Introduction
A novel coronavirus (SARS-CoV-2), named as coronavirus disease-19 (COVID-19) became a major healthcare threat since December 2019. The incidence continued to increase and caused a pandemic with a great proportion of mortality even though global containment and quarantine attempts were strictly performed.
Due to undefined pharmacological treatment for COVID-19, some pathological oral conditions can be expected to be aggravated by SARS-CoV-2, especially in patients with a compromised immune mechanism, or that take long-term pharmacotherapies. Previously, it was reported that oropharyngeal candidiasis (OPC) might be a probable cause of morbidity in these patients that begins with colonization of the Candida species on the oral mucosa.
Aim
To explore the prevalence, causative agents, and antifungal susceptibility pattern of OPC in Iranian COVID-19 patients.
Methodology
In this cross-sectional study, researchers included a total of 53 hospitalized COVID‐19 patients with OPC among 1059 COVID‐19 patients and their clinical data were investigated. Strain identification was conducted by the help of 21‐plex PCR and sequencing of the internal transcribed spacer region (ITS1‐5.8S‐ITS2). Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, amphotericin B, caspofungin, micafungin and anidulafungin was conducted based on the CLSI broth dilution method.
Results
Among 53 COVID‐19 patients with OPC, cardiovascular diseases, and diabetes were the major underlying conditions and commonest risk factor was lymphopenia as depicted in Fig. 1.
On the whole, 65 Candida isolates causing OPC were recovered. C. albicans (most common) (70.7%), followed by C. glabrata (10.7%), C. dubliniensis (9.2%), C. parapsilosis sensu stricto (4.6%), C. tropicalis (3%), and Pichia kudriavzevii (=C. krusei, 1.5%) (see Fig. 2).
Most of the Candida isolates were susceptible to all three classes of antifungal drugs.
Overall, a high level of susceptibility to all the tested antifungal drugs was observed.
Amphotericin, anidulafungin and micafungin were the highly active drugs, and there was no case of resistance to these antifungal drugs found (see Table 1).
On the whole, narrowest and widest MIC ranges were found in drugs, anidulafungin and micafungin (0.008–0.016 μg/mL) and caspofungin (0.008–2 μg/ mL), respectively.
Conclusion
Researchers of the study opined that antifungal drugs such as anidulafungin, micafungin and amphotericin were the highly active drugs with high level of susceptibility with no case of resistance found in OPC in older adult COVID-19 patients.
Source: Salehi M, Ahmadikia K, Mahmoudi S, et al. Oropharyngeal candidiasis in hospitalised COVID-19 patients from Iran Species identification and antifungal susceptibility pattern. Mycoses. 2020;63(8):771–778.
