In vitro species and antifungal susceptibility of yeast from the nails of patients with the human immunodeficiency virus

Objective The objective of this study was to identify yeasts from the genus Candida responsible for onychomycosis and their respective in vitro antifungal susceptibilities in outpatients with the human immunodeficiency virus and nail changes suggestive of onychomycosis. Methods Twenty-three strains of yeasts from 21 nail samples from fingers or toes were assessed. The colonies were identified using CHROMagar Candida+ and standard tests. ATB-Fungus 3+ method was used for the antifungal susceptibility testing and when there was resistance to fluconazole, the disk diffusion test was used for confirmation. Results A mixed infection with two species of Candida was found in two cases. Out of the 23 species found, 48% were C. albicans, 26% were C. parapsilosis, 8.5% were C. tropicalis, 8.5% were C. glabrata, 4.3% were C. guilliermondii and 4.3% were C. famata. In the susceptibility tests, 48% of the species were resistant to azotes, where 36% were C. albicans and 64% were non-albicans species. All fluconazole-resistant strains in the ATB-Fungus 3+ method were also resistant in the disk diffusion test. Patients with resistant strains had used antifungal agents before to treat oral candidiasis or recurrent onychomycosis. Conclusion Candida albicans is the most commonly isolated species in cases of onychomycosis caused by yeasts of the Candida genus in nails of patients with the human immunodeficiency virus. However, in this group of patients, the albicans species isolated from the nails are less susceptible to azoles. Yeast resistance to fluconazole, a drug routinely used to treat candidiases, could be due to its previous use. Thus, antifungal agents should be used with caution and only when the diagnosis and antifungal susceptibility are proven.Original Abstract: Objetivo Identificar leveduras do genero Candida responsaveis por onicomicose e as respectivas suscetibilidades antifungicas in vitro em pacientes ambulatoriais com virus da imunodeficiencia humana e alteracoes ungueais sugestivas de onicomicose. Metodos Avaliaram-se 23 cepas de leveduras isoladas de 21 amostras ungueais das maos e/ou pes. As coldnias foram identificadas por CHROMagar Candida+ e testes pa-droes. Para o antifungigrama, utilizou-se o ATB-Fungus 3+, e quando o fluconazol apresentou resistencia neste kit, utilizou-se, para confirmacao, o teste de disco difusao. Resultados Em dois casos houve infeccao mista por duas especies de Candida. Das 23 especies, 48% eram C. albicans, 26% C. parapsilosi