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Omosigho P O, Oghogho G P, Osayekewmen U V, Okesanya O J, Oladejo J M, Osarodion U P. Characterization and antifungal susceptibility patterns of candida species isolated from a tertiary hospital in Benin city, Nigeria. mljgoums 2025; 19 (3) :31-35
URL: http://mlj.goums.ac.ir/article-1-1711-en.html
URL: http://mlj.goums.ac.ir/article-1-1711-en.html
Pius Omoruyi Omosigho1 
, Guobadia Precious Oghogho1 , Ugiagbe Victory Osayekewmen1 , Olalekan John Okesanya2 , Janet Mosunmola Oladejo3 , Uyigue Paulinus Osarodion4
, Guobadia Precious Oghogho1 , Ugiagbe Victory Osayekewmen1 , Olalekan John Okesanya2 , Janet Mosunmola Oladejo3 , Uyigue Paulinus Osarodion4
1- Department of Medical Laboratory Science, Edo State University, Uzairue, Benin City, Benin, Nigeria
2- Department of Medical Laboratory Science, Neuropsychiatric Hospital Aro, Abeokuta, Ogun State, Nigeria ,okesanyaolalekanjohn@gmail.com
3- Department of Medical Laboratory Science, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
4- Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
2- Department of Medical Laboratory Science, Neuropsychiatric Hospital Aro, Abeokuta, Ogun State, Nigeria ,
3- Department of Medical Laboratory Science, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
4- Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
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Discussion
C. albicans and non-albicans candidiasis have been prevalent etiological agents causing candidiasis of human origin, ranging from localized infections to systemic colonization. This study investigated the characterization, speciation, and antibiogram of Candida species from clinical specimens of human origin from all age groups and genders. A total of 104 Candida isolates from various clinical specimens were included in this study. Candida was mainly isolated from high vaginal swabs (n=48; 46.2%), corresponding with previous works (13,14). C. albicans was the most common species isolated in this study (72.1%). This is due to its widespread prevalence in clinical practice and ubiquity in the human body, which agrees well with some studies (5,11), as well as disagrees with previous work stating C. glabrata to be the most commonly isolated species (14,15). The prevalence of Candida species varies due to factors like study populations, geographic areas, healthcare settings, and identification methods. Additionally, antifungal medication use and resistance patterns may impact the frequency of Candida species in clinical settings (16).
This finding reaffirms the high prevalence of Candida albicans and a gradual shift toward non-Candida albicans species, suggesting that non-Candida albicans are emerging as important pathogens in human infection (17). The identification of different Candida strains holds significant importance in epidemiological research and laboratory diagnosis, particularly due to the increasing prevalence of antifungal resistance and the shifting trends in resistance patterns observed in both C. albicans and non-Candida albicans species (18). Although Candida species can be found causing various infections that can occur at all ages, this study showed the highest prevalence among the age group 30-44 years at 41.3%, followed by 15-29 years at 25.3%, which is in line with the findings of studies (5,19,20) that reported high prevalence of candidiasis in the age group 21-40 years. This suggests that the 30-44 years age range represents the peak of childbearing in Nigerian societies due to many socio-demographic factors delaying young couples from settling down early (21). Advancement in age, on the other hand, reduces the effect of the estrogen hormone in women, which could lead to lower infection rates as women advance in age. Most women aged over 50 years might have reached menopause and are less or not sexually active, suggesting the reason why there is a decrease in the prevalence rate of Candida among these older age groups (22). Numerous factors, including immune status, hormonal changes, underlying medical conditions, lifestyle choices, sexual activity, personal hygiene practices, and genetic predisposition, can be linked to the varying prevalence of candidiasis among different age groups. It is a complex phenomenon that is influenced by several elements that work together to determine the risk of candidiasis in particular age groups (23).
A high female preponderance of candidiasis of 86 out of 104 was found in this study, with a species distribution of 61 (81.3%) Candida albicans, which agrees well with Omosigho et al., 2019 (5). Among females, vulvovaginal candidiasis represents the most prevalent form of genital candidiasis. Females are more likely to develop candidiasis due to various factors, including Candida fungus, hormonal fluctuations, contraceptive use, weakened immune responses, sexual activity, personal hygiene, tight clothing, and certain medications. Genetic susceptibility and differences in female anatomy also contribute to the higher incidence of candidiasis in women (24,25). A higher frequency of high vaginal swabs (49.3%) with Candida isolates confirms higher prevalence of vulvovaginal candidiasis among females of reproductive age in Benin, which is consistent with previous studies (5,26). High vaginal swabs are more likely to detect candidiasis due to their focus on the vaginal region, a common site for Candida colonization, making them the suitable specimen of choice for diagnosis (27,28).
