Skip to main content
  • Original article
  • Open access
  • Published:

Speciation of Candida isolates obtained from diarrheal stool

Abstract

Introduction

Candida is the most common fungi causing diarrhea. As pathogenesis and susceptibility to antifungals might vary in different species of Candida, their speciation is essential.

Objective

The aim of this study was to identify different species of Candida and investigate their antifungal susceptibility pattern.

Materials and methods

Of 2036 diarrheal stool samples, 212 samples were microscopically positive for budding yeast cells. We selected 50 of these samples and cultured on blood agar and MacConkey agar and incubated at 37°C for 18–24 h. Tiny colonies confirmed by means of Gram staining as budding yeast cells were subcultured on Sabouraud’s dextrose agar. Speciation of Candida was carried out using the germ tube test and inoculation into chrome agar and corn meal agar. Antifungal susceptibility testing was carried out as per CLSI guidelines using voriconazole, fluconazole, itraconazole, and amphotericin B.

Results

Candida was mostly isolated from children younger than 12 years (50%) and from male patients. A total of 64 isolates were obtained. Candida krusei (52%) was the most common isolate, followed by Candida tropicalis (16%), Candida albicans (0.02%), and Candida parapsilosis (0.01%). The isolates were mostly susceptible to voriconazole (97.4%), itraconazole (79.4%), amphotericin B (66.6%), and fluconazole (18%).

Conclusion

Candida diarrhea was mostly seen in individuals younger than 12 years, most commonly caused by C. krusei. Resistance to fluconazole was high. A rising resistance to amphotericin B is alarming. Speciation of Candida is important to see the difference in antifungal susceptibility in different species.

References

  1. Enweani IB, Obi CL, Jokpeyibo M. Prevalence of Candida species in Nigerian children with diarrhoea. J Diarrhoeal Dis Res 1994; 12: 133–135.

    CAS  PubMed  Google Scholar 

  2. Warren NG, Shadomy JH. Yeasts of medical importance. In: Balows A, Hausler WJ, Herrmann KL, et al., editors. Manual of clinical microbiology. Washington, DC: American Society for Microbiology; 1991. 617–629.

  3. Vazquez JA, Beckley A, Sobel JD, Zervos MJ. Comparison of restriction enzyme analysis versus pulsed-field gradient gel electrophoresis as a typing systems for Candida albicans. J Clin Microbiol 1991; 29: 962–967.

    Article  CAS  Google Scholar 

  4. Cohen R, Roth FJ, Delgado E, Ahearn DG, Kalser MH. Fungal flora of the normal human small and large intestine. N Engl J Med 1969; 280: 638–641.

    Article  CAS  Google Scholar 

  5. CLSI. Method for Antifungal Disk Diffusion Susceptibility Testing of Yeasts; Approved Guideline—Second Edition. CLSI document M44-A2. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.

  6. Vaishnavi C, Kaur S, Prakash S. Speciation of fecal Candida isolates in antibiotic-associated diarrhea in non-HIV patients. Jpn J Infect Dis 2008; 61: 1–4.

    PubMed  Google Scholar 

  7. Payne S, Gibson G, Wynne A, Hudspith B, Brostoff J, Tuohy K. In vitro studies on colonization resistance of the human gut microbiota to Candida albicans and the effects of tetracycline and Lactobacillus plantarum LPK. Curr Issues Intest Microbiol 2003; 4: 1–8.

    CAS  PubMed  Google Scholar 

  8. Helstrom PB, Balish E. Effect of oral tetracycline, the microbial flora, and the athymic state on gastrointestinal colonization and infection of BALB/c mice with Candida albicans. Infect Immun 1979; 23: 764–774.

    Article  CAS  Google Scholar 

  9. Uppal B, Rizvi M, Kaur R. Candida associated diarhoea in hospitalized children. Ind J Bio Res 2003; 50: 13–19.

    Google Scholar 

  10. Krause R, Schwab E, Bachhiesl D, Daxböck F, Wenisch C, Krejs GJ, Reisinger EC. Role of Candida in antibiotic-associated diarrhea. J Infect Dis 2001; 184: 1065–1069.

    Article  CAS  Google Scholar 

  11. Banerjee P, Kaur R, Uppal B. Study of fungal isolates in patients with chronic diarrhea at a tertiary care hospital in north India. J Mycol Med 2013; 23: 21–26.

    Article  CAS  Google Scholar 

  12. Babin D, Kotigadde S, Rao PS, Rao TV. Clinico-mycological profile of vaginal candidiasis in a tertiary care hospital in Kerala. Int J Res Bio Sci 2013; 3: 55–59.

    Google Scholar 

  13. Roopa C, Biradar SK. Isolation of Candida and its speciation in various samples in a tertiary care hospital in North Karnataka, India. Int J Curr Microbiol App Sci 2015; 4: 996–1000.

    CAS  Google Scholar 

  14. Patel LR, Pethani JD, Bhatia P, Rathod SD, Shah PD. Prevalence of Candida infection and its antifungal susceptibility pattern in tertiary care hospital, Ahmedabad. Natl J Med Res 2012; 2: 439–441.

    CAS  Google Scholar 

  15. Kashid RA, Belawadi S, Devi G, Indumati. Characterization and antifungal susceptibility testing for Candida species in a tertiary care hospital. J Health Sci Res 2011; 2: 1–7.

    Google Scholar 

  16. Vazquez JA, Sobel JD. Mucosal candidiasis. Infect Dis Clin N Am 2002; 16: 793–820.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Pragyan S. Panda MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uppal, B., Panda, P.S., Kishor, S. et al. Speciation of Candida isolates obtained from diarrheal stool. Egypt J Intern Med 28, 66–70 (2016). https://doi.org/10.4103/1110-7782.193888

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-7782.193888

Keywords