Identification and Antifungal Susceptibility Pattern of Candida Species isolated from a Tertiary Hospital in Irrua, Edo State, Nigeria

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This study aimed to determine the identity, prevalence and antifungal susceptibility pattern of Candida species isolated from clinical samples of patients attending a tertiary Hospital, Irrua, Edo State, Nigeria. Methods A total of 286 yeast isolates were recovered from clinical samples of patients sent to the Medical Microbiology Laboratory of Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo State, Nigeria. Identification of yeast isolates and antifungal susceptibility testing (AST) of the isolates to different antifungal agents were assayed using VITEK-2 Compact System (Biomerieux, France). Results A total of 286 yeast isolates which included 283 Candida isolates identified into six (6) Candida species ( Candida albicans, Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei and Candida ciferrii ), and 2 non-candida yeast ( Cryptoccocus laurentii and Trichosporon asahii ) were recovered. The prevalence of Candida species in this study was 21.7%, while that of yeast infection was 21.9%. Candida albicans was the most frequently isolated species, accounting for 69.6% of isolates while Candida ciferrii was the least isolated (0.3%). Urine specimens yielded the highest yeast isolates (43.4%), followed by Endocervical swab (24.8%, p = 0.0001). Females had higher prevalence of yeast infection (91.6%) than the males (8.4%). Although marked resistance was shown to flucytosine (44.8%) and fluconazole (54.1%), the most active antifungal agents were voriconazole (92.3%) and coaspfungin (92.0%). Conclusion There is a brazen need for regional and national surveillance of yeasts of medical importance. To aid effective diagnosis and treatment, culture and AST though expensive is strongly encouraged in resource-limited settings. Candida spp yeast antifungal VITEK-2 susceptibility resistance INTRODUCTION Candida belongs to the kingdom Fungi and the genus yeasts, and is the most common cause of fungal infections around the world [ 1 ]. While often harmless, Candida species can become opportunistic pathogens when mucosal barriers are disrupted and immunity is compromised, leading to infection [ 2 ]. Candidiasis occurs mostly in patients with weakened immune systems (immunocompromised) and damaged natural defenses enabling Candida to infiltrate host tissues, causing infections that range from mild, localized infections to life-threatening systemic infections [ 3 ]. Candida infections are a major concern worldwide, ranking fourth in hospital acquired bloodstream infections, with high rates of mortality and morbidity [ 4 ]. Candida species are frequently found on mucosal surfaces, especially in the gastrointestinal tract, and on the skin. Candida albicans is the most frequently isolated species and poses a significant infection risk to humans and animals alike. Over the last two decades, there have been remarkable shifts in the epidemiology of Candida species, strikingly coinciding with the rise of antifungal drug-resistant strains [ 3 ]. It has thus been emphasized that overuse and prolonged administration of antifungals in immunocompromised patients with recurrent infections has been a significant factor leading to the development of antifungal drug resistance [ 3 , 4 ]. Regional surveillance of fungal pathogens and antifungal susceptibility patterns is therefore imperative due to increasing antifungal resistance and changing epidemiological trends, which directly impact treatment efficacy. Systemic candidiasis carries a mortality rate of up to 40% [5], and even with newer antifungals such as the echinocardins, treatment outcomes remain suboptimal [ 6 , 7 ]. Non-albicans Candida such as C. tropicalis , C. rugosa , C. africana , C. glabrata , C. dubliniensis , C. parapsilosis , and notably C. auris are increasingly implicated in invasive infections worldwide [ 8 , 9 ]. Investigating prevalence rate of yeast infections and antifungal susceptibility patterns can improve knowledge of the etiological agents involved, guiding effective treatment strategies, in turn helping to limit the emergence of antifungal drug resistance. Moreover, in our locality (Irrua) and region (South-southern Nigeria), few studies have been conducted on this subject. Therefore, this study is aimed to determine the identity, prevalence rate, and antifungal susceptibility pattern of yeast causing clinical infections in patients attending a tertiary Hospital in Irrua, Edo State, Nigeria. MATERIALS AND METHODS Study Area This study was conducted in Irrua Specialist Teaching Hospital (ISTH), Irrua, Esan Central Local Government Area, Edo State, Nigeria. Irrua Specialist Teaching Hospital (ISTH), Irrua was established in 1993. Presently, it has a bed capacity of four hundred and ninety-seven (497), with over ten (10) wards. The hospital was formerly known as Otibhor Okhae Teaching Hospital. It offers diverse and specialized services in various aspects of healthcare. It is also a center for basic and post basic nursing studies and has an institute known for excellence in its service delivery for the control and research of viral and emergent pathogens. It lies on Latitude 6.73147946684 and Longitude 6.18976456886, at Km 87, Benin Auchi Road, (P.M.B 08) Irrua, Edo State, Nigeria. Data Sources Participant’s clinical data such as age, gender, clinical information, current antibiotic use and any other relevant information provided on the request forms were obtained between December 2022 to February 2024. Yeast Isolates Yeast isolates were recovered from 1,307 clinical samples obtained from 930 females and 377 males among inpatients and outpatients at ISTH, Irrua, Edo State. The youngest patient from whom candida species were isolated was 4 months old, and the oldest was 82 years old. The specimens included urine, sputum, wound swab, throat swab, ear swab, aspirates, high vaginal swab, endocervical swab and blood for culture, received into the Medical Microbiology laboratory of ISTH, Irrua, Edo State. These specimens were processed following standard techniques. For fungal processing, all specimens were cultured on Sabouraud dextrose agar (SDA) (Biotec, Ipswich, UK) containing 50mg/l of chloramphenicol and incubated aerobically at 37⁰C for 48hrs. Emergent colonies were Gram-stained, Yeast cells appeared as Gram positive, budding, oval cells with or without pseudo hyphae. These were subsequently identified and antimicrobial susceptibility test (AST) performed using the VITEK-2 Compact system (Biomerieux, France). Vitek-2 Compact System test procedure The Yeast identification (ID) card (VITEK 2 YST) and Yeast AST card (AST-YS07) were used for the identification to species level and antifungal susceptibility testing respectively. The yeast card ID can identify 54 different species of yeast and yeast-like fungi. It contains 46 different biochemical substrates that allows species identification by comparing the biochemical profile with an extensive database. The AST card (AST-YS07) contains 6 antifungal agents which are: amphotericin B, fluconazole, caspofungin, voriconazole, flucytosine and micafungin following CLSI guidelines [ 10 ]. Pure