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  3. 5. Antifungal Susceptibility Pattern of the Candida Species in Nail Infections
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5. Antifungal Susceptibility Pattern of the Candida Species in Nail Infections

Shahida Kashif1, Behram Khan Khoso2, Faiza Zeeshan3, Muhammad Khalid3, Wajid Hussain4 and Fakhur Uddin5


Objective: To determine the in-vitro susceptibility of Candida sp. against fluconazole, voriconazole and pasoconazole.

Study Design: A cross-sectional study

Place and Duration of Study: This study was conducted at the department of Microbiology, in collaboration with department of Dermatology, JPMC, Karachi from November 2018 to January 2020.

Materials and Methods: Total 358 nail samples has been collected. Sample was processed for direct microscopy with 20% potassium hydroxide and nail was inoculated on  two set of Sabouraud's dextrose agar (SDA) supplemented with antibiotics and plain SDA plates & a selective dermatophytes test medium (Dermasil) plate. Candida isolates were identified by commercial identification kit (API ID 32C system) and germ tube test. Susceptibility to fluconazole, posaconazole and voriconazole was determined by disc diffusion test and minimal inhibitory concentration (MIC) of fluconazole was determined by Epsilometer (Etest) strip [bioMerieux, France]

Results: Out of 358 case onychomycosis of 253(70.76%) were positive for fungal culture and 253/109 (43.08%) were of candidal onychomycosis. C. albicans was the major isolated species 60/109(55.04%) followed by C. tropicalis was the predominant species account for 29/109(26.60%). Majority of candidal onychomycosis cases were in age groups of ≤25 years and 36-45 years 25 (26.9%) and 22 (23.7%) respectively. The cases were more common in female 67(66%). Antifungal susceptibilities reveal that 76 (69.73%) Candida species were susceptible, 33(30.27%) were resistant to the fluconazole. Fluconazole resistance was lower in C. albican versus non-albicans species; C. glabrata, C. parapsilosis C. tropicalis, species presented 57.14%, 53.84%, 48.27%, respectively. All the species except C. glabrata were sensitive to voriconazole and pasoconazole.

Conclusion: Candida albican was the main species isolated from onychomycosis. Significant number of Candida species was resistant to fluconazole, whereas most of species susceptible to voriconazole and pasoconozole.

Key Words: Candida, Dermatophytes, Non-albicans, Onychomycosis, Potassium hydroxide, Voriconazole

Citation of article: Kashif S, Khoso BK, Zeeshan F, Khalid M, Hussain W, Fakhur Uddin. Antifungal Susceptibility Pattern of the Candida Species in Nail Infections. Med Forum 2023;34(2):20-24.