Candida albicans  Genotyping and Relationship of Virulence Factors with Fluconazole Tolerance in Infected Pediatric Patients

Figures & data

Table 1 Demographic and Clinical Data of Patients Enrolled in the Study

Sex
Male	40 (45.5%)
Female	48 (54.5%)
Age (years)
Mean ±Sd	2.5±2.3
(min-max)	6 month-12 years
Clinical data
1)Type of infection
UTI	45 (51.1%)
Blood stream infection	19 (21.6%)
Respiratory tract infections	24 (27.3%)
2)Presence of comorbidity
Present	50 (57%)
Absent	38 (43%)
3)Presence of risk factor
Present	70 (80%)
Absent	18 (20%)
4)Severity of illness
Critical	33 (37%)
Not critical	55 (63%)

Table 2 Distribution of Candida albicans Producing Virulence Factors among Different Clinical Samples and Genotypes

Virulence Factor	Clinical Sample							Genotype							Total
	Blood		Urine		Respiratory samples		P^* value	A		B		C		P* value	NO (%)	Pz Min-Max Mean±Sd
	NO (%)	Pz Mean±Sd	NO (%)	Pz Mean±Sd	NO (%)	Pz Mean±Sd		NO (%)	Pz Mean±Sd	NO (%)	Pz Mean±Sd	NO (%)	Pz Mean±Sd
Proteinase	18 (26.5)	0.65±0.18	31 (45.6)	0.73±0.22	19 (27.9)	0.71±0.26	0.1	34 (50)	0.72±0.23	24 (35.3)	0.65±0.21	10 (14.7)	0.78±0.22	0.4	68 (77.3)	0.25–0.81 0.38±0.12
Phospholipase	12 (20.7)	0.78±0.19	29 (50)	0.79±0.18	17 (29.3)	0.77±0.19	0.9	32 (55.2)	0.76±0.19	20 (34.5)	0.78±0.17	6 (10.3)	0.85±0.2	0.2	58 (65.9)	0.2–0.9 0.51±0.21
Biofilm	14 (20.9)	-	32 (47.8)	-	21 (31.3)	-	0.5	35 (52.3)	-	24 (35.8)	-	8 (11.9)	-	0.1	67 (76.1)	-

Note: *Chi square test was used.

Abbreviations: Pz, precipitation zone; SD, standard deviation.

Table 3 Prevalence of Fluconazole Tolerant Candida albicans among Different Clinical Samples, Genotypes and Virulence Factors Producers

	Fluconazole Tolerant	Fluconazole Non Tolerant	P^*  value
Clinical sample			0.06
Blood (N, %) (19)	10 (52.6)	9 (47.4)
Urine (N, %) (45)	10 (22.2)	35 (77.8)
Respiratory samples (N, %) (24)	9 (37.5)	15 (62.5)
Genotype			0.8
A (N, %) (46)	12 (26.1)	34 (73.9)
B (N, %) (28)	12 (42.9)	16 (57.1)
C ((N, %) (14)	5 (35.7)	9 (64.3)
Virulence factors
Proteinase production (N, %) (68)	23 (33.8)	45 (66.2)	0.7
Phospholipase production (N, %) (58)	17 (29.3)	41 (70.7)	0.5
Biofilm formation (N, %) (67)	28 (41.8)	39 (58.2)	0.001

Note: *Chi square test was used.

Table 4 Correlation Between Candida albicans Virulence Factors and Degree of Fluconazole Tolerance

Degree of Tolerance	Proteinase	Phospholipase	Biofilm
Moderate
≥50% residual growth <80%	7	7	12
Strong
Residual growth ≥80%	16	10	16
Correlation	P= 0.01 r= −0.4	P= 0.79 r= −0.15	P= 0.03 r= −0.15

Notes: The moderate tolerant isolates had residual growth ≥50% but less than 80%, and heavy tolerant had residual growth ≥80% after 48 h incubation compared to the drug free wells. r: Pearson’s correlation coefficient.