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

Abstract

Tuberculosis (TB) is an infection caused by <i>Mycobacterium tuberculosis</i> complex (MTBC), which can be exacerbated by fungal infections. This study evaluated the clinical characteristics and virulence of <i>Candida</i> 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. <i>Candida</i> 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 <i>Mycobacterium</i>, <i>Candida</i>, and HIV. <i>Candida albicans</i> (78.6%) and <i>Candida tropicalis</i> (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 <i>Candida</i> isolates from patients with TB, living with or without HIV, were compared to <i>Candida</i> isolates from healthy individuals. All isolates were biofilm producers. This study highlights the relevance of mycoses diagnosis in patients with TB, since <i>Candida</i> spp. may be more virulent and contribute to the deterioration of the clinical condition.