In vitro antifungal susceptibility of Candida spp.
DOI:
https://doi.org/10.51481/amc.v65i2.1263Keywords:
Antifungical agents, Candida spp., Fluconazole, itraconazole, amorolfine, ciclopirox, onychomycosisAbstract
Aim. The purpose of this investigation was to determine the in vitro susceptibility patterns of Candida spp. isolated from onychomycosis, in order to contribute with strategies for optimal clinical laboratory management of patients with onychomycosis infected with these yeasts.
Methods. A total of 23 isolates of Candida spp. were identified with the automatized system Vitek®2 (system bioMérieux, France). In vitro susceptibility patterns were evaluated with two topic antifungals (amorolfine and ciclopirox) and two systemic antifungals (fluconazole and itraconazole) using the Clinical Laboratory and Standards Institute (CLSI) broth microdilution M27-A3 guidelines.
Results. Most of the isolates were identified as Candida parapsilosis (34,8 %), followed by C. albicans (30,3 %), C. guilliermondii (17,4 %), C. tropicalis (8,7 %), C. dubliniensis (4,4 %) and C. krusei (4,4 %). There were no statistically significant differences among the MICs of the antifungals tested. However, there was one isolate of C. guilliermondii with high MIC for fluconazole and one fluconazole resistant isolate of C. parapsilosis.
Conclusions. Susceptibility tests are only recommended internationally for Candida spp. isolated from blood stream or tissue in systemic infections. In every other candidiasis there is only a species identification, while its susceptibility pattern for treatment is reviewed in literature. Therefore, it is important to report that Candida no-albicans isolates from onychomycosis, especially C. guilliermondii and C. parapsilosis, have a reduced susceptibility to some antifungals commonly used for treatment. According to the obtained in vitro results, we recommend performing antifungal susceptibility testing in those cases of onychomycosis caused by Candida spp. no responsive to treatment.
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References
Kaur R, Kashyap B, Bhalla P. Onychomycosis - Epidemiology, Diagnosis and Management. Indian J Med Microbiol. 2008; 26:108-116. DOI:10.1016/s0255-0857(21)01924-1
Jayatilake JAMS, Tilakaratne WM, Panagoda GJ. Candidal onychomycosis: A mini-review. Mycopathologia. 2009; 168:165-173. DOI:10.1007/s11046-009-9212-x
Alvarado A, Hernández-Álvarez G, Fernández R, Arenas R. Onicomicosis por Candida en las uñas de las manos. Dermatol Rev Mex. 2014; 58:323-330.
Salas-Campos I, Chaves-Madrigal O. Agentes de onicomicosis en Costa Rica. Rev Costarri Cienc Med. 2004; 25:43-47.
Salas Campos I, Gross Martínez N. Agentes etiológicos de onicomicosis diagnosticadas en el laboratorio de micología médica de la Universidad de Costa Rica. Acta med costarric. 2012; 54:114-118.
Manzano-Gayosso P, Méndez-Tovar LJ, Arenas R, Hernández-Hernández F, Millán-Chiu B, Torres-Rodríguez J, et al. Levaduras causantes de onicomicosis en cuatro centros dermatológicos mexicanos y su sensibilidad antifúngica a compuestos azólicos. Rev Iberoam Micol. 2011; 28:32-35. DOI:10.1016/j.riam.2010.11.002
Molina VD, Espíndola YS, de La Paz AS, Deseuza AS, Ponce-Olivera RM, Araiza J, et al. Onychomycosis caused by three Candida species. Dermatologia Cosmet Med y Quir. 2013; 11:23-25.
Ballesté R, Mousqués N, Gezuele E. Onicomicosis: revisión del tema. Rev Med Urug. 2003; 19:93-106.
