Virulence and Susceptibility Patterns of Clinical Candida spp. isolates from a Tertiary   Hospital, Mwanza-Tanzania 
*Martha F. Mushi1, Oliver Bader2, Christine Bii3, Uwe Groß2, Stephen E. Mshana1
1.	Department of Microbiology and immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences Mwanza, Tanzania.
2.	Institute of Medical Microbiology, University Medical Center Goettingen, Germany.
3.	Kenya Medical Research Institute, Center for Microbiology Research
*Corresponding Author
Martha F. Mushi
Department of Microbiology and Immunology, 
Catholic University of Health and Allied Sciences (CUHAS)
P.O. BOX 1464
Mwanza, Tanzania
MFM: marthamushi@yahoo.com
OB: oliver.bader@med.uni-goettingen.de
CB: biichristinec@gmail.com
UG: ugross@gwdg.de
SEM: mshana72@yahoo.com

 
Abstract 
Objective: This study was designed to determine virulence factors and the antifungal susceptibility pattern of Candida albicans, Candida glabrata and Candida tropicalis collected from human clinical samples in Mwanza, Tanzania. 
Methods: This was a cross-sectional study conducted between March and December 2017. Candida spp. isolated from blood, esophageal brushes, high vaginal swab, urine, sputum and oral swab of patients attending the Bugando Medical Centre during the study period were collected and characterized. Species identification was done by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. The antifungal susceptibility testing for fluconazole, voriconazole, posaconazole, micafungin, caspofungin and 5-fluorocytosine was done following the guidelines laid down by the European Committee on Antimicrobial Susceptibility Testing with MIC50(µg/ml) recorded. Virulence –associated phenotypes (Phospholipase, proteinase, hemolytic, and coagulase activity) were determined for all Candida spp. Data analysis was done using STATA version 13.
Results:  A total of 376 Candida spp., (high vaginal swab: 146 (38.8%), oral swab: 99 (26.3%), urine:  68(18.1%), sputum: 47(12.5%), esophageal brushes: 11(2.9%) and blood: 5(1.3%))   were obtained during the study period. Of 376 studied Candida spp., 278(73.9%), 51(13.6%) and 47(12.5%) were C. albicans, C. tropicalis and C. glabrata, respectively.
Phospholipase activity was the most frequently virulence factor detected in C. albicans 193/268 (72.0%) while for C. glabrata and C. tropicalis most frequently virulence factors detected were proteinase activity 32/51(62.8%) and coagulation 25/47(53.2%), respectively. Proteinase and phospholipase activity were frequently detected virulence factors from C. albicans isolated from blood (5/5(100%) and 4/5(80%)) and esophageal brushes (8/10(80%) and 5/11(45.5)) respectively.   
C. glabrata was sensitive (100%) to all antifungal agents tested with the mode (epidemiological cut off value μg/ml (ECV)) of 4(8), 0.063(4), 0.25(0.5), 0.25(0.5), 0.031(0.5) and 0.031(0.125), for fluconazole, voriconazole, posaconazole, caspofungin, micafungin and 5-fluorocytosine, respectively.  The mode MIC50 (ECV) μg/ml for fluconazole, voriconazole, posaconazole, micafungin, caspofungin and 5-fluorocytosine of C. albicans was 0.25(1), 0.031(0.125), 0.016(0.063), 0.25(1), 0.063(0.5) and 0.063(0.5), respectively while the mode MIC50 (ECV) μg/ml for fluconazole, voriconazole, posaconazole, micafungin, caspofungin and 5-fluorocytosine of C. tropicalis was 0.25(1), 0.031(0.125), 0.063(0.063), 0.125(0.25), 0.125(0.25) and 0.063(0.25), respectively. C. glabrata had the lowest mode for micafungin. C. albicans was 100% sensitive to caspofungin and C. tropicalis was 100% sensitive to fluconazole, caspofungin, micafungin and 5-fluorocytosine.
Conclusion: Phospholipase and proteinase production is high among C. albicans from invasive specimens (blood and esophageal brush). More than 95% of C. albicans, C. tropicalis and C. glabrata from Tanzania are sensitive to fluconazole, posaconazole, micafungin, caspofungin and 5-Fluorocytosine. There is a need of starting active surveillance of fungi infections in developing countries in order to monitor the emergence of antifungal resistant strains.

5 / Virulence factors and susceptibility pattern of Candida albicans, Candida tropicalis and Candida glabrata from clinical specimens, Mwanza-Tanzania