A Study on the Prevalence of Oropharyngeal Candidiasis in the Immunocompromised Individuals and their Antifungal Susceptibility Pattern in Tirunelveli Medical College Hospital.

Lucy, - (2007) A Study on the Prevalence of Oropharyngeal Candidiasis in the Immunocompromised Individuals and their Antifungal Susceptibility Pattern in Tirunelveli Medical College Hospital. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

INTRODUCTION : Historically, the fungi were regarded as relatively insignificant causes of infection and only until recently did clinical laboratories offer little more than passing interest in providing mycologic services. It is now well documented that the fungi are common causes of infection, particularly in immune compromised patients. The incidence of fungal infections is increasing at an alarming rate, presenting an enormous challenge to healthcare professionals. This increase is directly related to the growing population of immunocompromised individuals, resulting from changes in medical practice such as the use of intensive chemotherapy,radiotherapy and immunosuppressive drugs. HIV and other diseases which cause immunosuppression have also contributed to this problem. Systemic fungal infections may be caused by either an opportunistic organism that infects an at-risk host, or may be associated with a more invasive organism that is endemic to a specific geographical area. Systemic infections can be life threatening and are associated with high morbidity and mortality. Because diagnosis is difficult and the causative agent is often confirmed only at autopsy, the exact incidence of systemic infections is difficult to determine. The most frequently encountered pathogens are Candida albicans and Aspergillus spp. but other fungi such as non-albicans Candida spp. are increasingly important. AIMS AND OBJECTIVES : To study the prevalence of oropharyngeal candidiasis in the immune compromised individuals mainly, patients on radiotherapy, HIV infected and the diabetic patients who attended Tirunelveli Medical College Hospital. Objectives: 1. To detect the occurrence of Candida by Grams staining, Culture on Sabouraud’s Dextrose Agar. 2. To speciate the Candida by Germ tube test, Growth on Cornmeal Agar Tween 80, Sunflower Seed Husk Agar, Opalescence on Tween 80 Medium, Specific colour on CHROM agar candida, Morphology on Cornmeal Agar Tween 80, Carbohydrate Assimilation on Yeast nitrogen base medium. 3. To find out the antifungal susceptibility of the candida isolates by the disc diffusion method approved by NCCLS M44 – P document. MATERIALS AND METHODS : This prospective study was conducted at Tirunelveli Medical College Hospital for a period of 18 months from January 2005 – June 2006. The study group included immunocompromised individuals – patients who received radiotherapy for malignancies of the oral cavity, patients attending the Voluntary Counseling and Testing Center (VCTC), and the patients attending the diabetic out patient department. Inclusion criteria: 1. Patients who had received external beam radiotherapy (EBRT- 45 Gy in15days, 3Gy / day) and developed oral candidiasis. 2. Patients who were proved HIV (human immunodeficiency virus) positive by double ELISA method with clinical stages B1, B2, B3 according to CDC classification. (Symptomatic and CD4count >500cells/ml(B1), 200-500cells/ml(B2),<200cells/ml) or stage 3 of WHO clinical staging. 3. Patients with uncontrolled diabetes for more than a year. Exclusion criteria: 1. Patients on EBRT (external beam radiotherapy) for oral malignancies for <15days without any oral complication. 2. Patients proved HIV positive by double ELISA method but who were not in stage 3 of WHO clinical staging. 3. Patients with known history of diabetes for a short period (6 months). A total of 190 immunocompromised individuals were studied and evaluated for the occurrence of candidiasis. Speciation & antifungal susceptibility pattern of the yeast isolates were done. RESULTS : In the radiotherapy unit, 90 OPC samples were collected from patients who had received External Beam Radio Therapy (EBRT) for malignancy of the oral cavity for a period of 15 days. In VCTC, 58 samples were taken from HIV infected individuals. In the Diabetic out patient department, 42 samples were taken from individuals who had uncontrolled diabetes mellitus for more than a year. CONCLUSION : As C. albicans is a normal human commensal, it is not surprising that this organism is the most common opportunistic fungal pathogen in immunocompromised patients.105Colonization of the oropharynx and/or the alimentary tract often precedes invasive yeast infections. The incidence of oropharyngeal candidiasis is high among the diabetics. The males are more affected due to the associated risk factors like smoking, alcoholism and tobacco chewing. The age group above 30yrs is at high risk of developing oropharyngeal candidiasis. C.albicans is the most frequent species isolated from the post radiotherapy patients and HIV positive individuals. C.tropicalis is the predominant species in the diabetics. Direct microscopy using Grams stain and primary isolation on Sabourauds dextrose agar is the most simple, economic and easy method for the isolation of the Candida.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Oropharyngeal Candidiasis ; Prevalence ; Immunocompromised Individuals ; Antifungal Susceptibility Pattern ; Tirunelveli Medical College Hospital.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 14 Aug 2017 04:36
Last Modified: 14 Aug 2017 04:36
URI: http://repository-tnmgrmu.ac.in/id/eprint/1424

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