Cathcart S, Cantrell W, Elewski B. Onychomycosis and diabetes. J Eur Acad Dermatol Venereol 2009; 23:1119-1122. DOI:10.1111/j.1468-3083.2009.03225.x
Lipner SR, Scher RK. Onychomycosis: Treatment and prevention of recurrence. J Am Acad Dermatol. 2019; 80:853-867. DOI:10.1016/j.jaad.2018.05.1260
Tabara K, Szewczyk AE, Bienias W, Wojciechowska A, Pastuszka M, Oszukowska M, et al. Amorolfine vs. ciclopirox - lacquers for the treatment of onychomycosis. Postepy Dermatol Alergol. 2015; 32:40-45. DOI:10.5114/pdia.2014.40968
Alfaro S. DA, González F. CG. Onicomicosis en pediatría: Actualización y tratamiento. Rev Chil Pediatr. 2020; 91:131-138. DOI:10.32641/rchped.v91i1.1309
Aggarwal R, Targhotra M, Kumar B, Sahoo PK, Chauhan MK. Treatment and management strategies of onychomycosis. J Mycol Med. 2020; 30:100949. DOI:10.1016/j.mycmed.2020.100949
Pakshir K, Zomorodian K, Zakaei A, Motamedi M, Rahimi Ghiasi M, Karamitalab M. Molecular identification and in-vitro antifungal susceptibility testing of Candida species isolated from patients with onychomycosis. Curr Med Mycol. 2015; 1:26-32. DOI:10.18869/acadpub.cmm.1.4.2610
Sav H, Baris A, Turan D, Altinbas R, Sen S. The frequency, antifungal susceptibility and enzymatic profiles of Candida species in cases of onychomycosis infection. Microb Pathog. 2018; 116:257-262. DOI:10.1016/j.micpath.2018.01.036
Ataides FS, Chaul MH, el Essal FE, Costa CR, Souza L, Fernandes O, et al. Antifungal susceptibility patterns of yeasts and filamentous fungi isolated from nail infection. J Eur Acad Dermatol Venereol. 2012; 26:1479-1485. DOI:10.1111/j.1468-3083.2011.04315.x
Youssef A ben, Kallel A, Azaiz Z, Jemel S, Bada N, Chouchen A, et al. Onychomycosis: Which fungal species are involved? Experience of the Laboratory of Parasitology-Mycology of the Rabta Hospital of Tunis. J Mycol Med. 2018; 28:651-654. DOI:10.1016/j.mycmed.2018.07.005
Zuluaga de C A, de Bedout C, Tabares A, Cano LE, Restrepo A, Arango M, et al. Comportamiento de los agentes etiológicos de las onicomicosis en un laboratorio de micología de referencia (Medellín 1994-2003). Med Cutan Ibero Lat Am. 2005; 33:251-256.
Mobin M, Szeszs MW, Takahashi JP, Martins M, Porto JC, Teles JB, et al. Antifungal susceptibility of Candida species isolated from horticulturists with onychomycosis in Piauí, Brazil. Iran. J Public Health. 2018; 47:1816-1821.
Salas I, Gross N, Carrillo P. Micosis superficiales diagnosticadas en el laboratorio de micología médica de la Universidad de Costa Rica. Rev Costarric Cienc Med. 2007; 28:29-35.
Carrillo Dover P, Alvarez Vega C, Salas Campos I, Mora Brenes N. Aislamiento de Candida spp. y otras levaduras en el personal que labora en áreas críticas del Hospital San Juan de Dios. Acta med costarric 2009; 51:165-171. DOI:10.51481/amc.v51i3.443
Villalobos JM, Castro JA, Avilés Á, Peláez MC, Somogyi T, Sandoval L. Candida parapsilosis: principal causa de candidemia en un hospital de referencia para adultos de Costa Rica. Rev Chilena Infectol. 2016; 33:159-165.
