Candidiasis in Immunnocompromised Patients; Comparison between C. albicans and Non-albicans regarding the Type of Infection, Biofilm Formation and Virulence Genetic Profile

Document Type : New and original researches in the field of Microbiology.

Authors

1 Department of Clinical Microbiology and Immunology, National Liver Institute, Menoufia University, Egypt

2 Department of Medical Microbiology and Immunology, Faculty of Medicine, Menoufia University, Egypt

3 Department of Clinical Pathology, National Liver Institute, Menoufia University, Egypt

4 Depatment of Hepatology and Gastroenterology, National Liver Institute, Menoufia University,, Egypt

Abstract

Background: Fungal infections have been on the rise during the last few decades. Immunnocompromised patients are at risk for developing deep mycotic infections of which invasive candidiasis (IC) is particularly serious. Although Candida albicans is the most common cause of IC, other species such as C. krusei, C. tropicalis, and C. parapsilosis have also been recovered with variable virulence factors. Objectives: We compared between albicans and non-albicans Candida infections among immunnocompromised patients admitted to the National Liver Institute (NLI) and Menoufia University Hospitals (MUH) as regards the incidence and type of infection, ability of biofilm formation as well as the virulence genetic profile. Methodology: 42 Candida isolates were collected from different types of infections and classified as C.albicans and C. non-albicans according to their characteristic reactions on Brilliance™ Candida Chromogenic Agar. The biofilm-forming ability of the isolated species was demonstrated phenotypically by the microtitre plate method (MTP) and multiplex PCR assay verified the existence of the contributing virulence genes. Results: Out of 42 Candida isolates, 9 (21.4%), 26 (61.9%) and 7 isolates (16.6%) were recovered from superficial, invasive and device associated infections respectively. The number of non-albicans spp. exceeded that of C.albicans [25/42(59.52%): 17/42(40.48%)] and the highest frequency was for C. parapsilosis (14/25:56%) followed by C. tropicalis (8/25:32%) and finally C. krusei (3/25:12%).The percentage of biofilm-forming isolates was 94.1% for C. albicans and 72% for non-albicans Candida spp. with no significant statistical difference (P> 0.05). The expression of HWP1 gene was significantly higher in biofilm-forming Candida spp. (P= 0.02). Conclusion: Infections due to non-albicans species are rising especially in immunosuppressed patients. HWP1, ALS1, SAP5 and PLB1 genes were all detected in both C. albicans and non- albicans and the majority of isolated Candida spp. were biofilm producers.

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