Salehi Mohammadreza, Ahmadikia Kazem, Mahmoudi Shahram, Kalantari Saeed, Jamalimoghadamsiahkali Saeidreza, Izadi Alireza, Kord Mohammad, Dehghan Manshadi Seyed Ali, Seifi Arash, Ghiasvand Fereshteh, Khajavirad Nasim, Ebrahimi Saeedeh, Koohfar Amirhossein, Boekhout Teun, Khodavaisy Sadegh
Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran.
Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Mycoses. 2020 Aug;63(8):771-778. doi: 10.1111/myc.13137. Epub 2020 Jul 23.
Emergence of coronavirus disease 2019 (COVID-19) is a major healthcare threat. Apparently, the novel coronavirus (SARS-CoV-2) is armed by special abilities to spread and dysregulate the immune mechanisms. The likelihood of oropharyngeal candidiasis (OPC) development in COVID-19 patients with a list of attributable risk factors for oral infections has not yet been investigated.
We here aim to investigate the prevalence, causative agents and antifungal susceptibility pattern of OPC in Iranian COVID-19 patients.
A total of 53 hospitalised COVID-19 patients with OPC were studied. Relevant clinical data were mined. Strain identification was performed by 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, amphotericin B, caspofungin, micafungin and anidulafungin was performed according to the CLSI broth dilution method.
In 53 COVID-19 patients with OPC, cardiovascular diseases (52.83%) and diabetes (37.7%) were the principal underlying conditions. The most common risk factor was lymphopaenia (71%). In total, 65 Candida isolates causing OPC were recovered. C albicans (70.7%) was the most common, followed by C glabrata (10.7%), C dubliniensis (9.2%), C parapsilosis sensu stricto (4.6%), C tropicalis (3%) and Pichia kudriavzevii (=C krusei, 1.5%). Majority of the Candida isolates were susceptible to all three classes of antifungal drugs.
Our data clarified some concerns regarding the occurrence of OPC in Iranian COVID-19 patients. Further studies should be conducted to design an appropriate prophylaxis programme and improve management of OPC in critically ill COVID-19 patients.
2019年冠状病毒病（COVID-19）的出现是对医疗保健的重大威胁。显然，新型冠状病毒（SARS-CoV-2）具有特殊的传播能力，并能破坏免疫机制。尚未对具有一系列口腔感染归因风险因素的COVID-19患者发生口腔念珠菌病（OPC）的可能性进行研究。
我们旨在调查伊朗COVID-19患者中OPC的患病率、病原体及抗真菌药敏模式。
共研究了53例住院的COVID-19合并OPC患者。挖掘相关临床数据。通过21重PCR和内部转录间隔区（ITS1-5.8S-ITS2）测序进行菌株鉴定。根据CLSI肉汤稀释法对氟康唑、伊曲康唑、伏立康唑、两性霉素B、卡泊芬净、米卡芬净和阿尼芬净进行抗真菌药敏试验。
在53例COVID-19合并OPC患者中，心血管疾病（52.83%）和糖尿病（37.7%）是主要的基础疾病。最常见的危险因素是淋巴细胞减少（71%）。共分离出65株引起OPC的念珠菌。白色念珠菌（70.7%）最常见，其次是光滑念珠菌（10.7%）、都柏林念珠菌（9.2%）、近平滑念珠菌（4.6%）、热带念珠菌（3%）和季也蒙毕赤酵母（=克鲁斯念珠菌，1.5%）。大多数念珠菌分离株对所有三类抗真菌药物敏感。
我们的数据澄清了一些关于伊朗COVID-19患者中OPC发生情况的问题。应进一步开展研究，以设计适当的预防方案，并改善危重症COVID-
