Identification and Usage of Antifungal Agents Against the Opportunistic Yeast Causing Oral Candidiasis in Immunosuppressed Patients

Diman Mohammed Mahmood; Aras Q. Pirot

doi:10.36321/kjns.vi20252.21753

Authors

Diman Mohammed Mahmood Medical Laboratory Department, College of Health and Medical Technology, Suleimani Polytechnic University, Sulaymaniyah, Iraq.
Aras Q. Pirot Sulaimani Polytechnic University, Technical Institute of Sulaimani, Medical Laboratory Department, Sulaymaniyah, Iraq.

DOI:

https://doi.org/10.36321/kjns.vi20252.21753

Keywords:

antifungal, candidiasis, immunocomprommised patients

Abstract

Background: Candida species are among the most frequent opportunistic fungal pathogens in immunocompromised patients, often causing localized or systemic infections. Rising antifungal resistance has increased the need for regional studies on Candida prevalence and drug susceptibility.

Objectives: This study aimed to identify Candida species isolated from immunocompromised patients in Sulaimani, Kurdistan Region, Iraq, and to evaluate their susceptibility to commonly used antifungal agents.

Methodology: A total of 100 clinical samples were collected from patients with diabetes, renal failure, gastroenteritis, jaundice, and malnutrition. Samples were examined microscopically, cultured on Sabouraud Dextrose Agar and CHROMagar, and further tested using the germ tube method for species identification.

Results: Antifungal susceptibility testing was performed using the disk diffusion method against fluconazole, clotrimazole, and nystatin following CLSI guidelines. Five Candida species were identified. C. albicans was the most prevalent (42%), followed by C. glabrata (23%), C. krusei (15%), C. tropicalis (10%), and C. guilliermondii (10%). Antifungal susceptibility testing revealed universal resistance to nystatin. C. albicans was sensitive to fluconazole, while non-albicans species showed resistance. Clotrimazole exhibited broad sensitivity across all species tested, indicating its effectiveness as a primary therapeutic option. The predominance of C. albicans aligns with global data, but the emergence of resistant non-albicans Candida species highlights the need for routine species identification and antifungal susceptibility testing.

Conclusion: Clotrimazole demonstrated the highest efficacy and may serve as a preferred treatment option for oral candidiasis in immunocompromised patients. Continuous monitoring and rational antifungal use are essential to address the growing challenge of antifungal resistance.