cultures of the inoculums were suspended individually in aqueous 0.45% (weight /volume) sodium chloride (NaCl) to achieve a turbidity equivalent to a McFarland standard range of 1.8–2.2 recommended by the manufacturer and measured on the turbidimeter (Biomerieux, France). The cassettes were loaded into the Vitek-2 Compact System machine. Quality control strain used was C. parapsilosis ATCC 22019. Identification and Susceptibility testing, was carried out automatically following CLSI interpretative criteria in the VITEK database (10). Statistical Analysis Data obtained from this study were analyzed statistically with Chi square (X 2 ) test using the Statistical software INSTAT (R) (Graph Pad software Inc, La Jolla, Ca, USA). Statistical significance was set at P < 0.05 using Pearson’s chi square test. RESULTS During the study period, 286 yeast isolates were recovered from 1,307 clinical samples obtained from 930 females and 377 males. The youngest patient from whom candida was isolated was 4 months old and the oldest was 82 years old. The prevalence rate of Candida species in this study was 21.7%. The specimens included urine, sputum, ear swab, throat swab, wound swab, aspirates, high vaginal swab, endocervical swab and blood for culture. The highest number of isolates were from urine samples 124 (44.3%), while the lowest yield of yeast isolates was from blood culture 2 (1.6%). In relation to the identity of yeast isolated and the clinical specimen, Candida albicans was isolated from all clinical specimens and was the most prevalent species isolated (69.6%). The recovery rate of the non-albicans Candida species were Candida tropicalis (19.2%), C . parapsilosis (4.2%), C. glabrata (3.8%), C. krusei (1.7%), C. ciferrii (0.3). Two species of non-candida yeast were isolated namely Cryptococcus laurentii (0.7%) and Trichosporon asahii (0.3%) (Table 1 ). Table 2 illustrates the prevalence of Candida species and other non-candida yeast in relation to age of the patients. The prevalence rate of Candida species in this study was 21.7%. Candida infection was most prevalent in age group 21–30 yrs and 31–40 yrs with a percentage prevalence of 35% and 29.3% respectively. In relation to age and gender, females within ages 21–30 yrs and 31–40 yrs had the highest prevalence of yeast infection. Similarly, males > 51 yrs had the highest prevalence of yeast infection. However, the findings were not statistically significant (Table 3 ). The second-generation azole- voriconazole and the echinocandin- caspofungin were the most active antifungals with 92.3% and 92.0% susceptibility rates respectively. Flucytosine and fluconazole showed the poorest activity with 44.8% and 54.1% respectively, while moderate levels of susceptibility were observed against yeast isolated with the polyene amphotericin B and micafungin with 83.2% and 84.3% respectively. In comparison with other isolated yeast, C. albicans had the poorest susceptibility rates to the aforementioned antifungals (Table 4 ). Table 1 Distribution of Candida species and other non-candida yeast isolates recovered from various samples HVS- high vaginal swab, ECS-endocervical swab Organisms Urine (n = 124) HVS (n = 67) ECS (n = 71) Throat swab (n = 4) Aspirate (n = 2) Ear swab (n = 5) Wound swab (n = 5) Blood (n = 2) Sputum (n = 6) Total (n = 286) C. albicans 77(62.1) 53 (77.6) 61 (86) 1 (25) 2 (100) 2 (40) 1 (20) 2 (100) 1 (16.7) 199 (69.9) C. tropicalis 37 (29.8) 13 (19.4) 1 (25) 0 1 (20) 1 (20) 0 0 2 (33.3) 55 (19.2) C. parapsilosis 37 (29.8) 13 (19.4) 0 2 (50) 0 1 (20) 0 0 0 12 (4.2) C. glabarata 9 (7.3) 0 6 (8.5) 0 0 0 2 (40) 0 3 (50) 11 (3.8) C. krusei 0 2 (3) 3 (4.2) 0 0 0 0 0 0 5 (1.7) C. ciferrii 0 0 0 0 0 1 (20) 0 0 0 1 (0.3) Cryptococcus laurentii 1 (0.8) 0 1 (1.4) 0 0 0 0 0 0 2 (0.7) Trichosporon asahii 0 0 0 0 0 0 1 (20) 0 0 1 (0.3) TOTAL 124 (43.4) 67 (23.4) 71 (24.8) 4 (1.4) 2 (0.7) 5 (1.7) 5 (1.7) 2 (0.7) 6 (2.1) 286 (100) Table 2 Prevalence of Candida species and Yeast Isolates in Relation to Age of patients Organisms 0–10 11–20 Age(yrs) 21–30 31–40 41–50 ≥ 51 Total C. albicans 7 (50) 11 (55) 70 (70.7) 65 (77.4) 20 (62.5) 26 (70.3) 199(69.9) C. tropicalis 0 (0) 4 (20) 17 (17.2) 17 (20.2) 8 (25) 9 (24.3) 55(19.2) C. parapsilosis 7 (50) 0 (0) 5 (5.1) 0 (0) 0 (0) 0 (0) 12(4.2) C. glabrata 0 (0) 3 (15) 5 (5.1) 0 (0) 2 (6.3) 1 (2.7) 11(3.8) C. krusei 0 (0) 1 (5) 2 (2.0) 1 (1.2) 0 (0) 1 (2.7) 5(1.7) C. ciferrii 0 (0) 0 (0) 0 (0) 0 (0) 1(3.1) 0 (0) 1(0.3) C. laurentii 0 (0) 1 (5) 0 (0) 1 (1.2) 0 (0) 0 (0) 2(0.7) T. asahii 0 (0 0 (0) 0 (0) 0 (0) 1 (3.1) 0 (0) 1(0.3) Total 14 (4.9) 20 (7.0) 99 (34.6) 84 (29.4) 32 (11.2) 37 (12.9) 286 (100) Numbers in bracket are percentage values Table 3 Prevalence of Candida species in Relation to Age and Gender of patients Age (yrs) Female Male Total p-value 0–10 6 (2.3) 8 (34.8) 14 (4.9) 11.070 11–20 19 (7.3) 0 19 (6.7) 21–30 96 (36.9) 1 (4.3) 97 (34.3) 31–40 83 (31.9) 0 83 (29.3) 41–50 28 (10.8) 3 (13) 31 (11) ≥ 51 28 (10.8) 11 (47.8) 39 (13.8) TOTAL 260 (91.9) 23 (8.1) 283 (100) Numbers in bracket are percentage values. Table 4 Antifungal susceptibility pattern of Candida species and other non-candida yeast to various antifungal agents. Antifungal Drug C. albicans (n = 199) C. tropicalis (n = 55) C. parapsilosis (n = 12) C. glabrata (n = 11) C. krusei (n = 5) C. ciferii (n = 1) C. laurentii (n = 2) T. asahii (n = 1) Total (n = 286) Fluconazole 123(61.8) 23(41.8) 12(100) 5(45.5) NA 1(100) 0 (0) 0 (0) 169(59.1) Voriconazole 181(90.9) 51(92.7) 12(100) 11(100) 5(100) 1(100) 2(100) 1(100) 264(92.3) Caspofungin 182 (91.5) 55(100) 7(58.3) 11(100) 5(100) 1(100) 2(100) 0 (0) 263(92.0) Micafungin 160 (80.4) 50(90.9) 12(100) 11(100) 5(100) 1(100) 2(100) 0 (0) 241(84.3) Amphotericin B 157 (78.9) 50(90.9) 12(100) 11(100) 5(100) 0(0) 2(100) 1(100) 238(83.2) Flucytosine 59 (29.6) 50(90.9) 7(58.3) 11(100) 0 (0) 0(0) 1(50) 0(0) 128(44.8) NA- not applicable DISCUSSION Studies have shown that invasive and non-invasive infections with Candida species is on the increase worldwide, contributing to the burden of infectious diseases, particularly in immunocompromised individuals [ 11 ]. The rising tide of resistance to antifungal medications further exacerbates this fact especially in Low and middle-income countries with fragile healthcare systems characterized by poor surveillance and inadequate diagnostic infrastructure. Therefore, early isolation, identification and antifungal susceptibility testing are vital for appropriate therapeutic intervention [ 11 , 12 ] The prevalence rate of Candida species in this study was 21.7%. This finding is similar to the work done by Inyang et al. (2011), in Ekpoma, Edo state, Nigeria, where a prevalence rate of 21.4% was observed [ 13 ]. Similar research conducted by Unaeze et al. (2017) showed an overall prevalence of Candida species from different clinical samples in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-Eastern Nigeria as 23.9% [ 14 ]. These findings corroborate the results obtained from this study. The most prevalent species isolated from this research was Candida albicans with a prevalence of 69.6%. From the research done by Isibor et al . (2022) in the same study area, C. albicans was the most prevalent organism isolated with a prevalence of 62.5% [15]. Omosigho