Asymptomatic Candiduria among Type 1 and 2 Diabetes Mellitus Patients: Risk and Sociodemographic Factors, Prevalence, Virulence Markers and Antifungal Susceptibility

Abstract

Diabetes mellitus (DM) has been considered as one of the predisposing factors for candiduria and Candida urinary tract infections. The study determined the socio-demographic characteristics, risk factors of DM patients with asymptomatic candiduria and ascertained the prevalence, virulence factors and antifungal susceptibility of Candida isolated. Socio-demographic and risk factors were obtained via questionnaires. Microscopic, macroscopic and chemical analysis of mid-stream urine (MSU) samples were determined by microbiological method and dipsticks. The characterization, virulence factors, antibiotic susceptibility of Candida isolates were determined by conventional, mycological media and disc diffusion techniques, respectively. Of the 51 MSU samples, ≥ 31.4% were amber and clear in colour, contained yeast cells and leukocytes; between 5.9 to 25.5% had hyaline casts, urobilinogen, epithelial cells, red blood cells, pus cells and nitrite, while the specific gravity was ≥ 1.015. The prevalence of candiduria among subjects with respect to age, types and duration of diabetes, gender, tobacco and alcohol consumption were not significant (p ≥ 0.005). Candida dubliniensis and C. parapsilosis prevalence was highest in subjects with random blood sugar (mg/dL) of ≥ 400 and 300-399, respectively. Of the 39 isolates, 64.1% were Fluconazole sensitive, 10.3% were dose dependent susceptible to Ketoconazole, 74.4% exhibited Voriconazole sensitivity, 100% C. dubliniensis were Clotrimazole sensitive, ≤ 28.6% C. tropicalis and C. glabrata were resistant to Amphotericin B and Itraconazole, while between 23.1% and 71.8% isolates produced hydrolytic enzymes and biofilm. This study revealed the socio-demographic characteristics and risk factors among subjects and the necessity to continuously investigate pathogenic Candida against antifungal agents for effective treatments of asymptomatic candiduria in diabetes mellitus patients.

Keywords

• candiduria
• diabetes
• risk factors
• antifungal
• susceptibility
• virulence factors