Multiple Candida strains causing oral infection in COVID-19 patients under corticosteroids and antibiotic therapy: An observational study

Farhang Babamahmoodi; Mohammad Sadegh Rezai; Fatemeh Ahangarkani; Ali Mohammadi Kali; Reza Alizadeh-Navaei; Abbas Alishahi; Narges Najafi; Azam Haddadi; Alireza Davoudi; Leila Azargon; Zahra Daftarian; Shirafkan Kordi; Kiana Abbasi

doi:10.3389/fcimb.2022.1103226

Multiple Candida strains causing oral infection in COVID-19 patients under corticosteroids and antibiotic therapy: An observational study

Front Cell Infect Microbiol. 2022 Dec 23:12:1103226. doi: 10.3389/fcimb.2022.1103226. eCollection 2022.

Authors

Affiliations

¹ Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
² Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
³ Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
⁴ Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
⁵ Universal Scientific Education and Research Network (USERN), Tehran, Iran.
⁶ Department of Endodontics, Faculty of Dentistry, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
⁷ Northbay Medical Center, Vacaville Center for Primary Care, Vacaville, CA, United States.
⁸ Department of Microbiology, Zanjan Branch, Islamic Azad University, Zanjan, Iran.

Abstract

Introduction: The occurrence of oral candidiasis (OC) is expected in patients with COVID-19, especially those with moderate to severe forms of infection who are hospitalized and may be on long-term use of broad-spectrum antibiotics or prolonged corticosteroid therapy. We aimed to characterize clinical conditions, the prevalence profile of Candida species, and outcomes of COVID-19 patients with OC.

Methods: In this observational study, oral samples were obtained from COVID-19 patients suspected of OC admitted to Razi teaching hospital. Patients with OC were monitored daily until discharge from the hospital. Species identification was performed by a two-step multiplex assay named YEAST PLEX, which identifies 17 clinically important uncommon to common yeast strains.

Results: Among the 4133 patients admitted with COVID-19, 120 (2.90%) suffered from OC. The onset of signs and symptoms of OC in patients was, on average (2.92 ± 3.596 days) with a range (of 1-29 days). The most common OC presentation was white or yellow macules on the buccal surface or the tongue. In (39.16%) of patients suffering from OC multiple Candida strains (with two or more Candida spp.) were identified. The most common Candida species were C. albicans (60.57%), followed by C. glabrata (17.14%), C. tropicalis (11.42%), C. kefyr (10.83%) and C. krusei (3.42%). Notably, OC caused by multiple Candida strains was more predominant in patients under corticosteroid therapy (P <0.0001), broad-spectrum antibiotics therapy (P = 0.028), and those who used nasal corticosteroid spray (P <0.0001). The majority of patients who recovered from OC at the time of discharge were patients with OC by single Candida species (P = 0.049).

Discussion: Use of corticosteroids and antimicrobial therapy in COVID-19 patients increases risk of OC by multiple Candida strains.

Keywords: Antibiotic; COVID-19; Candida species; Corticosteroid; Oral candidiasis.

Publication types

Observational Study

MeSH terms

Anti-Bacterial Agents / therapeutic use
Antifungal Agents / therapeutic use
COVID-19*
Candida
Candida albicans
Candida glabrata
Candida tropicalis
Candidiasis, Oral* / drug therapy
Candidiasis, Oral* / epidemiology
Communicable Diseases*
Humans
Pichia

Substances

Anti-Bacterial Agents
Antifungal Agents

Supplementary concepts

Pichia kudriavzevii