FUNGAL URINARY INFECTIONS:EMERGING SPECIES, ANTIFUNGAL SUSCEPTIBILITY TRENDS AND ANTIBODY RESPONSE

Abstract

The study was designed to assess the role of Candida infeetions in 120 patients with urinary tract infections (UTis) with or without schistosomiasis and/or cancer bladder. It also aimed at comparing chromogenic (CHROM agar and BIGGY agar), morphologic (com meal-Tween 80 and rice agar-Tween 80) media and biochemical candifast test for identification of Candida to the species leveL Their susceptibility to antifungal agents using E test and candifast were also assessed. The performance of ELISA test for detection of anticandida antibodies (IgM and IgG) in serum was also evaluated. Results showed that Calbicans (43.4%) was the most frequent Candida species responsible for fungal UTis. However, non-albicans species namely, Cglabrata (23.3%), C.tropicalis (20%) and Ckrusei (13.3%) were isolated. Females were more prone to fungal UTis than males (P < 0.001). Broad spectrum antibiotic, diabetes mellitus and impaired kidney function were found to be significantly predisposing factors. Rice agar-Tween 80 found to be sufficient to make a final identification (100%), cheap and available CHROM agar absolutely identified Calbicans, Ctropicalis and Ckrusei but could not identified Cglabrata while BIGGY agar did not adequately differentiate Candida species. Biochemical identification using candifast could be helpful, but with low sensitivity of 83.3%. E test on Sabouraud dextrose agar is simple method for MICs determination and could detect S-DD strains in case of azoles. Serology was unreliable method for diagnosis of urinary candidiasis. In conclusion: Calbicans, Cglabrata, Ctropicalis and Ckrusei were responsible for UTis and their identification on rice agar-Tween 80 and their susceptibility using E test on Sabouraud dextrose agar were simple and easy methods, while serology was unreliable method.