A six-year hospital-based surveillance study on burden of esophageal candidiasis in Gangtok, Sikkim

Shrijana Gurung; Tara Devi Sharma; Suresh Madan Rasaily; Raju Singh; Peralam Yegneswaran Prakash

doi:10.18502/ijm.v14i4.10247

Shrijana Gurung Department of Microbiology, Sir Thutob Namgyal Memorial Hospital, Gangtok, Sikkim, India
Tara Devi Sharma Department of Microbiology, Sir Thutob Namgyal Memorial Hospital, Gangtok, Sikkim, India
Suresh Madan Rasaily Department of Gastroenterology, Sir Thutob Namgyal Memorial Hospital, Gangtok, Sikkim, India
Raju Singh Health & Family Welfare Department, Community Health Centre, Rhenock Hospital, East Sikkim, India
Peralam Yegneswaran Prakash Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

DOI: https://doi.org/10.18502/ijm.v14i4.10247

Keywords: Candida; Candidiasis; Esophagitis; Antifungal; Endoscopy; Amphotericin B; Fluconazole; Caspofungin

Abstract

Background and Objectives: Esophageal candidiasis once thought to be restricted amongst immunocompromised patients is being increasingly reported among non-immunocompromised individuals. It is debilitating and if not treated well may cause chronic long-lasting infections. The objective of this study was to identify the various species of Candida causing esophageal candidiasis and analyse their antifungal susceptibility pattern.

Materials and Methods: This was an observational, prospective study. Total of 108 patients who attended the Gastroenter- ology Department of Sir Thutob Namgyal Memorial Hospital, Govt of Sikkim, Gangtok, India between July 2012 – May 2018 were included in the study. They had complaints of upper gastrointestinal disturbances and chronic dyspeptic symptoms that required an endoscopy. Esophageal biopsy and brushings were taken and were transported to Microbiology Department. They were subjected to microscopic observation, fungal culture on Sabourauds dextrose agar. Preliminary species identifica- tion was done by chlamydospore formation and growth characteristics on CHROMagar Candida. Species confirmation and antifungal susceptibility testing was done on VITEK 2 system at Microbiology Department, Kasturba Medical College and Hospital, MAHE, Manipal, Karnataka, India.

Results: A total of 108 patients were screened among which 73 samples were positive for Candida species and species iden- tification and antifungal susceptibility was performed. Forty fiveisolates were found to be C. albicans, 8 were C. glabrata, 4 were C. tropicalis, 3 were C. lusitaniae 2 were C. krusei, 2 were C. lipolyticaand 1 was C. parapsilosis. Eight isolates could not be identified and were recorded as Candida spp. C. albicans isolates were predominantly sensitive strain with suscep- tibility of 95% for both amphotericin B and fluconazole and 100% for caspofungin. C. glabrata showed high resistance to fluconazole with one isolate showing intermediate resistance to caspofungin.

Conclusion: Upper gastrointestinal symptoms even in non-immunocompromised patients need to be screened by endoscopy to rule out esophageal candidiasis. With the emergence of drug resistant non albicans Candida species diagnostic testing laboratories should include Candida species identification and antifungal susceptibility testing facility to provide effective patient care.