Frequency and Distribution of the Clinical Presentation of Oral Candidiasis in Immunocompromised Patients with Candida and Non-Candida Genus Species

Abstract

Immunocompromised patients with symptoms compatible with mycoses in the oral mucosa can be caused by different etiological agents regardless of their clinical presentation or systemic disease. Yeast fungi have been described as disease markers for some specific diseases. That is why there is a tendency to carry out empirical treatments (Fluconazole) for oral mycosis, however these treatments are not always the best prescription or effective, due to ignorance of the strain or gender of the fungi. Thus, it’s always recommended to start with a phenotypic identification of the infection and complement it with a sensibilization test. The objectives of this study were to determine the distribution of Candida and Non-Candida species in immunocompromised patients with clinical symptoms of oral candidiasis.

For this, 145 patients with symptoms of oral candidiasis and immunocompromised, from different services of the Clínicas National Hospital of Córdoba, were selected over 16 pre-pandemic months. They were swabbed to confirm the disease mycologically. With the material obtained, the algorithm for isolation and phenotypic identification of yeasts was followed.

Of the 145, 127 patients presented clinically and mycologically confirmed oral candidiasis with the phenotypic march for yeast identification, the following species were isolated and identified: 1) Candida yeasts: (52%) C.albicans, (13%) C.tropicalis, (9%) C.glabrata, (7%) C.parapsilosis, (6%) C.dubliniensis, (5%) C. krussei, (2%) C.guilliermondii, (2%) C.kefyr, (1%) C.intermedia, C.lusitaniae, (1%) C.norvegensis, (1%) C.pararugosa; and 2) Non-Candida Yeasts: (1%) Trichosporon spp, (1%) Saccharomyces cerevisiae. There were n=150 samples of the 127 patients, unique (83%) and associated (17%).

With this we can conclude that the identification of species is essential when determining the appropriate treatment for the immunocompromised patient, since not all these yeasts are Candida species, so they may not be sensitive to commonly used azole antifungals. We then propose the identification of the yeasts, by means of an algorithm based on safe phenotypic methods and to carry out antifungal sensitivity tests in the presence of emerging species, little sensitive, or resistant to commonly used antifungals.