleyman Demirel Üniversitesi Tıp Fakültesi Dermatoloji Kliniğine başvuran hastalarda dermatofitoz etkenleri. Türk Mikrobiyol Cem Der. 2000;30(3-4):121-124.
• Bilgili ME, Sabuncu İ, Saraçoğlu ZN, Ürer SM, Kiraz N, Akgün Y. Kliniğimize başvuran dermatofitozlu olgulardan izole edilen dermatofit türleri. T Klin Dermatoloji. 2001;11(4):185-190.
• Pekbay A, Saniç A, Yenigün A, et al. Çalışanlarda yüzeyel mikoz prevelansı ve etken mantarların belirlenmesi. OMÜ Dergisi. 2000;17(1):45-49.
• Güdücüoğlu H, Akdeniz N, Bozkurt H, Aygül K, İzci H, Berktaş M. Beden eğitimi bölümü öğrencilerinin yüzeyel mantar hastalıkları açısından değerlendirilmesi. Van Tıp Derg. 2006; 13(2):53-55.
• Irmak H, Bozkurt H. Van yöresinde izole edilen dermatofitlerde tür tayini. Türk Hijyen Deneys Biyol Derg. 2021;78(4):451-466.
• de Albuquerque Maranhão FC, Oliveira-Júnior JB, dos Santos Araújo MA, Silva DMW. Mycoses in northeastern Brazil: epidemiology and prevalence of fungal species in 8 years of retrospective analysis in Alagoas. Braz J Microbiol. 2019;50(4): 969-978.
• Montes K, Ortiz B, Galindo C, Figueroa I, Braham S, Fontecha G. Identification of Candida species from clinical samples in a Honduran tertiary hospital. Pathogens. 2019;8(4):237.
• Köktürk A, Delialioğlu N, Kaya Tİ, et al. Mersin ilinin dermatofitik florası. Türkiye Klin Dermatol. 2002;12(3):135-139.
• Khodadadi H, Zomorodian K, Nouraei H, et al. Prevalence of superficial‐cutaneous fungal infections in Shiraz, Iran: a five‐year retrospective study (2015–2019). J Clin Laborat Analys. 2021;35(7):e23850.
• Otašević S, Momčilović S, Golubović M, et al. Species distribution and epidemiological characteristics of superficial fungal infections in Southeastern Serbia. Mycoses. 2019;62(5):458-465.
• Makni F, Sellami A, Trabelsi H, et al. Évolution de la flore des levures isolées au CHU de Sfax, Tunisie. J Mycolog Méd. 2010; 20(1):42-47.
• Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007; 20(1):133-163.
• Song Y, Chen X, Yan Y, Wan Z, Liu W, Li R. Prevalence and antifungal susceptibility of pathogenic yeasts in China: a 10-year retrospective study in a teaching hospital. Front Microbiol. 2020; 11:1401.
• Bilal H, Hou B, Shafiq M, Chen X, Shahid MA, Zeng Y. Antifungal susceptibility pattern of Candida isolated from cutaneous candidiasis patients in eastern Guangdong region: a retrospective study of the past 10 years. Front Microbiol. 2022; 13:981181.
• Altıntaş SN, Şahiner FJ. Antifungal agents in the treatment of Candidosis and susceptibility tests. Mol Virol Immunol. 2021; 2(2):56-66.
• Newland JG, Abdel-Rahman SM. Update on terbinafine with a focus on dermatophytoses. Clin Cosmet Investig Dermatol. 2009; 2:49-63.
• Gupta AK, Stec N, Summerbell RC, et al. Onychomycosis: a review. J Eur Acad Dermatol Venereol. 2020;34(9):1972-1990.
• Ameen M, Lear J, Madan V, et al. British association of dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014;171(5):937-958. doi: 10.1111/bjd.13358
• Noguchi H, Matsumoto T, Kimura U, et al. Fungal Melanonychia caused by Candida parapsilosis successfully treated with oral fosravuconazole. J Dermatol. 2019;46:911-913. doi: 10.1111/1346-8138.15024.
• Nett JE, Andes DR. Antifungal agents: spectrum of activity, pharmacology, and clinical indications. Infect Dis Clin North Am. 2016;30(1):51-83.
• Taudorf EH, Jemec GBE, Hay RJ, Saunte DML. Cutaneous candidiasis-an evidence-based review of topical and systemic treatments to inform clinical practice. J Eur Acad Dermatol Venereol. 2019;33(10):1863-1873. doi: 10.1111/jdv.15782
• Ksiezopolska E, Gabaldon T. Evolutionary emergence of drug resistance in Candida opportunistic pathogens. Genes. 2018;9(9): 461.
• Agbulu CO, Iwodi C, Onekutu A. In vitro susceptibility test of some antifungal drugs on selected dermatophytes and yeasts isolated from patients attending hospitals in Makurdi environ. Microbiol J. 2015;5:9-16. doi: 10.3923/mj.2014
• Carillo-Munoz AJ, Quindos G, Tur C, et al. In-vitro antifungal activity of liposomal nystatin in comparison with nystatin, amphotericin B cholesteryl sulphate, liposomal amphotericin B lipid complex, amphotericin B desoxycholate, fluconazole and itraconazole. J Antimicrob Chemother. 1999;44(3):397-401.
• Marquez L, Quave CL. Prevalence, and therapeutic challenges of fungal drug resistance: role for plants in drug discovery. Antibiotics. 2020;9(4):150.
• Frías-De-León MG, Hernández-Castro R, Conde-Cuevas E, et al. Candida glabrata antifungal resistance and virulence factors, a perfect pathogenic combination. Pharmaceutics. 2021;13(10): 1529.