Kokjohn K, Bradley M, Griffiths B, Ghannoum M. Evaluation of in vitro activity of ciclopirox olamine, butenafine HCl and econazole nitrate against dermatophytes, yeasts and bacteria. Int J Dermatol. 2003; 42:11-17. DOI:10.1046/j.1365-4362.42.s1.4.x
Gupta AK, Kohli Y. In vitro susceptibility testing of ciclopirox, terbinafine, ketoconazole and itraconazole against dermatophytes and non dermatophytes, and in vitro evaluation of combination antifungal activity. Br J Dermatol. 2003; 149:296-305. DOI:10.1046/j.1365-2133.2003.05418.x
Teixeira Figueiredo V, de Assis Santos D, Resende MA, Soares Hamdan J. Identification and in vitro antifungal susceptibility testing of 200 clinical isolates of Candida spp. responsible for fingernail infections. Mycopathologia. 2007; 164:27-33. DOI:10.1007/s11046-007-9027-6
Kwok YKC, Tay YK, Goh CL, Kamarudin A, Koh MT, Seow CS. Epidemiology and in vitro activity of antimycotics against candidal vaginal/skin/nail infections in Singapore. Int J Dermatol. 1998; 37:145-149. DOI:10.1046/j.1365-4362.1998.00038.x
Li R, Wan Z, Wang AP, Shen YN, Lu CM, Li M, et al. In vitro susceptibility testing of amorolfine in pathogenic fungi isolated from dermatomycosis patients in China. Mycoses. 2004; 47:402-406. DOI:10.1111/j.1439-0507.2004.01014.x
de Vroey C, Desmet P, Mukamurangwa P, Li Z, Raes-Wuytack C. Further studies on the in vitro antifungal activity of amorolfine. Mycoses. 1996; 39:41-44.
Lestringant GG, Nsanze H, Nada M, Usmani MA, Micallef RA, Montague A, et al. Effectiveness of amorolfine 5 % nail lacquer in the treatment of long-duration Candida onychomycosis with chronic paronychia. J Dermatolog Treat. 1996; 7:89-92. DOI:10.3109/09546639609089536
Jaikel-Víquez D, Villalobos-Castro S, Ortiz-Solano D, Chaves-González LE, Gross NT. Antifungal activity of fluconazole, itraconazole, voriconazole, amphotericin B and caspofungin against Candida parapsilosis blood isolates. Acta Sci Microbiol. 2020; 3:53-58. DOI:10.31080/ASMI.2020.03.0677
Singh A, Singh PK, de Groot T, Kumar A, Mathur P, Tarai B, et al. Emergence of clonal fluconazole-resistant Candida parapsilosis clinical isolates in a multicentre laboratory-based surveillance study in India. J Antimicrob Chemother. 2019; 74:1260-1268. DOI:10.1093/jac/dkz029
Magobo RE, Lockhart SR, Govender NP. Fluconazole-resistant Candida parapsilosis strains with a Y132F substitution in the ERG11 gene causing invasive infections in a neonatal unit, South Africa. Mycoses. 2020; 63:471-477. DOI:10.1111/myc.13070
Papp C, Bohner F, Kocsis K, Varga M, Szekeres A, Bodai L, et al. Triazole evolution of Candida parapsilosis results in cross-resistance to other antifungal drugs, influences stress responses, and alters virulence in an antifungal drug-dependent manner. mSphere. 2020; 5:1-15. DOI:https://doi.org/ 10.1128/mSphere.00821-20.
Pfaller MA, Diekema DJ, Mendez M, Kibbler C, Erzsebet P, Chang SC, et al. Candida guilliermondii, an opportunistic fungal pathogen with decreased susceptibility to fluconazole: Geographic and temporal trends
from the ARTEMIS DISK antifungal surveillance program. J Clin Microbiol. 2006; 44:3551-3556.
DOI:10.1128/JCM.00865-06
Savini V, Catavitello C, di Marzio I, Masciarelli G, Astolfi D, Balbinot A, et al. Pan-azole-resistant Candida
guilliermondii from a leukemia patient's silent funguria. Mycopathologia. 2010; 169:457-459. DOI:10.1007/s11046-010-9278-5
Tietz HJ, Czaika V, Sterry W. Case report. Osteomyelitis caused by high resistant Candida guilliermondii. Mycoses. 1999; 42:577-580. DOI:10.1046/j.1439-0507.1999.00497.x
Girmenia C, Pizzarelli G, Cristini F, Barchiesi F, Spreghini E, Scalise G, et al. Candida guilliermondii fungemia in patients with hematologic malignancies. J Clin Microbiol. 2006; 44:2458-2464. DOI:10.1128/JCM.00356-06
Vieille Oyarzo P, Cruz Choappa R. Onicomicosis por levaduras: agentes y estudio de sensibilidad en la región de Valparaíso, Chile. Rev Iberoam Micol 2015; 32:129-133. DOI:10.1016/j.riam.2014.03.001
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