The study illustrates how different Candida species and antifungal medications have varying degrees of resistance. Overall, Candida albicans exhibited significant resistance to Amphotericin B and Fluconazole, while other species showed mixed susceptibility patterns. In some species, drug resistance was statistically significant, suggesting a higher potential pathogenicity for those medications. The drug resistance pattern and overall pathogenicity of Candida species are dependent on the antifungal drugs as well as the species. The mixed and resistant patterns to antibiotics among Candida species can be attributed to intrinsic and acquired resistance mechanisms, alterations in drug targets, efflux pumps, and biofilm formation (29). The overuse of antifungal drugs, impaired host immunity, and cross-resistance also play significant roles (30). Antifungal susceptibility among Candida species varies; this could be due to differences in resistance, local resistance patterns, drug-resistant strains, and widespread use of antifungal medications. Patient-specific factors like health conditions and prior treatment also impact susceptibility. This complex interplay contributes to the diversity in antifungal susceptibility observed among Candida species (29,31). Comprehending the drug resistance patterns of Candida species is crucial for the betterment of patient treatment, public health, and upcoming drug research initiatives. It lowers the possibility of epidemics, improves patient outcomes, and enables more focused and efficient treatment of fungal diseases (32). Some of the limitations of this study include a small sample size and a single-center design. Additionally, the study focused on a limited set of antifungal agents, and the underlying mechanisms of antifungal resistance were not investigated. Incomplete patient data, such as comorbidities and treatment history, further restrict comprehensive analysis of Candida infections and resistance patterns. There are drawbacks to using CHROMagar to speciate Candida species, such as the possibility of misidentification and the inability to reliably identify new or unusual species. It is advised that future research consider molecular techniques, which provide more accuracy and specificity in species identification, to overcome these constraints. Addressing these limitations in future research is essential to gain a more comprehensive understanding of Candida infections and to develop effective strategies for prevention and treatment.
Conclusion
Understanding the Candida species and their susceptibility to antifungal drugs is crucial for selecting effective treatment. The rising rates of antifungal resistance in Candida isolates are concerning, necessitating continuous monitoring of susceptibility patterns and investigation of resistance mechanisms. Instances of breakthrough infections underscore the importance of staying vigilant in addressing this issue. The growing occurrence of less common Candida species that show resistance to currently available antifungal drugs, along with the emergence of new resistance mechanisms, underscores the significance of conducting both local and global surveillance studies. These studies are essential for monitoring the changing epidemiology of Candida infections and guiding the development of effective strategies to combat the challenges posed by antifungal resistance.
Acknowledgement
None.
Funding sources
We declare that no funding was received for this work.
Ethical statement
Ethical approval was obtained from the Ethics Committee, Edo State University, Uzairue, with the reference number EDSU/AHS/ERC/VOL.1/25/2022.
Conflicts of interest
The authors declare no conflicts of interest.
Author contributions
Pius Omoruyi Omosigho, Ugiagbe Victory Osayekewmen, Guobadia Precious Oghogho, Okesanya Olalekan John, Oladejo Janet Mosunmola, and Uyigue Paulinus Osarodion conceived and designed the research, reviewed, analyzed, performed the research, interpreted the data, wrote the paper, supervised, reviewed, edited, and proofread. All authors have read and approved the final draft of this paper.
Data availability statement
The dataset generated during this study is available from the corresponding author upon reasonable request.