et al . (2019) in Bida, North Central, Nigeria also reported Candida albicans as the most isolated species with a prevalence of 53.9%, followed by C. tropicalis 31.4%, C. glabrata and C. krusei 7.4% respectively [ 16 ]. Worldwide, C. albicans has been reported as the leading yeast causing clinical infections ranging from vulvovaginal candidiasis, oral thrush, onychomycosis, and in recent times, bloodstream infections [ 17 ]. Our finding is thus consistent with the global narrative. Similarly, Trichosporon asahii was recovered as a non-Candida yeast causing wound infection. This organism has been known to form biofilms on abiotic surfaces in the hospital [ 18 ], difficult to treat when causing infections and has been rarely implicated as causing clinical infections in Nigeria [ 13 , 14 ]. This study therefore highlights T. asahii as an emerging pathogen and presents the first report in Edo state, South-South Nigeria. From this study, urine samples had the highest prevalence of Candida species (43.5%). This is not surprising because Candida species has been reported as the seventh most common nosocomial pathogen in healthcare settings causing 25% of all urinary tract infection [ 19 ]. Work done by Gopi and Murthy (2014) shows that urine is one of the samples with high prevalence of Candida, having up to 20.4% prevalence rate [ 20 ]. This study showed a higher prevalence of Candida species, notably Candida albicans among females of reproductive age (21–40 yrs). The specimens most implicated were urogenital swabs, suggesting vulvovaginitis due to this organism. This finding correlates with studies done by Unaeze et al. (2017) and Omosigho et al. (2019) where the highest isolation rate of C. albicans were from age groups 21–30 years (38.5%) and 20–39 years (51.5%) from vaginal swabs respectively [ 14 , 16 ]. This age group constitutes the most sexually active and reproductive subset. Similarly, most youth tend to favor over-the-counter medications, misuse of antibiotics in turn increases the risk of candida infection and proliferation [ 21 , 22 , 23 ]. Our finding is however at variance with an Indian study. Marak and Dhanashree (2018) in India reported maximum isolation from age group 51–60 years [ 24 ]. The reasons attributed included lower immunity, aging, diabetes mellitus and malignancies. Candida ciferrii one of the re-emerging non-albicans Candida species was isolated from the ear of a patient presenting with otitis media in this study. Previous studies done by other researchers in Kano Northern-Nigeria isolated C. ciferrii not from humans, but from cow’s milk [ 25 ]. In a previous study done by AlrufaeMohamed and Alyassree in Kufa, Iraq, C. ciferrii was recovered from ear swabs of their participants [ 26 ]. Our study thus presents the first report of C. ciferrii causing clinical infection in our region. In relation to gender, the females had the highest prevalence of candidiasis (91.9%) than their male counterpart (8.1%). This could be due to predisposing factors such as recent use of antibiotics, use of oral contraceptives, and wearing tight-fitting synthetic underwear [15, 27, 28]. This finding also correlates with study done by Unaeze et al. (2017), where a prevalence of 92.6% was reported for females and 7.4% for males [ 14 ]. However, strikingly, with respect to age, males above 51 yrs had the highest prevalence of candidiasis (47.8%). Although not statistically significant, this could be due to decreased immunity, advanced age and other underlying medical conditions [ 24 ]. Among antifungals tested, fluconazole showed poor susceptibility. This finding is in agreement with a previous study in Benin City, Nigeria where 66.6% of candidal isolates from the genital tract showed resistance to the drug [ 29 ]. A recent systematic review on antifungal susceptibility and etiology of vulvovaginal candidiasis in Africa revealed that resistance to fluconazole is on the rise [ 30 ]. This antifungal which is readily available over-the-counter in oral formulations and as suppositories, is one of the most prescribed antifungals for treatment of vulvovaginal Candidiasis in outpatient clinics in Nigeria. Misuse and abuse of this antifungal may account for the poor susceptibility observed. In the same vein, flucytosine showed poor activity against Candida spp. This finding is worrisome as it’s hardly available in Nigerian pharmacies. Some studies have emphasized the potential for resistance to this antifungal when used in treating urinary candidiasis or cryptococcosis especially as monotherapy [ 31 ]. However, reassuringly, voriconazole and caspofungin showed good activity against fungal isolates recovered. Limitations Some commonly prescribed antifungals such as nystatin, ketoconazole and itraconazole could not be assayed for as the AST card for susceptibility testing had preselected antifungals. Secondly, since the research was laboratory based, the sociodemographic data of the patients and the predisposing risk factors to fungal infection could not be ascertained. Conclusion The prevalence of candidiasis in this study was 21.7%. Yeast was recovered from various clinical sites or specimens, with the highest isolation rate being from urogenital specimens. There is a brazen need for national surveillance of yeasts of medical importance. Owing to differing identity and AST pattern of yeast isolated, culture and AST though expensive is strongly encouraged even in resource-limited settings for effective management of such infections. Declarations Ethical Approval and Consent to participate Ethical approval was obtained from the Health Research Ethics Committee (HREC) of Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo State, Nigeria, and a waiver of informed consent was also granted through their letter referenced: ISTH/HREC/20231603/454 . This study was conducted in line with the Helsinki declaration. Conflict of interest None to declare. Clinical Trial Number Not applicable Funding The authors received no external funding for this study. Authors’ Contributions FIO, HOO and EEI conceived and designed the study. SSO, JO and FIO were involved in data collection and data analysis. FIO, HOO and EEI performed statistical analysis and interpretation. All authors were substantially involved in drafting the manuscript. Consent to Publish declaration Not applicable References Manolakaki D, Velmahos G, Kourkoumpetis T, Chang Y, Alam HB, De Moya MM, et al. Candida infection and colonization among trauma patients. 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Sigera LSM, Denning DW. Flucytosine and its clinical usage. Therapeutic Advances in Infectious Diseases 2023. PMCID: PMC10084540. 10.1177/20499361231161387 Additional Declarations No competing interests reported. 