Invasive candidiasis in the Southeast-Asian region

Abstract

Invasive fungal infections (IFIs) are being reported at a rising frequency worldwide. Amongst the opportunistic mycoses, invasive candidiasis, aspergillosis and mucormycosis are the common infections reported from Asia. Although the precise epidemiology of IFIs in Asia remains largely unknown and the magnitude of the problem is not available for all countries, the existing literature suggests a unique epidemiology with respect to the spectrum of agents, risk factors and disease pattern. The present chapter focuses on distinct peculiarities of invasive candidiasis in South-Asian region, highlighting epidemiology, diagnosis and management modalities. The projected prevalence of invasive candidiasis in South-Asian countries (1-12 cases/1000 hospital admissions) is nearly 20-30 times higher than the developed world. Several reasons have been predicted for this high prevalence. The compromise in health care in overpopulated public sector hospitals is the one of the possible reasons, as Candida hand carriage rates are significantly high among health-care workers. For the same reason, nosocomial outbreaks have been reported due to rare yeasts like Kodamaea ohmeri and Pichia anomala. Candidemia remains the predominant clinical manifestation. Intra-abdominal candidiasis and Candida pancreatitis are emerging problems. Nearly 70-90% of the invasive candidiasis are caused by non-albicans Candida species, with Candida tropicalis being the most common (35-40%) in the tropical regions. A new multidrug-resistant clonal Candida auris has emerged recently in India, causing infection in critically ill patients. The rising azole resistance in so-called susceptible species, C. albicans and C. tropicalis, is a cause of concern. Echinocandin resistant C. glabrata is also reported. Diagnosis and management of invasive candidiasis remains a challenge in South-Asian settings, owing to high Candida colonization rates, late presentation to the hospitals, limited availability of newer diagnostic techniques and poor affordability of antifungal agents. Although echinocandin is the preferred first-line drug for invasive candidiasis, fluconazole and amphotericin B deoxycholate are prescribed in majority of critically ill and unstable patients owing to cost constraints.