Oropharyngeal candidiasis in hospitalized COVID‐19 Patients from Iran: Species identification and antifungal susceptibility pattern

Salehi, Mohammadreza; Ahmadikia, Kazem; Mahmoudi, Shahram; Kalantari, Saeed; Jamalimoghadam Siahkali, Saeidreza; Izadi, Alireza; Kord, Mohammad; Dehghan Manshadi, Seyed Ali; Seifi, Arash; Ghiasvand, Fereshteh; Khajavirad, Nasim; Ebrahimi, Saeedeh; Koohfar, Amirhossein; Boekhout, Teun; Khodavaisy, Sadegh

BACKGROUND: Emergence of coronavirus disease 2019 (COVID‐19) is a major healthcare threat. Apparently, the novel coronavirus (SARS‐CoV‐2) is armed by special abilities to spread and dysregulate the immune mechanisms. The likelihood of oropharyngeal candidiasis (OPC) development in COVID‐19 patients with a list of attributable risk factors for oral infections has not yet been investigated. OBJECTIVES: We here aim to investigate the prevalence, causative agents, and antifungal susceptibility pattern of OPC in Iranian COVID‐19 patients. PATIENTS AND METHODS: A total of 53 hospitalized COVID‐19 patients with OPC were studied. Relevant clinical data were mined. Strain identification was performed by 21‐plex PCR and sequencing of the internal transcribed spacer region (ITS1‐5.8S‐ITS2). Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, amphotericin B, caspofungin, micafungin and anidulafungin was performed according to the CLSI broth dilution method. RESULTS: In 53 COVID‐19 patients with OPC, cardiovascular diseases (52.83 %), and diabetes (37.7 %) were the principal underlying conditions. The most common risk factor was lymphopenia (71%). In total, 65 Candida isolates causing OPC were recovered. C. albicans (70.7%) was the most common, followed by C. glabrata (10.7%), C. dubliniensis (9.2%), C. parapsilosis sensu stricto (4.6%), C. tropicalis (3%), and Pichia kudriavzevii (=C. krusei, 1.5%). Majority of the Candida isolates were susceptible to all three classes of antifungal drugs. CONCLUSION: Our data clarified some concerns regarding the occurrence of OPC in Iranian COVID‐19 patients. Further studies should be conducted to design an appropriate prophylaxis program and improve management of OPC in critically ill COVID‐19 patients.