INTRODUCTION:

A fungus is a eukaryotic organism that is a member of the kingdom fungi. The fungi are a monophyletic group, also called the Eumycota. Approximately 80,000 species of fungi have been described, but fewer than 400 are medically important and less than 50 species cause more than 90 % of the fungal infections of humans and other animals(Asmunds Dottir et al.,2002). “Yeast and Yeast like fungi” cause infection in man. Before culturing and identifying the specific pathogenic fungus, it is important to demonstrate the fungus in the clinical specimen. Some saprophytic fungi usually do not produce disease but may cause infection in immunologically compromised patient and in terminal stages of chronic disease. (“True fungi” or Eumycetes), that is phylogenetically distinct from the morphologically similar slime molds and water mold (oomycetes) ( Banerjee et al.,1991). Sexual and asexual reproduction of fungi is commonly via spores often produced and specialized structure or in fruiting bodies. Many fungi produce bioactive compounds called mycotoxin, such as alkaloids and prolectides that are toxic to animals including humans. Blood streams infection causes by candida are increasingly common with high mortality rates(Bodey, 1993). Candida species are most common causes of fungal infections worldwide.

They can cause a great verity of infection, including simple, mucocutaneous infection to server, invasive life – treating infection involving virtually any organ. Invasive candidiasis is a severe, life treating infection, with a mortality rate of 40 to 60%, and it cure mortality in immunosuppresed patents(Botas et al.,1995). This mortality may be upto 80% for bone marrow transplant recipient, and those under chemotherapy. Candida species causing invasive infection seen to vary according to the world region (Colombo et al., 1999). Invasive fungal infections are more due to the increasing number of high risk patents. With different degree of immunosuppression, chronic conditions like cancer, bone marrow transplantations, AIDS and chronic use of corticosteroid. The genus candida and species C. albicans was described by Botanist Christine Marie Berkhout in her doctoral thsis at the University of Utrecht in 1923. Among the most pathogenic species of candida is Candida albicans this is present in about 50 % to 60 % of all the cases of candidiasis (Edwards, 1991). The Candida glabrata has gradually become more medically significant, and its being less susceptible to antifungal (Fraser et al., 1992). After yeast cell of candida encounters a particular host tissue a part from its fate, both specific and non specific adhesive properties are required to allow binding at these site. Candida albicans and C. tropicalis produce aspertyl proteinase in vivo, which is an important pathogenicity (Girmenia et al.,1998). Phospholipase concentrated at the hyphal tip may be related to the greater intensiveness of this form as compared to the yeast form more over the hyphal being larger than the yeast form are most resistant to phagocytosis change contribute to the increased pathogenic potential of the fungus (Karabinis et al.,1988).

OBJECTIVE:

 To evaluate blood stream infection caused by Candida species.

 To evaluate culture characteristic grown on specific media.

 To evaluate drug sensitivity test

CLINICAL FEATURES:

The candida species are found as commensals on mucosal surface of the body but they can cause disease as and when conditions are favourable. These yeast like fungi typically colonize mucocutaneous surface, which can portals of entry into deeper tissue when the host defences are compromised (Pfaler et al., 1998).

METHOD:

Firstly we make smears by gently heating. Then we proceed gram’s stain and culturing a suspect strain of candida is grown on Sabouraud Dextrose Agar media. For the identification of yeast, candida species done by germ tube test and cornmeal tween agar method. The sensitivity of candida for the identification by mini API (Analytical Profile Index) is based on calorimetric and nephrometric principal. The ATB fungus strip is incubate at 37^oc for overnight. Then cheque the sensitivity species of the candida by mini API.

RESULT

No. of Candida species isolated from blood

Species	No.	Percentage
Candida albicans	5	33.33
Candida tropicalis	3	25
Candida glabrata	1	8.33
Candida parapsilosis	2	16.66
Candida krusei	1	8.33
Candida dubliniensis	2	16.66

Most frequency isolated species is Candida albicans (33.33)

Antifungal sensitivity pattern of candida isolates

FLU=Flucytosin; AMP-B=Amphotericin B; FLUC=Fluconazole; ITR=Itraconazole; VOR=Voriconazole

DISCUSSION:
Over the period of three month (March to May 2009), total 2500 blood samples were received. Among this candida species was isolated in 12(41.66%) samples. Out of this 12 candida species C. albicans (41.66%) was found to be most sensitive to Fluconazole, Itraconazole, Voriconazole.

CONCLUSION:

Candida species is the most common fungi causing fungal blood stream infection. Among this Candida albicans is the most common isolated species and Candida tropicalis is the least common species. Flucytosin, Fluconazole, Itraconazole, Voriconazole drug is found to be most effective for Candida albicans. So considering that candida species is the most common fungal pathogen, it is most important to rapidly identify candida species in routine clinical micro practises.

REFERENCES:

1. Asmunds Dottir L.R., Erlends Dottir H., Gott Fredsson M. Increasing incidence of Candidemia: Results from a 20 – Year Nationwide study in Iceland. J Clin Microbiol 2002;40:3489-92.

2. Banerjee S.N., Emori T.G., Culver D.H., et al. Secular Trends in Nosocomial Primary Bloodstream Infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. American Journal of Medicine1991;91:865-95.

3. Bodey G.P. Hematogenous and major organ candidiasis. In Candidiasis: pathogenesis, diagnosis and treatment, Raven Press Ltd., New York, 1993.

4. Botas C.M., Kurlat J., Young S.M., Sola A. Disseminated Candidal Infectious and Intravenous Hydrocortisone in Preterm Infants. Pediatrics 1995;95:883-7.

5. Colombo A.L., Nucci M., Salomão R., et al. High Rate of Non-Albicans Candidemia in Brazilian Tertiary Care Hospitals. Diagnostic Microbiology and Infections Diseases 1999;34:281-6.

6. Edwards J.R. Jr. Invasive Candida Infections. Evolution of a Fungal Pathogen. N Engl J Med 1991;324:1060-2.

7. Fraser V.J., Jones M., Dunkel J., et al. Candidemia in Tertiary care Hospital: Epidemiology, Risk Factors and Predictors of mortality. Clin Infect Dis 1992;15:414-21.

8. Girmenia C., Martiwo P. Fluconazol and the Changing Epidemiology of candidemia. Clin Infect Dis 1998;27:232-4.

9. Karabinis A., Hill C., Leclerca B., et al. A Risk factors for Candidemia in cancer patients: A Case-Control Study. J Clin Microbiol 1988;26:429-32.

10. Pfaler M.A., Messer S.A., Houston A., et al. National Epidemiology of Mycoses Survey: A Multicenter Study of Strain Variation an Antifungal Susceptibility Among Isolates of Candida Species. Diagn Microbiol Infect Dis1998;31:289-96

Organism

C. albicans

C. tropicalis

C. parapsilosis

C. glabrata

C. krusei