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Olowosile","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYBACAyA+wMAgx8DGwMP4AMjh4SNSizEDGxsPM4jDw0aMFgaQFgY2HjYJEJOgFnP23oMHf7YZyPPJ9x6r/JpjJ8PGwPzw0Q08Wix7ziUc5m0zMGxj40u7LbstGegwNmPjHHwOu5FjcJix7Q9jGxuP2W3JbcxALTxs0ni13H9jAHKYPUhLseS2eiK03OAxOAB0WCJIC+PHbYeJ0HIG6DCecwbJbWw5xtKM247zsDET8svxM8Yff5QZ2M5vPmP48ee2ant+9uaHj/FpQQHMPGCSWOUgwPiDFNWjYBSMglEwYgAAxHVCBuUXBZkAAAAASUVORK5CYII=","orcid":"","institution":"Irrua Specialist Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Faith","middleName":"Isuan","lastName":"Olowosile","suffix":""},{"id":531920926,"identity":"94c93e4b-eb03-4777-88c2-136c5bde3c7c","order_by":1,"name":"Helen Oroboghae Ogefere","email":"","orcid":"","institution":"University of Benin","correspondingAuthor":false,"prefix":"","firstName":"Helen","middleName":"Oroboghae","lastName":"Ogefere","suffix":""},{"id":531920927,"identity":"3de4c28a-46dc-474a-8d9a-968a783190f7","order_by":2,"name":"Ephraim Ehidiamen Ibadin","email":"","orcid":"","institution":"University of Benin Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ephraim","middleName":"Ehidiamen","lastName":"Ibadin","suffix":""},{"id":531920928,"identity":"f2724ed7-016a-4bba-889c-65a0d45f03ba","order_by":3,"name":"Samuel Sunday Olowo","email":"","orcid":"","institution":"Ambrose Alli University","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"Sunday","lastName":"Olowo","suffix":""},{"id":531920929,"identity":"3cc1a7f6-a840-498c-a915-f5b2e5430f35","order_by":4,"name":"Joseph Okoeguale","email":"","orcid":"","institution":"Ambrose Alli University Ekpoma","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Okoeguale","suffix":""},{"id":531920930,"identity":"ebc74d49-6f79-47e0-98c7-34687df6b9d7","order_by":5,"name":"Festus Idahosa Omorogbe","email":"","orcid":"","institution":"Ambrose Alli University Ekpoma","correspondingAuthor":false,"prefix":"","firstName":"Festus","middleName":"Idahosa","lastName":"Omorogbe","suffix":""},{"id":531920931,"identity":"9308d244-49f8-4bfb-991b-709e8658c288","order_by":6,"name":"Christiana Ashe Adelekun","email":"","orcid":"","institution":"Irrua Specialist Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Christiana","middleName":"Ashe","lastName":"Adelekun","suffix":""}],"badges":[],"createdAt":"2025-09-07 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16:04:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":930074,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7556109/v1/fd0be2dc-83e2-45b8-99fd-943e8237d3d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Identification and Antifungal Susceptibility Pattern of Candida Species isolated from a Tertiary Hospital in Irrua, Edo State, Nigeria","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e\u003cem\u003eCandida\u003c/em\u003e belongs to the kingdom Fungi and the genus yeasts, and is the most common cause of fungal infections around the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While often harmless, \u003cem\u003eCandida\u003c/em\u003e species can become opportunistic pathogens when mucosal barriers are disrupted and immunity is compromised, leading to infection [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Candidiasis occurs mostly in patients with weakened immune systems (immunocompromised) and damaged natural defenses enabling \u003cem\u003eCandida\u003c/em\u003e to infiltrate host tissues, causing infections that range from mild, localized infections to life-threatening systemic infections [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eCandida\u003c/em\u003e infections are a major concern worldwide, ranking fourth in hospital acquired bloodstream infections, with high rates of mortality and morbidity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cem\u003eCandida\u003c/em\u003e species are frequently found on mucosal surfaces, especially in the gastrointestinal tract, and on the skin. \u003cem\u003eCandida albicans\u003c/em\u003e is the most frequently isolated species and poses a significant infection risk to humans and animals alike. Over the last two decades, there have been remarkable shifts in the epidemiology of \u003cem\u003eCandida\u003c/em\u003e species, strikingly coinciding with the rise of antifungal drug-resistant strains [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It has thus been emphasized that overuse and prolonged administration of antifungals in immunocompromised patients with recurrent infections has been a significant factor leading to the development of antifungal drug resistance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Regional surveillance of fungal pathogens and antifungal susceptibility patterns is therefore imperative due to increasing antifungal resistance and changing epidemiological trends, which directly impact treatment efficacy.\u003c/p\u003e\u003cp\u003eSystemic candidiasis carries a mortality rate of up to 40% [5], and even with newer antifungals such as the echinocardins, treatment outcomes remain suboptimal [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Non-albicans \u003cem\u003eCandida\u003c/em\u003e such as \u003cem\u003eC. tropicalis\u003c/em\u003e, \u003cem\u003eC. rugosa\u003c/em\u003e, \u003cem\u003eC. africana\u003c/em\u003e, \u003cem\u003eC. glabrata\u003c/em\u003e, \u003cem\u003eC. dubliniensis\u003c/em\u003e, \u003cem\u003eC. parapsilosis\u003c/em\u003e, and notably \u003cem\u003eC. auris\u003c/em\u003e are increasingly implicated in invasive infections worldwide [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Investigating prevalence rate of yeast infections and antifungal susceptibility patterns can improve knowledge of the etiological agents involved, guiding effective treatment strategies, in turn helping to limit the emergence of antifungal drug resistance. Moreover, in our locality (Irrua) and region (South-southern Nigeria), few studies have been conducted on this subject. Therefore, this study is aimed to determine the identity, prevalence rate, and antifungal susceptibility pattern of yeast causing clinical infections in patients attending a tertiary Hospital in Irrua, Edo State, Nigeria.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Area\u003c/h2\u003e\u003cp\u003eThis study was conducted in Irrua Specialist Teaching Hospital (ISTH), Irrua, Esan Central Local Government Area, Edo State, Nigeria. Irrua Specialist Teaching Hospital (ISTH), Irrua was established in 1993. Presently, it has a bed capacity of four hundred and ninety-seven (497), with over ten (10) wards. The hospital was formerly known as Otibhor Okhae Teaching Hospital. It offers diverse and specialized services in various aspects of healthcare. It is also a center for basic and post basic nursing studies and has an institute known for excellence in its service delivery for the control and research of viral and emergent pathogens. It lies on Latitude 6.73147946684 and Longitude 6.18976456886, at Km 87, Benin Auchi Road, (P.M.B 08) Irrua, Edo State, Nigeria.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Sources\u003c/h3\u003e\n\u003cp\u003eParticipant\u0026rsquo;s clinical data such as age, gender, clinical information, current antibiotic use and any other relevant information provided on the request forms were obtained between December 2022 to February 2024.