CLINICAL AND MYCOLOGICAL STUDY OF MUCOCUTANEOUS CANDIDIASIS
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Keywords
Clinical, Mycological, Mucocutaneous Candidiasis.
Abstract
BACKGROUND: This study was conducted to evaluate the clinico-morphological pattern of mucocutaneous candidiasis, and to identify the species of Candida by culture, sugar fermentation and sugar assimilation tests.
METHODS: This was a hospital-based descriptive-case series that was carried out over the course of a year, among 64 patients who had been clinically diagnosed with mucocutaneous candidiasis. The study was approved by the institutional ethics committee, and the participants provided written informed consent.
RESULTS: Sixty-four patients with clinical diagnosis of mucocutaneous candidiasis excluding children below 5 years of age and patients with onychomycosis and paronychia were studied during a period of one year. Both the clinico-morphological and mycological aspects were studied. The age of patients ranged from 20 years to 78 years with a mean age of 45.89 years. The male to female ratio was 1:1.9 indicating a female preponderance. Diabetes mellitus was the most common co-morbid condition noted. Majority of the patients had several known predisposing factors. In this study, the most common clinical type of mucocutaneous candidiasis was intertrigo (42.2%) followed by oral candidiasis (32.8%). Among males, the most common clinical type was oral candidiasis (54%), whereas intertrigo (48%) was the predominant presentation among females. Genital candidiasis was twice more common in females than in males. Acute pseudo-membranous candidiasis accounted for 80.9% of oral candidiasis cases. Out of all the cases, direct microscopy by KOH mount was positive in 31.2% cases and correlation with culture showed significant level of agreement. Oral candidiasis had the highest rate of positive direct microscopy (38.10 %) while balanoposthitis had the lowest rate (0%). Fungal culture yielded Candida in 57.8% of the study population. The most common isolate was C.tropicalis (56.8%). Positive Candida culture was highest for oral candidiasis and balanoposthitis (66.7% each) and lowest for vulvovaginitis (46.2%). C.tropicalis (42.7%) was the most common species isolated in oral candidiasis followed by C.albicans (21.3%). The rest of the isolates were made up by C.parapsilosis (14.4%), C.glabrata and C.stellatoidea (7.2% each). In intertrigo, C.tropicalis accounted for 73.2% of the isolates, far outnumbering C.albicans, C.stellatoidea, C.parapsilosis and C.kefyr (6.7% each). C.tropicalis and C.stellatidea (33.3% each) together made up the majority in vulvovaginitis. The other isolates were C.albicans and C.glabrata (16.7% each). The two isolates obtained from balanoposthitis were identified as C.tropicalis.
CONCLUSION: The results of the study showed a significant change in the relative prevalence of the different species of Candida, with non-albicans Candida being the predominant isolate and C.tropicalis emerging as the most common species. Further research on Mucocutaneous Candidiasis is needed to determine whether this finding is unique or if it is the beginning of an emerging trend as seen in nosocomial candidaemia.
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Dr. Bismi Sherief
Consultant, Department of Dermatology, Dr. Yogiraj Centre for Dermatology and Cosmetology, Trivandrum, Kerala, India.
Dr. Lilakumari Subramoniam
Associate Professor, Department of Dermatology, Government Medical College, Kollam, Kerala, India.