Isolation of Candida africana in oral candidiasis: First report among cancer patients in Iran

Document Type: Case report

Authors

1 Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medial Sciences, Tehran, Iran

3 Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background and Purpose: Oropharyngeal candidiasis (OPC) is a fungal infection of the oral cavity caused by the members of C. albicans complex. Although C. africana, as a part of the complex, is considered to be mostly responsible for the development of vulvovaginal candidiasis, it may be associated with a wider clinical spectrum.
Case report: This report described two cases diagnosed with oral candidiasis during the receipt of treatment for malignancies. Conventional and molecular tests were performed on the samples collected from the patients’ oral cavities. The test results revealed C. africana as the causative agent of oral candidiasis. Furthermore, in vitro antifungal susceptibility test indicated the full susceptibility of all C. africana isolates to caspofungin. However, the data were also suggestive of the resistance against fluconazole and amphotericin B. Caspofungin was used as the main antifungal agent for the treatment of oral candidiasis, resulting in the improvement of thrush in patients. The resistance of C. africana to fluconazole and amphotericin B suggests the necessity of performing in vitro susceptibility testing on the isolates for the selection of appropriate antifungal agents.
Conclusion: As the findings indicated, the achievement of knowledge regarding C. africana as an emerging non-albicans Candida species and its antifungal susceptibility profile is crucial to select antifungal prophylaxis and empirical therapy for oral candidiasis in cancer patients undergoing chemotherapy.

Keywords


1. Koohi F, Salehiniya H, Shamlou R, Eslami S, Ghojogh ZM, Kor Y, et al. Leukemia in Iran: epidemiology and morphology trends. Asian Pac J Cancer Prev. 2015; 16(17):7759-63.
2. Ansari S, Shirzadi E, Elahi M. The prevalence of fungal infections in children with hematologic malignancy in Ali-Asghar Children Hospital between 2005 and 2010. Iran J Ped Hematol Oncol. 2015; 5(1):1-10.
3. Badiee P, Badali H, Boekhout T, Diba K, Moghadam AG, Nasab AH, et al. Antifungal susceptibility testing of Candida species isolated from the immunocompromised patients admitted to ten university hospitals in Iran: comparison of colonizing and infecting isolates. BMC Infect Dis. 2017; 17(1):727.
4. Turner SA, Butler G. The Candida pathogenic species complex. Cold Spring Harbor Perspect Med. 2014; 4(9):a019778.
5. Romeo O, Tietz HJ, Criseo G. Candida africana: is it a fungal pathogen? Curr Fungal Infect Rep. 2013; 7(3):192-7.
6. Castagnola E, Mikulska M, Viscoli C. Prophylaxis and empirical therapy of infection in cancer patients. In: Bennett JE, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 9th ed: New York: Elsevier; 2020. P. 3628-53.
7. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016; 62(4):e1-50.
8. Ghajari A, Lotfali E, Ahmadi NA, Fassihi PN, Shahmohammadi N, Ansari S, et al. Isolation of different species of Candida in patients with vulvovaginal candidiasis from Damavand, Iran. Arch Clin Infect Dis. 2018; 13(6):e5929.
9. Romeo O, Criseo G. First molecular method for discriminating between Candida africana, Candida albicans, and Candida dubliniensis by using hwp1 gene. Diagn Microbiol Infect Dis. 2008; 62(2):230-3.
10. Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts, approved standard. CLSI document M27-A2. Wayne P: Clinical and Laboratory Standards Institute; 2002.
11. Nnadi NE, Ayanbimpe GM, Scordino F, Okolo MO, Enweani IB, Criseo G, et al. Isolation and molecular characterization of Candida africana from Jos, Nigeria. Med Mycol. 2012; 50(7):765-7.
12. Sharifynia S, Badali H, Sharifi SM, Shidfar MR, Hadian A, Shahrokhi S, et al. In vitro antifungal susceptibility profiles of Candida albicans complex isolated from patients with respiratory infections. Acta Med Iran. 2016; 54(6):376-81.
13. Khedri S, Santos A, Roudbary M, Hadighi R, Falahati M, Farahyar S, et al. Iranian HIV/AIDS patients with oropharyngeal candidiasis: identification, prevalence and antifungal susceptibility of Candida species. Lett Appl Microbiol. 2018; 67(4):392-9.
14. Garnacho-Montero J, Díaz-Martín A, García-Cabrera E, de Pipaón MRP, Hernández-Caballero C, Aznar-Martín J, et al. Risk factors for fluconazole-resistant candidemia. Antimicrob Agents Chemother. 2010; 54(8):3149-54.
15. Zhu Y, Shi Y, Fan SR, Liu XP, Yang J, Zhong SL. Multilocus sequence typing analysis of Candida africana from vulvovaginal candidiasis. BMC Infect Dis. 2019; 19(1):461.
16. Perlin DS. Mechanisms of echinocandin antifungal drug resistance. Ann N Y Acad Sci. 2015; 1354(1):1.
17. Yang F, Zhang L, Wakabayashi H, Myers J, Jiang Y, Cao Y, et al. Tolerance to caspofungin in Candida albicans is associated with at least three distinctive mechanisms that govern expression
of FKS genes and cell wall remodeling. Antimicrob Agents Chemother. 2017; 61(5):e00071-17.
18. McCarthy M, O’Shaughnessy EM, Walsh TJ. Amphotericin B: polyene resistance mechanisms. Antimicrobial Drug Resist. 2017; 26:387-95.
19. Graman PS. Esophagitis. In: Bennett JE, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 9th ed. New York: Elsevier; 2020. P. 1340-5.