AUTHOR=Babamahmoodi Farhang , Rezai Mohammad Sadegh , Ahangarkani Fatemeh , Mohammadi Kali Ali , Alizadeh-Navaei Reza , Alishahi Abbas , Najafi Narges , Haddadi Azam , Davoudi Alireza , Azargon Leila , Daftarian Zahra , Kordi Shirafkan , Abbasi Kiana 

TITLE=Multiple Candida strains causing oral infection in COVID-19 patients under corticosteroids and antibiotic therapy: An observational study

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2022.1103226

DOI=10.3389/fcimb.2022.1103226

ISSN=2235-2988

ABSTRACT=<sec><title>Introduction</title><p>The occurrence of oral candidiasis (OC) is expected in patients with COVID-19, especially those with moderate to severe forms of infection who are hospitalized and may be on long-term use of broad-spectrum antibiotics or prolonged corticosteroid therapy. We aimed to characterize clinical conditions, the prevalence profile of <italic>Candida</italic> species, and outcomes of COVID-19 patients with OC.</p></sec><sec><title>Methods</title><p>In this observational study, oral samples were obtained from COVID-19 patients suspected of OC admitted to Razi teaching hospital. Patients with OC were monitored daily until discharge from the hospital. Species identification was performed by a two-step multiplex assay named YEAST PLEX, which identifies 17 clinically important uncommon to common yeast strains.</p></sec><sec><title>Results</title><p>Among the 4133 patients admitted with COVID-19, 120 (2.90%) suffered from OC. The onset of signs and symptoms of OC in patients was, on average (2.92 ± 3.596 days) with a range (of 1-29 days). The most common OC presentation was white or yellow macules on the buccal surface or the tongue. In (39.16%) of patients suffering from OC multiple <italic>Candida</italic> strains (with two or more <italic>Candida</italic> spp.) were identified. The most common <italic>Candida</italic> species were <italic>C. albicans</italic> (60.57%), followed by <italic>C. glabrata</italic> (17.14%), <italic>C. tropicalis</italic> (11.42%), <italic>C. kefyr</italic> (10.83%) and <italic>C. krusei</italic> (3.42%). Notably, OC caused by multiple <italic>Candida</italic> strains was more predominant in patients under corticosteroid therapy (P &lt;0.0001), broad-spectrum antibiotics therapy (P = 0.028), and those who used nasal corticosteroid spray (P &lt;0.0001). The majority of patients who recovered from OC at the time of discharge were patients with OC by single <italic>Candida</italic> species (P = 0.049).</p></sec><sec><title>Discussion</title><p>Use of corticosteroids and antimicrobial therapy in COVID-19 patients increases risk of OC by multiple <italic>Candida</italic> strains.</p></sec>