In vitro antifungal susceptibility patterns of Candida albicans from HIV and AIDS patients attending the Nylon Health District Hospital in Douala, Cameroon

Abstract

HIV and AIDS are major public health problems in Cameroon where the HIV prevalence is 5.5%. Candidiasis is the leading opportunistic mycosis in HIV and AIDS patients. The objective of this study was to determine the in vitro antifungal susceptibility pattern of Candida albicans in HIV and AIDS patients to eight antifungal agents in the Nylon Health District of Douala in Cameroon. Three hundred and four HIV and AIDS patients were recruited between March and August 2007 to participate in a cross-sectional study. All subjects who fulfilled the inclusion criteria were enrolled. Informed consent was obtained from all subjects before samples were collected. Three samples comprising oral swabs, vagina/urethra swabs and a mid-stream urine were collected from each subject. Specimens were cultured on sabouraud dextrose agar and C. albicans isolates were identified using the germ tube technique. The disk diffusion method was used for antifungal susceptibility testing using eight antifungal agents. The prevalence of candidiasis in the study population was 67.8% (95% CI: 62.5-73.1%) and that of C. albicans was 42.8% (95% CI: 37.2-48.4%). Oral swabs had the highest prevalence of C. albicans followed by vaginal/urethral samples (52.6% vs. 29.7% respectively). Forty (30.8%) subjects had C. albicans infection at more than one collection site. There was a statistically significant difference in the infectivity of C. albicans with age, sex and site of infection (P<0.05). C. albicans isolates were most sensitive to ketoconazole (80%) followed by econazole (64.6%) while fluconazole and 5-flurocytosin recorded the poorest sensitivities (22.9% vs 24.6%, respectively). There was a statistically significant difference in the sensitivity pattern of antifungal agents with respect to the site of isolation of the organism (P<0.05). Ketoconazole is the drug of choice for the treatment of C. albicans infection in HIV and AIDS patients in the Nylon Health District of Douala, Cameroon.