\u003c/p\u003e\n\u003ch3\u003eYeast Isolates\u003c/h3\u003e\n\u003cp\u003eYeast isolates were recovered from 1,307 clinical samples obtained from 930 females and 377 males among inpatients and outpatients at ISTH, Irrua, Edo State. The youngest patient from whom \u003cem\u003ecandida\u003c/em\u003e species were isolated was 4 months old, and the oldest was 82 years old. The specimens included urine, sputum, wound swab, throat swab, ear swab, aspirates, high vaginal swab, endocervical swab and blood for culture, received into the Medical Microbiology laboratory of ISTH, Irrua, Edo State. These specimens were processed following standard techniques. For fungal processing, all specimens were cultured on Sabouraud dextrose agar (SDA) (Biotec, Ipswich, UK) containing 50mg/l of chloramphenicol and incubated aerobically at 37⁰C for 48hrs. Emergent colonies were Gram-stained, Yeast cells appeared as Gram positive, budding, oval cells with or without pseudo hyphae. These were subsequently identified and antimicrobial susceptibility test (AST) performed using the VITEK-2 Compact system (Biomerieux, France).\u003c/p\u003e\n\u003ch3\u003eVitek-2 Compact System test procedure\u003c/h3\u003e\n\u003cp\u003eThe Yeast identification (ID) card (VITEK 2 YST) and Yeast AST card (AST-YS07) were used for the identification to species level and antifungal susceptibility testing respectively. The yeast card ID can identify 54 different species of yeast and yeast-like fungi. It contains 46 different biochemical substrates that allows species identification by comparing the biochemical profile with an extensive database. The AST card (AST-YS07) contains 6 antifungal agents which are: amphotericin B, fluconazole, caspofungin, voriconazole, flucytosine and micafungin following CLSI guidelines [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePure cultures of the inoculums were suspended individually in aqueous 0.45% (weight /volume) sodium chloride (NaCl) to achieve a turbidity equivalent to a McFarland standard range of 1.8\u0026ndash;2.2 recommended by the manufacturer and measured on the turbidimeter (Biomerieux, France). The cassettes were loaded into the Vitek-2 Compact System machine. Quality control strain used was \u003cem\u003eC. parapsilosis\u003c/em\u003e ATCC 22019. Identification and Susceptibility testing, was carried out automatically following CLSI interpretative criteria in the VITEK database (10).\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData obtained from this study were analyzed statistically with Chi square (X\u003csup\u003e2\u003c/sup\u003e) test using the Statistical software INSTAT \u003csup\u003e(R)\u003c/sup\u003e (Graph Pad software Inc, La Jolla, Ca, USA). Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 using Pearson\u0026rsquo;s chi square test.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the study period, 286 yeast isolates were recovered from 1,307 clinical samples obtained from 930 females and 377 males. The youngest patient from whom candida was isolated was 4 months old and the oldest was 82 years old. The prevalence rate of \u003cem\u003eCandida\u003c/em\u003e species in this study was 21.7%. The specimens included urine, sputum, ear swab, throat swab, wound swab, aspirates, high vaginal swab, endocervical swab and blood for culture. The highest number of isolates were from urine samples 124 (44.3%), while the lowest yield of yeast isolates was from blood culture 2 (1.6%).\u003c/p\u003e\u003cp\u003eIn relation to the identity of yeast isolated and the clinical specimen, \u003cem\u003eCandida albicans\u003c/em\u003e was isolated from all clinical specimens and was the most prevalent species isolated (69.6%). The recovery rate of the non-albicans \u003cem\u003eCandida\u003c/em\u003e species were \u003cem\u003eCandida tropicalis\u003c/em\u003e (19.2%), \u003cem\u003eC\u003c/em\u003e. \u003cem\u003eparapsilosis\u003c/em\u003e (4.2%), \u003cem\u003eC. glabrata\u003c/em\u003e (3.8%), \u003cem\u003eC. krusei\u003c/em\u003e (1.7%), \u003cem\u003eC. ciferrii\u003c/em\u003e (0.3). Two species of non-candida yeast were isolated namely \u003cem\u003eCryptococcus laurentii\u003c/em\u003e (0.7%) and \u003cem\u003eTrichosporon asahii\u003c/em\u003e (0.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the prevalence of \u003cem\u003eCandida\u003c/em\u003e species and other non-candida yeast in relation to age of the patients. The prevalence rate of \u003cem\u003eCandida\u003c/em\u003e species in this study was 21.7%. Candida infection was most prevalent in age group 21\u0026ndash;30 yrs and 31\u0026ndash;40 yrs with a percentage prevalence of 35% and 29.3% respectively.\u003c/p\u003e\u003cp\u003eIn relation to age and gender, females within ages 21\u0026ndash;30 yrs and 31\u0026ndash;40 yrs had the highest prevalence of yeast infection. Similarly, males\u0026thinsp;\u0026gt;\u0026thinsp;51 yrs had the highest prevalence of yeast infection. However, the findings were not statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe second-generation azole- voriconazole and the echinocandin- caspofungin were the most active antifungals with 92.3% and 92.0% susceptibility rates respectively. Flucytosine and fluconazole showed the poorest activity with 44.8% and 54.1% respectively, while moderate levels of susceptibility were observed against yeast isolated with the polyene amphotericin B and micafungin with 83.2% and 84.3% respectively. In comparison with other isolated yeast, \u003cem\u003eC. albicans\u003c/em\u003e had the poorest susceptibility rates to the aforementioned antifungals (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eDistribution of\u003c/b\u003e \u003cb\u003eCandida\u003c/b\u003e \u003cb\u003especies and other non-candida yeast isolates recovered from various samples\u003c/b\u003e HVS- high vaginal swab, ECS-endocervical swab\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrganisms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrine\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;124)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHVS\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eECS\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThroat swab\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAspirate (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEar swab (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eWound swab\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBlood (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eSputum\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. albicans\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77(62.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53 (77.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61 (86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e199 (69.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. tropicalis\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (29.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e55 (19.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. parapsilosis\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37 (29.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e12 (4.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. glabarata\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (8.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2 (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e11 (3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. krusei\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5 (1.