Full-Text: (69 Views)
Introduction
Candidiasis can be caused by various types of Candida yeast, which belong to the natural microorganisms found on the skin, mucous membranes, and gastrointestinal tract (1). Following birth, Candida species establish themselves on the mucosal surfaces of all individuals, creating a constant risk of endogenous infection. Among systemic fungal infections, candidiasis is the most widespread, with Candida albicans, Candida parapsilosis, Candida glabrata, Candida tropicalis, Candida guilliermondii, and Candida dubliniensis being the most commonly identified agents (2). Candida species are the primary opportunistic fungal pathogens that have an impact on patients receiving medical care in healthcare settings. Among newborns, Candida species rank as the third most isolated microorganism in cases of invasive infections (3). In critical neonates, the morbidity and mortality rates associated with invasive candidiasis can be as high as 59%. Furthermore, around 60% of neonates who survive such infections may experience neurodegenerative complications. Newborns who are admitted to a neonatal intensive care unit possess an underdeveloped immune system due to factors such as low birth weight, prematurity, and external risk factors (Such as the use of central venous catheters and parenteral nutrition). These factors increase their vulnerability to invasive infections (4). CHROMagar Candida is a specialized medium used to isolate and distinguish the primary clinical species of Candida. It exhibits a high degree of specificity and sensitivity for three major Candida species: Candida albicans, Candida tropicalis, and Candida krusei. Candida isolates were cultured on CHROMagar Candida and incubated aerobically at 37°C for 36 to 48 hours. The identification of Candida species was based on the production of characteristic colors on the medium (5).
The infection caused by Candida species occurs when there is an imbalance in the parasite–host relationship, a consequence of the association between the inefficiency of individual defenses and the expression of virulence factors by microorganisms. Although C. albicans remains the main causative pathogen, the increasing isolations of non-Candida albicans species resistant to first- and second-line antifungals in nosocomial infections is concerning (6).
Candida species’ resistance to antifungal medicines is often attributed to mutations in genes or other alterations in the drug target. The prevalence and impact of Candida species infections in Nigeria, including their resistance to antifungal drugs, remain poorly understood. There is a need to investigate the epidemiology, antifungal susceptibility patterns, risk factors, and clinical outcomes associated with Candida infections in Nigerian populations to develop effective strategies for prevention, diagnosis, and treatment. This study aims to specify different species of Candida isolates and perform antifungal susceptibility testing from different clinical specimens of the in- and out-patients attending Edo State Specialist Hospital in Benin, Edo State, Nigeria.
Methods
Study settings and design: A simple random sampling technique was used in selecting participants in a cross-sectional and prospective survey to characterize and perform antifungal susceptibility testing on Candida isolates from clinical specimens of patients attending the Edo State Specialist Hospital, Nigeria. The sample size of 346 was calculated by a formula given by (7), with a 95% confidence level, a 5% margin of error, and a prevalence of Candida in Asaba, Nigeria, of 34.25% (8). A total of 104 Candida isolates from various clinical specimens were included in this study.
Data and sample collection: The bar data of the patients were collected from the laboratory register. The data obtained included socio-demographic characteristics. Candida isolates of each patient were collected and subcultured onto Sabouraud dextrose agar (SDA) slants and incubated at 37℃. Data collected from the fungal analysis of the collected samples were collated and analyzed statistically.
Isolate identification and antifungal susceptibility test: Every isolate diagnosed as a Candida species was included in this study. These isolates were inoculated on modified SDA slants that had gentamycin and chloramphenicol added. They were incubated for a duration of 24 to 48 hours at 37°C in an aerobic environment. In the case of blood culture, 5 mL of blood was withdrawn aseptically and subsequently cultured in Brain Heart Infusion broth. The cultures were then incubated for 96 hours at 37°C. Species identification was done on the isolates that had obvious growth on the SDA slants. This required performing tests on a colony recovered from the sample using macroscopic assessment, Gram staining technique, urea hydrolysis, and germ tube testing, and their morphological characteristics were observed. Colonies that were creamy and yeasty, showed Gram-positive budding yeast cells with pseudohyphae under a microscope, and produced negative urea hydrolysis test results were then subcultured on CHROMagar for the identification of Candida species (9).
CHROMagar™ Candida (HiMedia, Mumbai, India), a selective and differential medium, was employed to specifically inhibit the growth of microorganisms other than Candida (10). The subcultured CHROMagar plate was incubated at 37°C for 24-48 hours. After 24 hours of incubation, colonies produced different hues, with Candida albicans colonies producing a green color, Candida tropicalis colonies producing a metallic blue color, Candida krusei colonies producing a pink color, and Candida glabrata producing a mauve color (11). Using the disc diffusion method, antifungal susceptibility testing for Candida isolates was conducted following the Clinical and Laboratory Standards Institute M44-A recommendations. Three to five colonies of growth were suspended in five milliliters of sterile saline, which had been adjusted to match the turbidity of a 0.5 McFarland Standard. This inoculum was streaked on Mueller-Hinton agar, and the susceptibility of fungal growth was evaluated. Following a 24-hour incubation period at 37°C, the zone of inhibition surrounding the discs was assessed (9,12).
