Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Gastroenterology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
J Clin Lab Anal. 2021 Jul;35(7):e23826. doi: 10.1002/jcla.23826. Epub 2021 May 14.
Esophageal candidiasis is the most frequent form of esophagitis. The pathogenicity of Candida spp. is related to a combination of microbial factors, hydrolytic enzyme secretion and phenotypic switching. This study was designed to investigate esophageal candidiasis, antifungal activity, enzymatic activity patterns, phenotyping, and genotyping profiles of Candida albicans species.
Nine hundred thirty-three visited patients were evaluated, and esophageal biopsies from patients were included in this study during 2019-2020. Direct smear, Gram staining, and culture on CHROMagar were performed for each sample. Isolated species were identified with conventional procedures and PCR-RFLP. Susceptibility to antifungals was determined according to CLSI guidelines. ABC typing, phenotype switching, hemolysin, proteinase, phospholipase, and esterase activity were also determined with the appropriate protocols.
Twenty-three (2.5%) patients (mean age 55.2 years) were diagnosed with esophageal candidiasis. The species isolated were 19(82.6%) C. albicans, 3(13.1%) C. glabrata, and 1(4.3%) C. tropicalis. Genotype A (57.9%) was the predominant type in C. albicans isolates. 50% of C. albicans isolates exhibited a white phenotype. A high level of phospholipase (47.4%), hemolysin (68.4%), and proteinase activity (36.8%) was observed in the C. albicans isolates. Only three C. glabrata isolates displayed non-wild type susceptibility to voriconazole and itraconazole.
This study shows that C. albicans are still the most frequent isolates from patients with esophageal candidiasis. The predominance of genotype A, the white phenotype, and strong hemolysin activity may indicate a high prevalence of pathogenicity in these isolates. Sensitivity to antifungal drugs was greatest for amphotericin and fluconazole.
食管念珠菌病是最常见的食管炎形式。念珠菌属的致病性与微生物因素、水解酶分泌和表型转换的组合有关。本研究旨在调查食管念珠菌病、抗真菌活性、酶活性模式、表型和白念珠菌种的基因型谱。
对 933 名就诊患者进行评估，并在 2019-2020 年期间纳入该研究的食管活检患者。对每个样本进行直接涂片、革兰氏染色和 CHROMagar 培养。通过常规程序和 PCR-RFLP 鉴定分离出的物种。根据 CLSI 指南测定抗真菌药物的敏感性。还通过适当的方案测定 ABC 分型、表型转换、溶血素、蛋白酶、磷脂酶和酯酶活性。
23 例（2.5%）患者（平均年龄 55.2 岁）被诊断为食管念珠菌病。分离出的物种为 19 株（82.6%）白念珠菌、3 株（13.1%）近平滑念珠菌和 1 株（4.3%）热带念珠菌。白念珠菌分离株中优势基因型为 A（57.9%）。50%的白念珠菌分离株表现为白色表型。观察到白念珠菌分离株的磷脂酶（47.4%）、溶血素（68.4%）和蛋白酶活性（36.8%）水平较高。仅 3 株近平滑念珠菌分离株对伏立康唑和伊曲康唑显示非野生型易感性。
本研究表明，白念珠菌仍然是食管念珠菌病患者最常见的分离株。基因型 A 的优势、白色表型和较强的溶血素活性可能表明这些分离株的致病性较高。对两性霉素和氟康唑的抗真菌药物敏感性最高。
