EVALUATION OF CANDIDIASIS AND ITS SUSCEPTIBILITY PATTERN IN PATIENTS UNDERGOING RADIOTHERAPY AND CHEMOTHERAPY

Shyam Kishor Kumar, Balram ji Omar, Priyanka Bajpai, Ashish Kothari, Aroop Mohanty, Ravi Shankar

Abstract


Background: Radiotherapy & chemotherapy, which lead to immunosuppression, act as favourable conditions for Candida to develop as pathogen.

Materials & Methods: We included 120 cases treated either with radiotherapy or chemotherapy after taking consent. Samples from tongue were collected with a sterile cotton swab and processed according to standard protocol. Candida species identification was done by germ tube test, Chrome agar media (HI media) and Corn meal agar. Antifungal susceptibility was done by disc diffusion method for Amphotericin B, Nystatin, Voriconazole, Fluconazole and Itraconazole.

Result: Out of 120 cases, 100 cases yielded positive for candidiasis. Out of 100 positive cases, 46% were presented with oral carcinoma, 11% presented with gastrointestinal carcinoma, 8% with breast carcinoma, 20% with other carcinoma and 15% with non-malignant cases. 86% patients were treated with radiotherapy and 14% with chemotherapy. Total 84 isolates were identified by both Chrome agar and Corn meal agar. Fungal isolates were Candida albicans (28%), Candida tropicalis (25%), Candida parapsilosis (11%), Candida glabrata (15%), Candida krusei (5%) and 16% unidentified Candida species. Nystatin and Amphotericin B were the most effective antifungal drugs. However, all Candida krusei were resistant against both of these drugs. Fluconazole was not much effective except Candida tropicalis which showed 60% sensitive. All Candida albicans & Candida tropicalis were resistant to voriconazole while all Candida parapsilosis, Candida glabrata & Candida krusei were resistant to itraconazole.  

Conclusion: Non-albicans Candida are getting increased over Candida albicans. Only Chrome agar or Corn meal agar is not sufficient for species identification. Some other methods like sugar assimilation tests or molecular tests should be used. Not only fluconazole or itraconazole, even Amphotericin B, Nystatin and Voriconazole are showing marked resistance, so antifungal susceptibility test is necessary for target therapy to achieve better outcome.


Keywords


radiotherapy, chemotherapy, Chrome agar, antifungal susceptibility test

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