Statistical analysis: All data were encoded into Excel spreadsheets and analyzed using IBM SPSS version 20.0. The variables were expressed as means and standard deviations. Student's t-test and ANOVA were the statistical methods used. Levels of significance were considered at P < 0.05.
Ethical considerations: Before the commencement of the study, permission was obtained from the Chief Medical Director of Edo State Specialist Hospital. Ethical approval was sought and obtained from the Ethics Committee, Edo State University, Uzairue, Nigeria, with the reference number EDSU/AHS/ERC/VOL.1/25/2022.
Results
In Table 1, a total of 104 Candida species were isolated from the specimens. The distribution of Candida revealed that high vaginal swabs had the highest frequency for Candida species (n=48; 46.2%), followed by urine (n=23; 22.1%), endocervical swab (n=12; 11.5%), catheter tip (n=11; 10.6%), wound swab (n=4; 3.8%), ear swab (n=3; 2.9%), and the least, abdominal drain efflux (n=1; 1.0%). The distribution of Candida species presented Candida albicans with the highest frequency (n=75; 72.1%), followed by Candida krusei (n=18; 17.3%), Candida tropicalis (n=8; 7.7%), and Candida glabrata ((n=3; 2.9%), respectively (Table 1). The age distribution of Candida species among the participants in the study showed that Candida albicans had the highest frequency (n=31; 41.3%) between ages 30-44. Moreover, C. krusei had the highest frequency (n=7; 38.9%), followed by C. tropicalis (n=3, 37.5%), in the age group 30-44 years. In addition, C. glabrata had a frequency of 1 (33.3%) in the age groups 30-44 years, 45-59 years, and 60-74 years, respectively. There was no statistically significant difference (P = 0.065) between age and Candida species distribution among the participants, as revealed in Table 2.
Candidiasis can be caused by various types of Candida yeast, which belong to the natural microorganisms found on the skin, mucous membranes, and gastrointestinal tract (1). Following birth, Candida species establish themselves on the mucosal surfaces of all individuals, creating a constant risk of endogenous infection. Among systemic fungal infections, candidiasis is the most widespread, with Candida albicans, Candida parapsilosis, Candida glabrata, Candida tropicalis, Candida guilliermondii, and Candida dubliniensis being the most commonly identified agents (2). Candida species are the primary opportunistic fungal pathogens that have an impact on patients receiving medical care in healthcare settings. Among newborns, Candida species rank as the third most isolated microorganism in cases of invasive infections (3). In critical neonates, the morbidity and mortality rates associated with invasive candidiasis can be as high as 59%. Furthermore, around 60% of neonates who survive such infections may experience neurodegenerative complications. Newborns who are admitted to a neonatal intensive care unit possess an underdeveloped immune system due to factors such as low birth weight, prematurity, and external risk factors (Such as the use of central venous catheters and parenteral nutrition). These factors increase their vulnerability to invasive infections (4). CHROMagar Candida is a specialized medium used to isolate and distinguish the primary clinical species of Candida. It exhibits a high degree of specificity and sensitivity for three major Candida species: Candida albicans, Candida tropicalis, and Candida krusei. Candida isolates were cultured on CHROMagar Candida and incubated aerobically at 37°C for 36 to 48 hours. The identification of Candida species was based on the production of characteristic colors on the medium (5).
The infection caused by Candida species occurs when there is an imbalance in the parasite–host relationship, a consequence of the association between the inefficiency of individual defenses and the expression of virulence factors by microorganisms. Although C. albicans remains the main causative pathogen, the increasing isolations of non-Candida albicans species resistant to first- and second-line antifungals in nosocomial infections is concerning (6).
Candida species’ resistance to antifungal medicines is often attributed to mutations in genes or other alterations in the drug target. The prevalence and impact of Candida species infections in Nigeria, including their resistance to antifungal drugs, remain poorly understood. There is a need to investigate the epidemiology, antifungal susceptibility patterns, risk factors, and clinical outcomes associated with Candida infections in Nigerian populations to develop effective strategies for prevention, diagnosis, and treatment. This study aims to specify different species of Candida isolates and perform antifungal susceptibility testing from different clinical specimens of the in- and out-patients attending Edo State Specialist Hospital in Benin, Edo State, Nigeria.
