Abstract

A urinary tract infection (UTI) is a major disease that affects people of all age groups. Women are more susceptible to UTI than men especially pregnancy, mainly due to the different structural features make easy contamination of the UTI with fecal flora. Candida is one of pathogenic which causing this problem. A total of 196 Clean-Catch midstream urine samples were collected from pregnancy referred to Kassala new Hospital and Abdurrahman Elmobark Medical center, their ages between 15 to 40 year old. Grams’ staining, chlamydospores formation and Chromogenic Agar medium used to differentiate between Candida spp. 17 (8.67%) were positive for Candida species, these were C. glabrata (41.18%), C. albicans (23.52%), C. krusei (17.66%), C. dubliniensis (11.76%) and C. tropicalis (5.88%). No co-existence of Candida species was found. In the present study C .glabrata and C. albicans scored the highest frequency of occurrence.

1. Introduction

Urinary tract infection (UTI) is a major disease that affect people of all age groups, it is separated into asymptomatic and symptomatic cases based on its pathogenicity ¹. UTI is a common nonsurgical and nosocomial infection in postoperative patients and it is a healthcare associated infection ^{2, 3}. Worldwide, about 150 million people are diagnosed with UTI each year ⁴ that’s why it is a major driver of antibiotic usage globally ⁵. Women are more susceptible to UTI than men. This is mainly due to short urethra, absence of prostatic secretion and easy contamination of the urinary tract with fecal flora ⁶, in addition to several anatomical and hormonal changes related to pregnancy ⁷. The most isolated strains associated with uro-pathogenic biofilms are Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus and Candida tropicalis ⁸. Other causes included Chlamydia spp and fungi such as C. albicans ⁹. 20% of the pregnant women with UTI are liable to be admitted in obstetrical wards ¹⁰. Untreated UTI can lead to serious obstetric complications, poor maternal and perinatal outcomes e.g. intrauterine growth restriction, preeclampsia, caesarean delivery and preterm deliveries ¹¹. The study aimed to determine the prevalence of Candida spp infection, isolate and identify it in urine samples from pregnant women.

2. Materials and Methods

A total of 196 urine samples were collected from pregnant women referred to Kassala new Hospital and Abdurrahman Elmobark Medical center, their ages between 15 to 40 years old. Clean-Catch midstream urine method was used as described ^{12, 13}. Collected urine samples were cultured on sabouraud dextrose agar with chloramphenicol medium ¹⁴.

Pure isolation on sabouraud dextrose agar with chloramphenicol medium and identification of pathogenic fungi was suggested by ^{14, 15}.

Microscopical examination of gram reaction and formation of chlamydospores was performed according to ^{16, 17, 18} to observe yeast cells and chlamydospore formation.

3. Results

Out of 196 pregnant women cases 17 (8.67%) were positive for Candida species, these were Candida. glabrat, C. albicans, C. krusei, C. dubliniensis and C. tropicales. No co-existence of Candida spp. was found of the urine samples. Candida species cultural on Sabouraud Dextrose Agar with Chloramphenicol media appere white colour (Figure 1).

Chromogenic agar medium differentiated between Candida spp. on basis of colour produced due to the reaction between the isolates and the medium (Table 1). Green colony colour was shown by C.albicans and C.dubliniensis that is why formation of Chlamydospore was used as an additional differentiating tool (Table 1).

All the isolates were Gram positive and oval cells in shape (Figure 2).

On Corn Meal Agar medium Candida spp. form five types of chlamydospores. Seven isolates lack hyphae or pseudohyphae. Both are characteristic feature of C. glabrat. Four isolates which forming large, thick-walled chlamydospore, usually terminal and single indicating C. albicans. Three isolates formed long, slender, straight cells tree-like branching and chains of blastoconidia arising from the point between cells showing C. krusei. Two isolates formed true hyphae with solitary or cluster of blastoconidia, characteristic of C. dubliniensis and C.tropicales forming abundant branched pseudohyphae composed of elongated cells (Table 1 and Figure 3).

4. Discussion

Out of 196 patients cases, 17 (8.67%) were positive for Candida species. C. albicans were found in 8% of patients attending Khartoum hospitals ¹⁹. In other study recorded 36% ^{20, 21}. Kauffman et al reported that 10-15% of Candida spp. account for almost nosocomial UTIs cases ²². Subsequent epidemiological surveillance found that Candida spp. are one of the most common pathogens causing nosocomial bloodstream and UTI ²³, The most frequently isolated species is C. albicans, but C. tropicalis, C. glabrata, C. krusei, and C. parapsilosis are also emerging as important etiologic agents of Candida UTI ²⁴. The current study showed that seven out of 17 isolates belongs to C. glabrata (41.18%). Four isolates were C. albicans (23.52%), three isolates were C. krusei (17.66%), two isolates were C. dubliniensis (11.76%) and one isolate was C. tropicalis (5.88%). The present study agreed with ²⁵ in the flowing spp. C. glabrata, C. albicans, C. krusei, C. tropicalis except in C. kefyr. In the present study C. glabrata scored the highest frequency of occurrence, while it is C. albicans as reported by other study ^{21, 26, 27, 28, 29, 30}. Non-albicans species, especially C. tropicalis and C. glabrata predominate in many regions ³¹. Using Chromogenic Agar medium, each species isolates showed a distinct colour which is in accord with ^{32, 33, 34}. The description of chlamydospore formed by Candida spp. (Table 1) is in agreement with ³⁵.

Ethics

This study was approved by Ethical Clearance Committee Federal Ministry of Health, Kassala, Sudan. It worth mentioning that in some rural communities women get married under legal age.

Acknowledgments

The authorities of Kassala new Hospital and Abdurrahman Elmobark Medical center, Kassala state, Sudan, are highly acknowledged.

References