Virulence of Candida Isolates in Patients with Tuberculosis and Oral/Oesophageal Candidiasis: Co-Infection Evaluation

Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis complex (MTBC), which can be exacerbated by fungal infections. This study evaluated the clinical characteristics and virulence of Candida spp. in patients with tuberculosis. Antifungal sensitivity, phospholipase and proteinase production, biofilm formation, phagocytic index, and reactive oxygen (ROS) and nitrogen (RNS) species were assessed. Candida spp. were isolated from 14 patients, 28.5% women and 71.4% men, mainly from sputum and tracheal secretions. Five (35.7%) patients were co-infected with Mycobacterium, Candida, and HIV. Candida albicans (78.6%) and Candida tropicalis (21.4%) were identified in all 14 patients. All isolates showed sensitivity to amphotericin B and dose-dependent responses to fluconazole (16 μg/mL). Phospholipase activity was detected in 35.7% of the isolates, whereas all isolates showed proteinase activity (100%). A significant difference in phospholipase activity, phagocytosis, and production of reactive oxygen species (ROS) and nitrogen species (RNS) was observed when Candida isolates from patients with TB, living with or without HIV, were compared to Candida isolates from healthy individuals. All isolates were biofilm producers. This study highlights the relevance of mycoses diagnosis in patients with TB, since Candida spp. may be more virulent and contribute to the deterioration of the clinical condition.