In vitro species and antifungal susceptibility of yeast from the nails of patients with the human immunodeficiency virus
Keywords:
Antifungal agents, Candida, HIV, OnychomycosisAbstract
Objective
The objective of this study was to identify yeasts from the genus Candida responsible for onychomycosis and their respective in vitro antifungal susceptibilities in outpatients with the human immunodeficiency virus and nail changes suggestive of onychomycosis.
Methods
Twenty-three strains of yeasts from 21 nail samples from fingers or toes were
assessed. The colonies were identified using CHROMagar Candida® and standard
tests. ATB-Fungus 3® method was used for the antifungal susceptibility testing
and when there was resistance to fluconazole, the disk diffusion test was used
for confirmation.
Results
A mixed infection with two species of Candida was found in two cases. Out of the
23 species found, 48% were C. albicans, 26% were C. parapsilosis, 8.5% were C.
tropicalis, 8.5% were C. glabrata, 4.3% were C. guilliermondii and 4.3% were C.
famata. In the susceptibility tests, 48% of the species were resistant to azoles,
where 36% were C. albicans and 64% were non-albicans species. All fluconazoleresistant strains in the ATB-Fungus 3® method were also resistant in the disk
diffusion test. Patients with resistant strains had used antifungal agents before
to treat oral candidiasis or recurrent onychomycosis.
Conclusion
Candida albicans is the most commonly isolated species in cases of onychomycosis
caused by yeasts of the Candida genus in nails of patients with the human
immunodeficiency virus. However, in this group of patients, the albicans species
isolated from the nails are less susceptible to azoles. Yeast resistance to
fluconazole, a drug routinely used to treat candidiases, could be due to its
previous use. Thus, antifungal agents should be used with caution and only
when the diagnosis and antifungal susceptibility are proven.
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