# Oral Candidiasis in COVID-19 Patients Under Critical Care Involving Non-albicans Candida Species Alongside Candida albicans

## TL;DR

This study examines oral candidiasis in critically ill COVID-19 patients, finding common Candida species and some drug resistance.

## Contribution

The study reports antifungal resistance patterns in Candida species among critically ill COVID-19 patients.

## Key findings

- Candida albicans was the most common species found in oral candidiasis cases.
- Some isolates showed multidrug resistance or intermediate drug sensitivity.
- Females had a slightly higher susceptibility to oral candidiasis than males.

## Abstract

Introduction

People around the world faced the possibility of death during the COVID-19 outbreak, including in India in 2019. Coinfection of oral candidiasis-like symptoms was not uncommon among COVID-19-infected patients undergoing treatment with prolonged broad-spectrum antibiotics or corticosteroid therapy. The present study aims to characterize the prevalence profile of Candida species and their antifungal drug susceptibility patterns among patients with COVID-19.

Material and methods

A short-term, hospital-based observational study was conducted on patients with Reverse Transcription Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 infections admitted to the critical care unit of a medical college hospital who presented with oral candidiasis-like symptoms. Oral swab samples were collected and cultured on Sabouraud dextrose agar. Species identification was performed using the VITEK-2 automated system (Biomerieux, France).

Results

Among 544 patients diagnosed with COVID-19, 20 were microbiologically positive for oral candidiasis. Candida albicans was the predominant species, followed by Candida glabrata, Candida tropicalis, and Candida kefyr. Females (55%) exhibited a slightly higher susceptibility than males (45%). Antifungal susceptibility testing revealed one isolate with multidrug resistance and five additional isolates displaying resistant or intermediate drug sensitivity patterns. COVID-19-related immune suppression and associated overuse of antibiotics and corticosteroids contributed to an increased incidence of oral candidiasis due to opportunistic fungi, including Candida albicans and non-albicans Candida species.

Conclusion

The candidal species profile associated with oral candidiasis did not significantly alter during the COVID-19 period compared to pre-COVID-19 baselines.

Key message

There was no occurrence of emerging Candida species during the COVID-19 period.