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. ciferrii\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eCryptococcus laurentii\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eTrichosporon asahii\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1 (0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTOTAL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124 (43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71 (24.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2 (0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6 (2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e286 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of \u003cem\u003eCandida\u003c/em\u003e species and Yeast Isolates in Relation to Age of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrganisms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026ndash;10\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u0026ndash;20\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge(yrs)\u003c/p\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;51\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. albicans\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70 (70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65 (77.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20 (62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26 (70.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e199(69.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. tropicalis\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (20.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9 (24.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e55(19.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. parapsilosis\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12(4.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. glabrata\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11(3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. krusei\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5(1.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. ciferrii\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1(3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eC. laurentii\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2(0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eT. asahii\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(0.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99\u003c/p\u003e\u003cp\u003e(34.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84 (29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32 (11.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e37 (12.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e286\u003c/p\u003e\u003cp\u003e(100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eNumbers in bracket are percentage values\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of \u003cem\u003eCandida\u003c/em\u003e species in Relation to Age and Gender of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (yrs)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.070\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96 (36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e83 (31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83 (29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTOTAL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e260 (91.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e283 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNumbers in bracket are percentage values.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAntifungal susceptibility pattern of \u003cem\u003eCandida\u003c/em\u003e species and other non-candida yeast to various antifungal agents.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntifungal Drug\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eC. albicans\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;199)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eC. tropicalis\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eC. parapsilosis\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eC. glabrata\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eC. krusei\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eC.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eciferii\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eC.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003elaurentii\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eT.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003easahii\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;286)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFluconazole\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e123(61.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(41.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(45.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e169(59.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVoriconazole\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e181(90.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51(92.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e264(92.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaspofungin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e182 (91.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e263(92.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMicafungin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160 (80.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(90.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e241(84.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmphotericin B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e157 (78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(90.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e238(83.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlucytosine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59 (29.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(90.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e128(44.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003eNA- not applicable\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eStudies have shown that invasive and non-invasive infections with \u003cem\u003eCandida\u003c/em\u003e species is on the increase worldwide, contributing to the burden of infectious diseases, particularly in immunocompromised individuals [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The rising tide of resistance to antifungal medications further exacerbates this fact especially in Low and middle-income countries with fragile healthcare systems characterized by poor surveillance and inadequate diagnostic infrastructure. Therefore, early isolation, identification and antifungal susceptibility testing are vital for appropriate therapeutic intervention [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe prevalence rate of \u003cem\u003eCandida\u003c/em\u003e species in this study was 21.7%. This finding is similar to the work done by Inyang \u003cem\u003eet al.\u003c/em\u003e (2011), in Ekpoma, Edo state, Nigeria, where a prevalence rate of 21.4% was observed [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similar research conducted by Unaeze \u003cem\u003eet al.\u003c/em\u003e (2017) showed an overall prevalence of \u003cem\u003eCandida\u003c/em\u003e species from different clinical samples in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-Eastern Nigeria as 23.9% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These findings corroborate the results obtained from this study.