Introduction: Candida is an opportunistic fungal pathogen that lives in the gastrointestinal tract. Infection is due to different types of Candida species that involves the oral route. Although the clinical significance of isolated biliary candidiasis has remained unclear, nowadays, candidiasis is common in cancer patients such as gallbladder cancer and cholangiocarcinoma. Because of antibiotic resistance, failure of gallbladder stents and other complications, the potential role of the candida and other less important fungal genera in the etiology of cholangiocarcinoma is the subject of this study.
Methods: A total of 110 bile extract from clogged bile duct were taken from patients who were undergoing percutaneous transhepatic biliary drainage (PTBD) according to ethical regulations. The samples were taken from patients suffering from cholangiocarcinoma and aged 34 to 79 years referring to two hospitals (Imam Khomeini, Mehrad and Taleqani) in Tehran, Iran. The samples were cultured on Sabouraud agar .The yeasts were cultivated on CHROMagar media and C. albicans suspected colonies were confirmed by germ tube experiment. The polymerase chain reaction (PCR) was performed by ITS1 and ITS4 to amplify the internal transcribed spacer (ITS) region. The amplified fragment was sequenced and blasted for further identification. The antimicrobial susceptibility test is under investigation.
Results: Among 110 specimens, 19 fungi were isolated. They were taken from 9 men and 6 women aged between 37 to 79 years. Four of the specimens contained mixed infection of two and one mixed infections contained three fungi. Patients were suffering from cholangiocarcinoma. The isolated fungal species which were found include C. glabrata (n=8), C. parapsilosis (n=1), C.albicans (n= 4), Kluyveromyces marxianus (n=1), Millerozyma farinos (n=1), Pichia guilliermondii (n=1) and Meyerozyma guilliermondii (n=3)
Conclusion: Candidiasis as a nosocomial fungal infection happens in patients with immunosuppression, surgery and biliary stents that could induce cholangitis and malignant biliary obstruction. In the last several years, the number of patients with biliary candidiasis has been increased. They could be either missed or become resistant to antibiotic treatment regimen which has been seen in patients with repeated biliary candidiasis. Monitoring the prevalence and the causes of infection could help the surveillance and prevent the spreading of this opportunistic disease.