Methods
Study settings and design: A simple random sampling technique was used in selecting participants in a cross-sectional and prospective survey to characterize and perform antifungal susceptibility testing on Candida isolates from clinical specimens of patients attending the Edo State Specialist Hospital, Nigeria. The sample size of 346 was calculated by a formula given by (7), with a 95% confidence level, a 5% margin of error, and a prevalence of Candida in Asaba, Nigeria, of 34.25% (8). A total of 104 Candida isolates from various clinical specimens were included in this study.
Data and sample collection: The bar data of the patients were collected from the laboratory register. The data obtained included socio-demographic characteristics. Candida isolates of each patient were collected and subcultured onto Sabouraud dextrose agar (SDA) slants and incubated at 37℃. Data collected from the fungal analysis of the collected samples were collated and analyzed statistically.
Isolate identification and antifungal susceptibility test: Every isolate diagnosed as a Candida species was included in this study. These isolates were inoculated on modified SDA slants that had gentamycin and chloramphenicol added. They were incubated for a duration of 24 to 48 hours at 37°C in an aerobic environment. In the case of blood culture, 5 mL of blood was withdrawn aseptically and subsequently cultured in Brain Heart Infusion broth. The cultures were then incubated for 96 hours at 37°C. Species identification was done on the isolates that had obvious growth on the SDA slants. This required performing tests on a colony recovered from the sample using macroscopic assessment, Gram staining technique, urea hydrolysis, and germ tube testing, and their morphological characteristics were observed. Colonies that were creamy and yeasty, showed Gram-positive budding yeast cells with pseudohyphae under a microscope, and produced negative urea hydrolysis test results were then subcultured on CHROMagar for the identification of Candida species (9).
CHROMagar™ Candida (HiMedia, Mumbai, India), a selective and differential medium, was employed to specifically inhibit the growth of microorganisms other than Candida (10). The subcultured CHROMagar plate was incubated at 37°C for 24-48 hours. After 24 hours of incubation, colonies produced different hues, with Candida albicans colonies producing a green color, Candida tropicalis colonies producing a metallic blue color, Candida krusei colonies producing a pink color, and Candida glabrata producing a mauve color (11). Using the disc diffusion method, antifungal susceptibility testing for Candida isolates was conducted following the Clinical and Laboratory Standards Institute M44-A recommendations. Three to five colonies of growth were suspended in five milliliters of sterile saline, which had been adjusted to match the turbidity of a 0.5 McFarland Standard. This inoculum was streaked on Mueller-Hinton agar, and the susceptibility of fungal growth was evaluated. Following a 24-hour incubation period at 37°C, the zone of inhibition surrounding the discs was assessed (9,12).
Statistical analysis: All data were encoded into Excel spreadsheets and analyzed using IBM SPSS version 20.0. The variables were expressed as means and standard deviations. Student's t-test and ANOVA were the statistical methods used. Levels of significance were considered at P < 0.05.
Ethical considerations: Before the commencement of the study, permission was obtained from the Chief Medical Director of Edo State Specialist Hospital. Ethical approval was sought and obtained from the Ethics Committee, Edo State University, Uzairue, Nigeria, with the reference number EDSU/AHS/ERC/VOL.1/25/2022.
Results
In Table 1, a total of 104 Candida species were isolated from the specimens. The distribution of Candida revealed that high vaginal swabs had the highest frequency for Candida species (n=48; 46.2%), followed by urine (n=23; 22.1%), endocervical swab (n=12; 11.5%), catheter tip (n=11; 10.6%), wound swab (n=4; 3.8%), ear swab (n=3; 2.9%), and the least, abdominal drain efflux (n=1; 1.0%). The distribution of Candida species presented Candida albicans with the highest frequency (n=75; 72.1%), followed by Candida krusei (n=18; 17.3%), Candida tropicalis (n=8; 7.7%), and Candida glabrata ((n=3; 2.9%), respectively (Table 1). The age distribution of Candida species among the participants in the study showed that Candida albicans had the highest frequency (n=31; 41.3%) between ages 30-44. Moreover, C. krusei had the highest frequency (n=7; 38.9%), followed by C. tropicalis (n=3, 37.5%), in the age group 30-44 years. In addition, C. glabrata had a frequency of 1 (33.3%) in the age groups 30-44 years, 45-59 years, and 60-74 years, respectively. There was no statistically significant difference (P = 0.065) between age and Candida species distribution among the participants, as revealed in Table 2.