\u003c/p\u003e\u003cp\u003eThe most prevalent species isolated from this research was \u003cem\u003eCandida albicans\u003c/em\u003e with a prevalence of 69.6%. From the research done by Isibor \u003cem\u003eet al\u003c/em\u003e. (2022) in the same study area, \u003cem\u003eC. albicans\u003c/em\u003e was the most prevalent organism isolated with a prevalence of 62.5% [15]. Omosigho \u003cem\u003eet al\u003c/em\u003e. (2019) in Bida, North Central, Nigeria also reported \u003cem\u003eCandida albicans\u003c/em\u003e as the most isolated species with a prevalence of 53.9%, followed by \u003cem\u003eC. tropicalis\u003c/em\u003e 31.4%, \u003cem\u003eC. glabrata\u003c/em\u003e and \u003cem\u003eC. krusei\u003c/em\u003e 7.4% respectively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Worldwide, \u003cem\u003eC. albicans\u003c/em\u003e has been reported as the leading yeast causing clinical infections ranging from vulvovaginal candidiasis, oral thrush, onychomycosis, and in recent times, bloodstream infections [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our finding is thus consistent with the global narrative. Similarly, \u003cem\u003eTrichosporon asahii\u003c/em\u003e was recovered as a non-Candida yeast causing wound infection. This organism has been known to form biofilms on abiotic surfaces in the hospital [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e18\u003c/span\u003e], difficult to treat when causing infections and has been rarely implicated as causing clinical infections in Nigeria [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This study therefore highlights \u003cem\u003eT. asahii\u003c/em\u003e as an emerging pathogen and presents the first report in Edo state, South-South Nigeria.\u003c/p\u003e\u003cp\u003eFrom this study, urine samples had the highest prevalence of \u003cem\u003eCandida\u003c/em\u003e species (43.5%). This is not surprising because \u003cem\u003eCandida\u003c/em\u003e species has been reported as the seventh most common nosocomial pathogen in healthcare settings causing 25% of all urinary tract infection [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Work done by Gopi and Murthy (2014) shows that urine is one of the samples with high prevalence of Candida, having up to 20.4% prevalence rate [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study showed a higher prevalence of \u003cem\u003eCandida\u003c/em\u003e species, notably \u003cem\u003eCandida albicans\u003c/em\u003e among females of reproductive age (21\u0026ndash;40 yrs). The specimens most implicated were urogenital swabs, suggesting vulvovaginitis due to this organism. This finding correlates with studies done by Unaeze \u003cem\u003eet al.\u003c/em\u003e (2017) and Omosigho \u003cem\u003eet al.\u003c/em\u003e (2019) where the highest isolation rate of \u003cem\u003eC. albicans\u003c/em\u003e were from age groups 21\u0026ndash;30 years (38.5%) and 20\u0026ndash;39 years (51.5%) from vaginal swabs respectively [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This age group constitutes the most sexually active and reproductive subset. Similarly, most youth tend to favor over-the-counter medications, misuse of antibiotics in turn increases the risk of candida infection and proliferation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our finding is however at variance with an Indian study. Marak and Dhanashree (2018) in India reported maximum isolation from age group 51\u0026ndash;60 years [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The reasons attributed included lower immunity, aging, diabetes mellitus and malignancies.\u003c/p\u003e\u003cp\u003e\u003cem\u003eCandida ciferrii\u003c/em\u003e one of the re-emerging non-albicans \u003cem\u003eCandida\u003c/em\u003e species was isolated from the ear of a patient presenting with otitis media in this study. Previous studies done by other researchers in Kano Northern-Nigeria isolated \u003cem\u003eC. ciferrii\u003c/em\u003e not from humans, but from cow\u0026rsquo;s milk [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In a previous study done by AlrufaeMohamed and Alyassree in Kufa, Iraq, \u003cem\u003eC. ciferrii\u003c/em\u003e was recovered from ear swabs of their participants [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Our study thus presents the first report of \u003cem\u003eC. ciferrii\u003c/em\u003e causing clinical infection in our region.\u003c/p\u003e\u003cp\u003eIn relation to gender, the females had the highest prevalence of candidiasis (91.9%) than their male counterpart (8.1%). This could be due to predisposing factors such as recent use of antibiotics, use of oral contraceptives, and wearing tight-fitting synthetic underwear [15, 27, 28]. This finding also correlates with study done by Unaeze \u003cem\u003eet al.\u003c/em\u003e (2017), where a prevalence of 92.6% was reported for females and 7.4% for males [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, strikingly, with respect to age, males above 51 yrs had the highest prevalence of candidiasis (47.8%). Although not statistically significant, this could be due to decreased immunity, advanced age and other underlying medical conditions [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong antifungals tested, fluconazole showed poor susceptibility. This finding is in agreement with a previous study in Benin City, Nigeria where 66.6% of candidal isolates from the genital tract showed resistance to the drug [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A recent systematic review on antifungal susceptibility and etiology of vulvovaginal candidiasis in Africa revealed that resistance to fluconazole is on the rise [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This antifungal which is readily available over-the-counter in oral formulations and as suppositories, is one of the most prescribed antifungals for treatment of vulvovaginal Candidiasis in outpatient clinics in Nigeria. Misuse and abuse of this antifungal may account for the poor susceptibility observed. In the same vein, flucytosine showed poor activity against \u003cem\u003eCandida\u003c/em\u003e spp. This finding is worrisome as it\u0026rsquo;s hardly available in Nigerian pharmacies. Some studies have emphasized the potential for resistance to this antifungal when used in treating urinary candidiasis or cryptococcosis especially as monotherapy [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, reassuringly, voriconazole and caspofungin showed good activity against fungal isolates recovered.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eSome commonly prescribed antifungals such as nystatin, ketoconazole and itraconazole could not be assayed for as the AST card for susceptibility testing had preselected antifungals. Secondly, since the research was laboratory based, the sociodemographic data of the patients and the predisposing risk factors to fungal infection could not be ascertained.