Candida and other yeasts of clinical importance in Aseer region, southern Saudi Arabia

رئاملخاو تاضيبلما راشتنا ىدم ديدتحو زييتمو لزع :فادهلأا .ةيدوعسلاب ريسع ةقطنم يف ةيمهلأا تاذ ىرخلأا تانيعلا نم 6100 ليلتح ةضرعتسلما ةساردلا هذه تلمتشا :ةقيرطلا ،اهبأ ،يزكرلما ريسع ىفشتسم ،ةقيقدلا ءايحلأا ربتخم ىلإ ةمدقلما لزعو 2012 و2011 ينب ام ةرتفلا للاخ ةيدوعسلا ةيبرعلا ةكلملما يتلا ةيكينيلكلاا تانيعلا فلتخم نم ةلوزعم ةريمخ 84 ديدتحو مادختساب م2013 و م2012 ينب ةقيقدلا ءايحلأا ربتخم ىلع تضرع .2 كيتيف يللآا ماظنلا ينب ام ةرتفلا للاخ يعجرلا رثلأاب ليلحتلا جئاتن ترهظأ :جئاتنلا ملع ربتخم ىلإ ةفلتخم ةنيع 6100 ينب نم نأ )م2012 -م2011( عيزوت .تاضيبلما عاونأ نم)2.35%( 143 دوجو ةقيقدلا ءايحلأا لوبلا :يلي امك ةيكينيلكلاا تانيعلل اقفو )143 ددع( تاضيبلما ؛4.2% مدلا ؛7% ةيئاوهلا ةبصقلا بوبنأ ؛10.5% مغلبلا ؛72% تازارفإ ؛0.7% ينعلا ةحسم ؛2.1% قللحا ةحسم ؛2.1% ةرطسقلا ةساردلا جئاتن تراشأ .0.7% يعاخنلا لئاسلاو 0.7% حورلجا يهو ةنيع 84 نم رئاملخا لزع )م2013 -م2012( ينب ام ةرتفلا للاخ ةضيبلماو 21.4%ةيطرلما ةضيبلما اهيلت ،)28.6%( ءاضيبلا ةضيبلما . 9.5% ةيناتيسوللا ةضيبلما ، 14.3% ةيرادلما ةضيبلماو ةيطرلما ةضيبلما نم ةيلاع بسن ةساردلا تفشك :ةتمالخا رثكلأا ءاضيبلا ةضيبلما ىلإ ةفاضلإاب ةيناتيسوللا ةضيبلماو ةيرادلما ىرخلأا رئاملخا ضعبو تاضيبلما عاونأ نم ديدعلا دوجو ينبت .اًعويش ردصلما يه لوبلا تانيع نأ دجو دقو اذه ،ةقطنلما يف ىلولأا ةرملل .ةساردلا هذه يف اهنع فشك يتلا تاضيبملل يسيئرلا Objectives: To isolate, identify, and determine the prevalence of Candida and other yeasts of clinical importance in Aseer region, Saudi Arabia. Methods: This is a cross-sectional study involving retrospective analysis of 6100 samples submitted to the Microbiology Laboratory, Aseer Central Hospital, Abha, Saudi Arabia between 2011 and 2012, and prospective isolation and identification of 84 isolates recovered from various clinical specimens presented to the Microbiology Laboratory between 2012 and 2013 using the classic morphological schemes and the Vitek 2 automated system. Results: The results of the retrospective analysis (20112012) indicated that of the 6100 various clinical specimens submitted to the routine microbiology analysis, 143 (2.35%) revealed the presence of Candida spp. The distribution of the 143 Candida spp. according to specimens was as follows: urine 72%, sputum 10.5%, endotracheal tube 7%, blood 4.2%, catheter tip 2.1%, throat swab 2.1%, eye swab 0.7%, wound exudates 0.7%, and cerebrospinal fluid 0.7%. The results of the prospective study (2012-2013), which involved the identification of yeast recovered from 84 specimens indicated that Candida albicans 28.6% was the predominant species, followed by Candida parapsilosis 21.4%, Candida tropicalis 14.3%, and Candida lusitaniae 9.5%. Conclusions: Along with the commonly encountered Candida albicans, Candida parapsilosis, Candida tropicalis, and Candida lusitaniae were detected with significant rates. Many other Candida species and some other pathogenic yeasts have been detected for the first time in the region. Urinary tract samples were the main source of Candida species. Saudi Med J 2014; Vol. 35 (10): 1210-1214 From the Department of Microbiology (Hamid, Joseph, Abdelrahim, Fadul, Al-Hakami), College of Medicine, King Khalid University and the Microbiology Laboratory (Assiry, Haimour, Al-Abed), Aseer Central Hospital, Abha, Kingdom of Saudi Arabia. Received 10th July 2014. Accepted 22nd July 2014. Address correspondence and reprint request to: Dr. Mohamed E. Hamid, Department of Microbiology, College of Medicine, King Khalid University, PO Box 641, Abha, Kingdom of Saudi Arabia. E-mail: [email protected] 1210 Saudi Med J 2014; Vol. 35 (10) www.smj.org.sa OPEN ACCESS 1211 www.smj.org.sa Saudi Med J 2014; Vol. 35 (10) Candida and other yeasts of clinical importance ... Hamid et al F diseases notably those due to candida have become an increasing risk to human health. This is particularly true among patients with immune compromised systems.1,2 Candida and Aspergillus species are the most common agents associated with invasive fungal infections.3 Candida infections like other fungal infections are believed to be opportunistic in nature, since some aspects of the host’s defense system is impaired in some way. On the contrary, Candida infections manifest in a variety of forms ranging from superficial skin conditions, onychomycosis, oral, vaginal infections to fatal invasive illnesses that involve vital body organs such as heart, lungs, and