Molecular Characterization and Antifungal Susceptibility patterns of Candida Isolates from Women attending Federal Medical Centre Makurdi, Benue State

Abstract

The emergence of Multi-Drug-Resistant (MDR) Candida albicans to commonly used antifungals has posed significantchallenges in the treatment of candidiasis, particularly in resource-limited settings. The aim of this study was to determinethe antifungal susceptibility patterns and molecular resistance profiles of Candida albicans isolates from vaginal swab samples collected from women attending Federal Medical Centre, Makurdi, Nigeria. Six hundred and ninety-eight (698) swab samples were obtained from women attending both the Outpatient Department (OPD) and the HIV clinic at Federal Medical Centre, Makurdi. Candida albicans was isolated using Saboroud Dextrose Potato Agar, and confirmed by the germ tube test and CHROMagar. Antifungal susceptibility testing was conducted against fluconazole, voriconazole, nystatin, amphotericin B and clotrimazole. The isolation rate of Candida albicans was 49.0% (n=342). Significant associations were observed between C. albicans prevalence and variables such as location (χ² = 5.383), age (χ² = 59.269), marital status (χ² = 7.833), occupation (χ² = 14.668), and HIV status (χ² = 7.096) (p < 0.05).  The highest prevalence was among women aged 31–40 years (31.0%, n=106), with married women showing a higher infection rate (65.2%, n=223). C. albicans infection was most prevalent in subjects aged 31-40 years (31.0%, n=106). Marriedwomen had a significantly (65.2%, n=223) higher isolation ratethan the single and widowed ones. The antifungal susceptibility pattern of the Candida albicans isolates showed that 80% were resistant to one or more antifungals with the highest resistance observed against fluconazole (84.7 %; n=277). All the isolates were however, susceptible to nystatin. In addition, multidrug resistance was observed in 21.3% of isolates, with the < 20 years age group showing the highest proportion of MDR strains (25.9%, n=7). MDR was more prevalent in isolates from the HIV clinic compared to those from the OPD (χ² = 12.459, p < 0.05).  Molecular characterization of DNA extracted from MDR isolates showed high purity (OD260:OD280 ratio between 1.8 and 2.0). Gel electrophoresis confirmed the presence of the Candida Drug Resistance gene (CDR1) resistance gene as shown by the photo-transilluminator image, while ERG11_A, ERG11_B, ERG11_C, and MDR_A genes were absent.  This study highlights a high prevalence of Candida albicansinfections among women in Makurdi, with a considerable proportion exhibiting multi-drug resistance. The presence of CDR1 among MDR isolates underscores the urgent need for regular surveillance and antifungal stewardship in the region.

Keywords: Candida albicans, Multi-drug resistance (MDR), Antifungal susceptibility, Vaginal candidiasis, Resistance genes, CDR1, Makurdi, Nigeria