|
Table 1. Distribution of clinical specimens and frequency of candida isolates
.PNG) |
The gender distribution of Candida species in this study revealed that females had the highest frequency (n=61; 81.3%) of Candida albicans compared to males (n=14; 18.7%). Candida glabrata was only 3 (100%) in females; Candida krusei had the highest frequency of 16 (88.9%) in females compared to 2 (11.1%) in males; and Candida tropicalis had the highest frequency in females. There was no statistically significant relationship (P = 0.067) between gender and Candida species distribution, respectively, as shown in Table 2. C. albicans had the highest frequency of 37 (49.3%) in high vaginal swabs. C. krusei had the highest frequency, 8 (44.4%), in high vaginal swabs. C. tropicalis had the highest frequency in urine samples, 4 (50%). C. glabrata had a frequency of 1 (33.3%) each in catheter tips, ear swab, and urine samples, respectively. There was a statistically significant association (P = 0.05) between the type of specimen and Candida species distribution, respectively. Candida albicans had its highest frequency, 39 (52%), among the inpatients, while Candida glabrata was 2 (66.7%) among the inpatients. Candida krusei was 11 (61.7%) among the inpatients, while Candida tropicalis had its highest frequency, 5 (62.5%), among the outpatients (Table 2). There was no statistically significant relationship (P = 0.61) between patients' admission status and Candida species distribution. The antimicrobial susceptibility pattern of the Candida species to antifungal agents revealed that C. albicans was more susceptible to ketoconazole (n=47), Nystatin (n=40), and Fluconazole (n=39), while most were resistant to Amphotericin B (n=72). C. glabrata was more susceptible to Fluconazole (n=3). C. krusei was most resistant to Amphotericin B (n=16), while C. tropicalis was most susceptible to Fluconazole (n=8). There was a statistically significant association between Amphotericin B (P = 0.007) and Fluconazole (P = 0.028) with Candida species. However, no statistically significant association was observed between other antibiotics and Candida species distribution, as shown in Table 3.
.PNG)
.PNG)
Discussion
C. albicans and non-albicans candidiasis have been prevalent etiological agents causing candidiasis of human origin, ranging from localized infections to systemic colonization. This study investigated the characterization, speciation, and antibiogram of Candida species from clinical specimens of human origin from all age groups and genders. A total of 104 Candida isolates from various clinical specimens were included in this study. Candida was mainly isolated from high vaginal swabs (n=48; 46.2%), corresponding with previous works (13,14). C. albicans was the most common species isolated in this study (72.1%). This is due to its widespread prevalence in clinical practice and ubiquity in the human body, which agrees well with some studies (5,11), as well as disagrees with previous work stating C. glabrata to be the most commonly isolated species (14,15). The prevalence of Candida species varies due to factors like study populations, geographic areas, healthcare settings, and identification methods. Additionally, antifungal medication use and resistance patterns may impact the frequency of Candida species in clinical settings (16).
This finding reaffirms the high prevalence of Candida albicans and a gradual shift toward non-Candida albicans species, suggesting that non-Candida albicans are emerging as important pathogens in human infection (17). The identification of different Candida strains holds significant importance in epidemiological research and laboratory diagnosis, particularly due to the increasing prevalence of antifungal resistance and the shifting trends in resistance patterns observed in both C. albicans and non-Candida albicans species (18). Although Candida species can be found causing various infections that can occur at all ages, this study showed the highest prevalence among the age group 30-44 years at 41.3%, followed by 15-29 years at 25.3%, which is in line with the findings of studies (5,19,20) that reported high prevalence of candidiasis in the age group 21-40 years. This suggests that the 30-44 years age range represents the peak of childbearing in Nigerian societies due to many socio-demographic factors delaying young couples from settling down early (21). Advancement in age, on the other hand, reduces the effect of the estrogen hormone in women, which could lead to lower infection rates as women advance in age. Most women aged over 50 years might have reached menopause and are less or not sexually active, suggesting the reason why there is a decrease in the prevalence rate of Candida among these older age groups (22). Numerous factors, including immune status, hormonal changes, underlying medical conditions, lifestyle choices, sexual activity, personal hygiene practices, and genetic predisposition, can be linked to the varying prevalence of candidiasis among different age groups. It is a complex phenomenon that is influenced by several elements that work together to determine the risk of candidiasis in particular age groups (23).
