Studying the Prevalence, Species Distribution, and Detection of In vitro Production of Phospholipase from Candida Isolated from Cases of Invasive Candidiasis

Background and Aim: Candida spp. have emerged as successful pathogens both in invasive and mucosal infections. C. albicans is the sixth cause of most common nosocomial infections according to studies by the Centers for Disease Control and Prevention. A shift toward non-albicans species has been reported. There is a dearth of knowledge regarding the virulence factors of Candida, especially from this part of India. The aim was to study the prevalence of Candida, speciate, and determine antifungal sensitivity along with the detection of in vitro production of phospholipases in 100 Candida isolates. Materials and Methods: A total of 100 Candida isolates from various clinical specimens were studied (February 1, 2015-May 31, 2015; 4 months). Speciation was done by conventional methods and antifungal drugs fluconazole and voriconazole tested. Phospholipase activity (Pz value) was determined. Results: Of the 100 Candida spp., 35% were C. albicans and 65% were nonalbicans Candida (NAC). Species spectrum was of the 100 isolates as follows: 35 were C. albicans, 17 Candida tropicalis, 6 Candida glabrata, 8 Candida guilliermondi, 1 Candida kefyr, 6 Candida krusei, 14 Candida parapsilosis, 2 Candida lusitaniae, and 1 Trichosporon and 10 Candida spp. (not speciated). Phospholipase production was seen in 81 (81%) of the total isolates. The majority (63%) of phospholipase producers were NAC. Among NAC spp., the maximum phospholipase activity was seen in C. tropicalis (30%) and C. parapsilosis (24%). Of these, 60% of Candida was from patients admitted to the hospital. Sensitivity rates of C. albicans for fluconazole and voriconazole were 89.5% and 90.5%, respectively. Conclusion: Increasing usage of devices, total parenteral nutrition, broad-spectrum antibiotics, chemotherapies, and transplantation are factors contributing to the increase of candidal infections. Recent studies underline the increasing frequency of infections by NAC. The present study showcases the increased prevalence as well as virulence of NAC. In addition, early detection of virulence factors by Candida is useful in clinical decision-making.