ERG11 Expression in Azole Resistant Candida species isolated from Diabetic Patients in a Tertiary Care Centre

Candidiasis has emerged as an alarming opportunistic infection with an increase in a number of patients among the diabetics who have immune dysfunction. Over the last decade, non-albicans Candida associated with human infections have increased and in recent times have developed resistance to anti‑fungal agents, in particular to the azole compounds. In this study conducted in Tirunelveli Medical College, Tirunelveli from June 2017 - July 2018, 41.1% of diabetic females had Vulvovaginal candidiasis whereas only 13% of diabetic males had Candiduria. Among the isolates obtained from Vulvovaginal candidiasis 39.1% were Candida albicans and 61.9% were non-albicans Candida whereas among candiduria isolates, only 33.3% isolates were Candida albicans and the rest were non-albicans Candida. The antifungal susceptibility testing of isolates from Vulvovaginal candidiasis shows that 39.1% were sensitive, 34.8% were susceptible dose dependent and 17.4% were resistant to Fluconazole while most of the isolates were sensitive to Voriconazole and all the isolates were sensitive to Itraconazole. Candiduria isolates showed 66.7% susceptibility and 33.3% dose dependent susceptibility to Fluconazole and 100% susceptibility to Voriconazole and Itraconazole. Overall the non-albicans Candida isolates showed more resistance to azoles. Only one isolate was positive for PCR done to indirectly detect ERG11 overexpression among the four Fluconazole resistant isolates. The emergence of non-albicans Candida have clinical implication due to their reduced susceptibility to various antifungals, thus highlighting the importance of isolation, species identification and antifungal susceptibility of Candida prior to initiation of therapy. Further studies are required to explore the molecular mechanisms that could be targeted to control Fluconazole resistance