A high female preponderance of candidiasis of 86 out of 104 was found in this study, with a species distribution of 61 (81.3%) Candida albicans, which agrees well with Omosigho et al., 2019 (5). Among females, vulvovaginal candidiasis represents the most prevalent form of genital candidiasis. Females are more likely to develop candidiasis due to various factors, including Candida fungus, hormonal fluctuations, contraceptive use, weakened immune responses, sexual activity, personal hygiene, tight clothing, and certain medications. Genetic susceptibility and differences in female anatomy also contribute to the higher incidence of candidiasis in women (24,25). A higher frequency of high vaginal swabs (49.3%) with Candida isolates confirms higher prevalence of vulvovaginal candidiasis among females of reproductive age in Benin, which is consistent with previous studies (5,26). High vaginal swabs are more likely to detect candidiasis due to their focus on the vaginal region, a common site for Candida colonization, making them the suitable specimen of choice for diagnosis (27,28).
The study illustrates how different Candida species and antifungal medications have varying degrees of resistance. Overall, Candida albicans exhibited significant resistance to Amphotericin B and Fluconazole, while other species showed mixed susceptibility patterns. In some species, drug resistance was statistically significant, suggesting a higher potential pathogenicity for those medications. The drug resistance pattern and overall pathogenicity of Candida species are dependent on the antifungal drugs as well as the species. The mixed and resistant patterns to antibiotics among Candida species can be attributed to intrinsic and acquired resistance mechanisms, alterations in drug targets, efflux pumps, and biofilm formation (29). The overuse of antifungal drugs, impaired host immunity, and cross-resistance also play significant roles (30). Antifungal susceptibility among Candida species varies; this could be due to differences in resistance, local resistance patterns, drug-resistant strains, and widespread use of antifungal medications. Patient-specific factors like health conditions and prior treatment also impact susceptibility. This complex interplay contributes to the diversity in antifungal susceptibility observed among Candida species (29,31). Comprehending the drug resistance patterns of Candida species is crucial for the betterment of patient treatment, public health, and upcoming drug research initiatives. It lowers the possibility of epidemics, improves patient outcomes, and enables more focused and efficient treatment of fungal diseases (32). Some of the limitations of this study include a small sample size and a single-center design. Additionally, the study focused on a limited set of antifungal agents, and the underlying mechanisms of antifungal resistance were not investigated. Incomplete patient data, such as comorbidities and treatment history, further restrict comprehensive analysis of Candida infections and resistance patterns. There are drawbacks to using CHROMagar to speciate Candida species, such as the possibility of misidentification and the inability to reliably identify new or unusual species. It is advised that future research consider molecular techniques, which provide more accuracy and specificity in species identification, to overcome these constraints. Addressing these limitations in future research is essential to gain a more comprehensive understanding of Candida infections and to develop effective strategies for prevention and treatment.
Conclusion
Understanding the Candida species and their susceptibility to antifungal drugs is crucial for selecting effective treatment. The rising rates of antifungal resistance in Candida isolates are concerning, necessitating continuous monitoring of susceptibility patterns and investigation of resistance mechanisms. Instances of breakthrough infections underscore the importance of staying vigilant in addressing this issue. The growing occurrence of less common Candida species that show resistance to currently available antifungal drugs, along with the emergence of new resistance mechanisms, underscores the significance of conducting both local and global surveillance studies. These studies are essential for monitoring the changing epidemiology of Candida infections and guiding the development of effective strategies to combat the challenges posed by antifungal resistance.
Acknowledgement
None.
Funding sources
We declare that no funding was received for this work.
Ethical statement
Ethical approval was obtained from the Ethics Committee, Edo State University, Uzairue, with the reference number EDSU/AHS/ERC/VOL.1/25/2022.
Conflicts of interest
The authors declare no conflicts of interest.
Author contributions
Pius Omoruyi Omosigho, Ugiagbe Victory Osayekewmen, Guobadia Precious Oghogho, Okesanya Olalekan John, Oladejo Janet Mosunmola, and Uyigue Paulinus Osarodion conceived and designed the research, reviewed, analyzed, performed the research, interpreted the data, wrote the paper, supervised, reviewed, edited, and proofread. All authors have read and approved the final draft of this paper.
Data availability statement
The dataset generated during this study is available from the corresponding author upon reasonable request.
Research Article: Research Article |
Subject:
Mycology
Received: 2023/08/31 | Accepted: 2024/05/20 | Published: 2025/06/22 | ePublished: 2025/06/22
Received: 2023/08/31 | Accepted: 2024/05/20 | Published: 2025/06/22 | ePublished: 2025/06/22
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