Prevalence and Antifungal Susceptibility of Candida Infections in Patients with Pulmonary Tuberculosis: A Cross-sectional Study from the Union Territory of Puducherry, India

Abstract

Introduction: Pulmonary Tuberculosis (TB) is a bacterial infectious disease caused by Mycobacterium tuberculosis. Candida albicans is the most commonly isolated fungal pathogen in bronchopulmonary patients. Invasive candidiasis due to Candida species has been on the rise in recent years. However, drug sensitivity studies of C. albicans isolated from TB patients are not routinely conducted in India and other developing countries. Aim: To isolate and identify Candida albicans from patients with TB and to determine its antifungal susceptibility. Materials and Methods: This cross-sectional study was conducted on 129 patients suspected of having pulmonary TB, analysed from August 2016 to January 2018 at the Department of Chest Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India. Sputum samples were collected and processed to identify Candida species through Gram staining, Ziehl-Neelsen staining, germ tube formation, and sugar fermentation. Antifungal resistance testing was performed using the disk diffusion method recommended by the Clinical and Laboratory Standards Institute (CLSI). The collected data were subsequently analysed using descriptive statistics and the Chi-square test to evaluate the results. Results: Candida infection was observed in 10 (7.75%) out of 129 patients with pulmonary TB. Among patients with co-infection, C. albicans was the most common, accounting for 4 (40%) cases, followed by C. krusei with 2 (20%) cases, C. tropicalis with 1 (10%) case, C. kefyr with 1 (10%) case, C. glabrata with 1 (10%) case, and C. parapsilosis with 1 (10%) case. Among the azole category, itraconazole and amphotericin B exhibited the highest sensitivity percentages against Candida. Conclusion: The current study revealed a high prevalence of coinfection between pulmonary TB and Candida spp., which may contribute to the symptoms of pulmonary lung disorders. The prevalence of Candida species could also be associated with an inadequate response to antitubercular drugs. Amphotericin B and itraconazole, two commonly used drugs in the community, are often employed as the preferred treatments for fungal infections. Early detection and treatment of this opportunistic candidiasis in patients with pulmonary TB will likely enhance outcomes for such individuals.