Candida Co-Infection with Mycobacterium tuberculosis in Tuberculosis Patients and Antifungal Susceptibility of the Isolates

Abstract

It had been observed that tuberculosis (TB) subjects can be co-infected with Candida sp. which was previously assumed as normal flora of the oral cavity. Candida sp. might become an opportunistic pathogen in immune compromised individuals. Candida co-infection with Mycobacterium tuberculosis in TB patients might complicate underlying disease process in the lungs. Materials and Methods: A total of 400 sputum samples were collected from TB patients and examined using Ziehl-Neelsen staining technique and MDR/RIF Genexpert system for TB. Samples positive for Mycobacterium tuberculosis were cultured on Sabouraud Dextrose Agar with gentamicin and examined for the presence of budding yeast cells and pseudohyphae on Gram’s stain. Candida sp. isolated from TB positive sputa were cultured on CHROMager Candida for identification to species level and subjected to antifungal susceptibility testing. Results: Out of 400 sputum samples examined for TB 93 (23.3%) were positive and 32 (34.4%) out of 93 TB positive cases were co-infected with Candida sp. Candida albicans was the most predominant species with a prevalence of 23 (67.6%), C. tropicals 4 (11.8%), C. krusei 4 (11.8%) and C. parapsilosis 3 (8.8%). One sample had dual infection. Female subjects had high prevalence (19.4%) than the male (15.7%). Age group 31 - 40 years had both high prevalence of TB 32.3% and Candida 25.0%. Antifungal susceptibility testing showed that isolated Candida sp. were more susceptible to vericonazole and fluconazole compared to nystatin. Conclusions: Tuberculosis weakens the immune systems of infected persons especially when prophylactic administration proves abortive or there is non-adherence to treatment prescriptions. This may cause the development of multidrug resistance TB. Candida sp. may utilize these opportunities to establish alongside M. tuberculosis and worsen treatment and patient condition. For good treatment of TB, Candida co-infection should be screened concomitantly with TB in TB suspected individuals.