Incidence and spectrum of yeast species isolated from the oral cavity of Iranian patients suffering from hematological malignancies

Figures & data

Figure 1. Application of 21-plex PCR for identification of clinical isolates. The majority of the strains were identified in the first multiplex PCR (C. albicans, C. dubliniensis, and C. tropicalis), the isolates of K. marxianus (C. kefyr) by the second multiplex PCR, and the only isolate of Hanseniaspora opuntiae was not identified by any of the PCR reactions.

Table 1. Antifungal susceptibility testing against yeast species isolated from oral lesions of patients with hematological malignancies.

		ECV^a (µG/ml)		CBP^b (µG/ml)
Organism	Antifungal	<ECV	>ECV	S	SDD	I	R	GM	Range
C. albicans (n=69)	AMB	69	0	NA	NA	NA	NA	0.439	0.12–1
	FLZ	67	2	67	0	NA	2	0.461	0.125–8
	ITZ	65	4	65	4	NA	0	0.046	0.016–0.5
	VRZ	53	16	69	NA	0	0	0.022	≤0.015–0.06
	PSZ	69	0	NA	NA	NA	NA	0.026	≤0.015–0.06
	CAS	69	0	100%	NA	0	0	0.019	≤0.008–0.12
	AND	68	1	100%	NA	0	0	0.026	0.015–0.12
	5-FC	69	0	NA	NA	NA	NA	0.060	<0.06–0.06
K. marxianus (n=11)	AMB	10	0	NA	NA	NA	NA	1.149	0.012–2^C
	FLZ	10	0	NA	NA	NA	NA	0.326	0.12–0.5
	ITZ	10	0	NA	NA	NA	NA	0.053	0.06–0.25^d
	VRZ	9	1	NA	NA	NA	NA	0.016	0.015–0.03
	PSZ	10	0	NA	NA	NA	NA	0.028	0.015–0.03
	CAS	10	0	NA	NA	NA	NA	0.014	≤0.008–0.03
	AND	10	0	NA	NA	NA	NA	0.024	0.015–0.12
	5-FC	10	0	NA	NA	NA	NA	0.056	<0.06–0.12^e
C. tropicalis (n=3)	AMB	3	0	NA	NA	NA	NA	NA	0.12–0.5
	FLZ	3	0	3	0	NA	0	NA	0.25–1
	ITZ	3	0	NA	NA	NA	NA	NA	0.03–0.25
	VRZ	1	2	1	NA	2	0	NA	≤0.008–0.25
	PSZ	3	0	NA	NA	NA	NA	NA	≤0.015–0.06
	CAS	3	0	3	NA	0	0	NA	≤0.008–0.06
	AND	3	0	3	NA	0	0	NA	0.015–0.06
	5-FC	3	0	NA	NA	NA	NA	NA	≤0.12–0.25
C. dubliniensis (n=2)	AMB	2	0	NA	NA	NA	NA	NA	0.03–0.25
	FLZ	2	0	NA	NA	NA	NA	NA	0.06–0.25
	ITZ	2	0	NA	NA	NA	NA	NA	0.015–0.03
	VRZ	2	0	NA	NA	NA	NA	NA	<0.008–0.03
	PSZ	2	0	NA	NA	NA	NA	NA	0.06–0.25
	CAS	2	0	NA	NA	NA	NA	NA	0.008–0.06
	AND	2	0	NA	NA	NA	NA	NA	0.015–0.06
	5-FC	2	0	NA	NA	NA	NA	NA	0.06–0.12
H. opuntiae (n=1)	AMB (0.5)	NA	NA	NA	NA	NA	NA	NA	0.5
	FLZ (1)	NA	NA	NA	NA	NA	NA	NA	1
	ITZ (0.03)	NA	NA	NA	NA	NA	NA	NA	0.03
	VRZ (0.015)	NA	NA	NA	NA	NA	NA	NA	0.015
	PSZ (0.015)	NA	NA	NA	NA	NA	NA	NA	0.015
	CAS (0.03)	NA	NA	NA	NA	NA	NA	NA	0.03
	AND (0.015)	NA	NA	NA	NA	NA	NA	NA	0.015
	5-FC (0.06)	NA	NA	NA	NA	NA	NA	NA	0.06

a. Epidemiological cut-off value

b. Clinical breakpoint

c. For the isolates of K. marxianus, the epidemiological cut-off value of >2 were considered resistant to AMB

d and e. For the isolates of K. marxianus, the epidemiological cut-off value of ≥0.5 were considered resistant to ITZ and 5-FC

S; Susceptible, SDD; Susceptible dose-dependent, I; Intermediate, R; Resistant, NA; Not applicable

Geometric mean value was not calculated for species containing less than 10 isolates.

The only isolate of H. opuntiae showed low MIC values for all antifungal agents, which have are mentioned next to each antifungal used.