central nervous system.1,2 Candidiasis, notably candidemia continues to be a major cause of morbidity and mortality in the health care settings. Moreover, the epidemiology of Candida infection is changing.4,5 Candida species are frequently encountered as part of the human commensal flora. Colonization mostly paves the way to candidemia and is considered an independent risk factor for the development of candidemia.1,4 The frequency of nosocomial bloodstream infections by Candida species has risen dramatically in the past 2 decades. It has been found that more than two-thirds of patients with invasive candidiasis in ICUs have candidemia. Of these isolates, the non-albicans Candida species constituted about half of the isolates and death from these invasive ICU infections was notable.1 There is a lack of sufficient literature showing in a systematic way, the incidence of fungal infections in the Kingdom of Saudi Arabia. Available data indicated that fungal infections, generally, represent approximately 10% of reported laboratory diagnosed infections; whereas gram-positive organisms (10%), gram-negative organisms (32%), and the remaining 48% were polymicrobial.6,7 The aims of this study were to isolate, identify (prospectively), and to determine the prevalence (retrospectively) of Candida infections and other yeasts of clinical importance in Aseer region, Saudi Arabia. Methods. This is a cross-sectional study involving firstly, a retrospective analysis of 6100 samples submitted to the Microbiology Laboratory, Aseer Central Hospital, Abha, Saudi Arabia between February 2011 and January 2012. Clinical and microbiology data of positive cases were collected. Secondly, a prospective analysis was undertaken, which included the isolation and identification of strains presented to the laboratory from October 2012 to November 2013. This was carried out using initial phenotypic identification based on morphological and culture characteristics8 followed by confirmation using the Vitek 2 automated system. Samples included in this study were the ones with complete clinical records, requests from the relevant wards, and samples that met the criteria of submission. Samples that did not meet the above mentioned criteria were excluded from the study. Ethical approval. This research was approved by the Research Ethics Committee, College of Medicine, King Khalid University, Abha, Saudi Arabia. Isolation of yeasts. Fungal cultures were carried out on sabouraud dextrose agar (SDA) and Brain Heart Infusion Agar + 5% sheep blood (BHIA) plates. Inoculated plates were incubated at 30°C and examined daily for up to 10 days for yeast growth. Identification of yeasts. Identification of yeasts encountered during routine bacteriological cultures or from SDA and BHIA plates was performed using conventional growth and colonial morphology criteria.8 Confirmation of identification of Candida spp. by VITEK 2 system. The VITEK 2 automated system was used for confirming identities of Candida species following protocols described by the manufacturer (bioMérieux Inc., Durham, NC 27712, USA). The VITEK card consists of 64 wells that contain various fluorescent biochemical tests. Of these, 20 are carbohydrate assimilation; 4 are phosphatase, urea, nitrate, and actidione tests. When a test result is recorded as “low discrimination,” this means that the result is doubtful. In such cases, supplementary tests were carried out manually to resolve such uncertain findings. These supplementary tests were: microscopic detection of blastospores or arthrospores, apiculated cells, capsule, carotenoid pigment, convoluted colony, hyphae or pseudohyphae, sporangia, growth at 37°C, and growth without oil. The VITEK 2 device handled card automatically from filling, sealing then transferring them into the connected incubator (35°C). The cards are filled automatically every 15 min by a fluorescence system. Each output profile is decoded as per a specific algorithm. The obtained results were equated to the ID-YST (identification of yeasts) database. This, in most of the known yeast with clear cut profile, led to a correct identification of the unknown yeast. Results. Retrospective analysis of 6100 samples. Out of the 6100 various clinical specimens, 143 Disclosure. This research was funded by the Deanship of Scientific Research, King Khalid University, Abha, Kingdom of Saudi Arabia (Project No: 1433H/ 380).