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of candidiasis in this study was 21.7%. Yeast was recovered from various clinical sites or specimens, with the highest isolation rate being from urogenital specimens. There is a brazen need for national surveillance of yeasts of medical importance. Owing to differing identity and AST pattern of yeast isolated, culture and AST though expensive is strongly encouraged even in resource-limited settings for effective management of such infections.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Health Research Ethics Committee (HREC) of Irrua Specialist Teaching Hospital\u0026nbsp;(ISTH), Irrua, Edo State, Nigeria, and a\u0026nbsp;waiver of informed consent was also granted through their letter referenced: \u003cstrong\u003eISTH/HREC/20231603/454\u003c/strong\u003e. This study was conducted in line with the Helsinki declaration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no external funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFIO, HOO and EEI conceived and designed the study. SSO, JO and FIO were involved in data collection and data analysis. FIO, HOO and EEI performed statistical analysis and interpretation. All authors were substantially involved in drafting the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eManolakaki D, Velmahos G, Kourkoumpetis T, Chang Y, Alam HB, De Moya MM, et al. Candida infection and colonization among trauma patients. Virulence. 2010;1(5):367\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4161/viru.1.5.12796\u003c/span\u003e\u003cspan address=\"10.4161/viru.1.5.12796\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKourkoumpetis TK, Velmahos GC, Ziakas PD, Tampakakis E, Manolakaki D, Coleman JJ, et al. 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Identification and Antifungal Susceptibility Profiles of Yeast Urogenital Tract Infection among Women in Benin City, Nigeria. J Appl Sci Environ Manage. 2022;26(11):1743\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4314/jasem.v26i11.2\u003c/span\u003e\u003cspan address=\"10.4314/jasem.v26i11.2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMushi MF, Olum R, Bongomin F. Prevalence, antifungal susceptibility and etiology of vulvovaginal candidiasis in sub-Saharan Africa: a systematic review with meta-analysis and meta-regression. 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PMCID: PMC10084540. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/20499361231161387\u003c/span\u003e\u003cspan address=\"10.1177/20499361231161387\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Candida spp, yeast, antifungal, VITEK-2, susceptibility, resistance","lastPublishedDoi":"10.21203/rs.3.rs-7556109/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7556109/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e\u003cem\u003eCandida\u003c/em\u003e species is a genus of yeast that can be commensals or pathogenic, causing invasive fungal infections that could lead to morbidity and mortality. This study aimed to determine the identity, prevalence and antifungal susceptibility pattern of \u003cem\u003eCandida\u003c/em\u003e species isolated from clinical samples of patients attending a tertiary Hospital, Irrua, Edo State, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 286 yeast isolates were recovered from clinical samples of patients sent to the Medical Microbiology Laboratory of Irrua Specialist Teaching Hospital (ISTH), Irrua, Edo State, Nigeria. Identification of yeast isolates and antifungal susceptibility testing (AST) of the isolates to different antifungal agents were assayed using VITEK-2 Compact System (Biomerieux, France).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 286 yeast isolates which included 283 \u003cem\u003eCandida\u003c/em\u003e isolates identified into six (6) \u003cem\u003eCandida\u003c/em\u003e species (\u003cem\u003eCandida albicans, Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei\u003c/em\u003e and \u003cem\u003eCandida ciferrii\u003c/em\u003e), and 2 non-candida yeast (\u003cem\u003eCryptoccocus laurentii and Trichosporon asahii\u003c/em\u003e) were recovered. The prevalence of \u003cem\u003eCandida\u003c/em\u003e species in this study was 21.7%, while that of yeast infection was 21.9%. \u003cem\u003eCandida albicans\u003c/em\u003e was the most frequently isolated species, accounting for 69.6% of isolates while \u003cem\u003eCandida ciferrii\u003c/em\u003e was the least isolated (0.3%). Urine specimens yielded the highest yeast isolates (43.4%), followed by Endocervical swab (24.8%, p\u0026thinsp;=\u0026thinsp;0.0001). Females had higher prevalence of yeast infection (91.6%) than the males (8.4%). Although marked resistance was shown to flucytosine (44.8%) and fluconazole (54.1%), the most active antifungal agents were voriconazole (92.3%) and coaspfungin (92.0%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThere is a brazen need for regional and national surveillance of yeasts of medical importance. To aid effective diagnosis and treatment, culture and AST though expensive is strongly encouraged in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Identification and Antifungal Susceptibility Pattern of Candida Species isolated from a Tertiary Hospital in Irrua, Edo State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-21 18:48:37","doi":"10.21203/rs.3.rs-7556109/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-01T05:13:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-30T01:30:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-25T20:11:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-25T13:09:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324000911396532087445013796713640576679","date":"2025-11-20T16:28:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24275066110179803597184723037031779119","date":"2025-11-19T19:45:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243470393878242315372735560679092322869","date":"2025-11-17T08:08:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-13T21:28:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42620614092743691658879523767030875991","date":"2025-11-04T11:41:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-26T04:23:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249491584730400304726102415647060200050","date":"2025-10-15T02:17:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T02:29:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-26T21:55:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-26T14:25:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T03:36:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Microbiology","date":"2025-09-26T03:33:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06377734-b9a9-4059-9f54-1363f0766b06","owner":[],"postedDate":"October 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:01:30+00:00","versionOfRecord":{"articleIdentity":"rs-7556109","link":"https://doi.org/10.1186/s12866-026-04852-9","journal":{"identity":"bmc-microbiology","isVorOnly":false,"title":"BMC Microbiology"},"publishedOn":"2026-02-19 15:57:59","publishedOnDateReadable":"February 19th, 2026"},"versionCreatedAt":"2025-10-21 18:48:37","video":"","vorDoi":"10.1186/s12866-026-04852-9","vorDoiUrl":"https://doi.org/10.1186/s12866-026-04852-9","workflowStages":[]},"version":"v1","identity":"rs-7556109","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7556109","identity":"rs-7556109","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}