Oral Candidiasis in COVID-19 Patients Under Critical Care Involving Non-albicans Candida Species Alongside Candida albicans

Introduction People around the world faced the possibility of death during the COVID-19 outbreak, including in India in 2019. Coinfection of oral candidiasis-like symptoms was not uncommon among COVID-19-infected patients undergoing treatment with prolonged broad-spectrum antibiotics or corticosteroid therapy. The present study aims to characterize the prevalence profile of <i>Candida</i> species and their antifungal drug susceptibility patterns among patients with COVID-19. Material and methods A short-term, hospital-based observational study was conducted on patients with Reverse Transcription Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 infections admitted to the critical care unit of a medical college hospital who presented with oral candidiasis-like symptoms. Oral swab samples were collected and cultured on Sabouraud dextrose agar. Species identification was performed using the VITEK-2 automated system (Biomerieux, France). Results Among 544 patients diagnosed with COVID-19, 20 were microbiologically positive for oral candidiasis. <i>Candida albicans</i> was the predominant species, followed by <i>Candida glabrata</i>, <i>Candida tropicalis</i>, and <i>Candida kefyr</i>. Females (55%) exhibited a slightly higher susceptibility than males (45%). Antifungal susceptibility testing revealed one isolate with multidrug resistance and five additional isolates displaying resistant or intermediate drug sensitivity patterns. COVID-19-related immune suppression and associated overuse of antibiotics and corticosteroids contributed to an increased incidence of oral candidiasis due to opportunistic fungi, including <i>Candida albicans</i> and non-<i>albicans Candida</i> species. Conclusion The candidal species profile associated with oral candidiasis did not significantly alter during the COVID-19 period compared to pre-COVID-19 baselines. Key message There was no occurrence of emerging <i>Candida species</i> during the COVID-19 period.