The Evaluation of the virulence factors of clinical Candida isolates and the anti-biofilm activity of Elettaria cardamomum against multi-drug resistant Candida albicans

Background and Purpose: Today, treatment of life-threatening fungal infections, caused by Candida species, has become a major problem. In the present study, we aimed to evaluate the antifungal susceptibility patterns of different clinical Candida isolates, determine the virulence factors in multi-drug resistant (MDR) Candida species, and assess the anti-biofilm activity of Elettaria cardamomum against MDR Candida species. Materials and Methods: A total of 202 isolates from different Candida species were obtained from three governmental hospitals in Senthamangalam, Tiruchengode, and Namakkal, Tamil Nadu, India. The isolates were identified, using conventional methods. Candida species were tested for virulence factors such as biofilm, protease, and phospholipase activity. The minimum inhibitory concentration (MIC) of Elettaria cardamomum against MDR biofilm-forming C. albicans was determined, using plate and tube methods. Results:The identified Candida isolates (n=202) were C. albicans (74/202), C. glabrata (53/202), C. parapsilosis (44/202), C. tropicalis (15/202), and C. dubliniensis (16/202). The isolates were subjected to antifungal susceptibility testing and the virulence factors were determined. In terms of biofilm production, non-C. albicans species such as C. dubliniensis showed 75% activity. Also, regarding protease activity, C. parapsilosis (75%) showed the highest percentage of protease production. In addition, Candida species showed strong positivity for phospholipase activity (62.87%). In the MIC method, the acetonic extract completely inhibited biofilm production at a concentration of 125 μl (56.25 μg). In comparison with the ethanolic extract, the acetonic extract showed major activity against biofilm production. Conclusion: Based on the findings, pathogenic C. albicans species were inhibited by the ethanolic and acetonic extracts of E. cardamomum. In recent years, MDR and biofilm-forming pathogenic Candida species have been increasingly detected in clinical settings. Therefore, herbal derivatives might contribute to the treatment of infections without causing any sideeffects and prevent the associated mortality.