Oropharyngeal candidiasis in hospitalised COVID-19 patients from Iran: Species identification and antifungal susceptibility pattern

Mohammadreza Salehi, Kazem Ahmadikia, Shahram Mahmoudi, Saeed Kalantari, Saeidreza Jamalimoghadamsiahkali, Alireza Izadi, Mohammad Kord, Seyed Ali Dehghan Manshadi, Arash Seifi, Fereshteh Ghiasvand, Nasim Khajavirad, Saeedeh Ebrahimi, Amirhossein Koohfar, Teun Boekhout, Sadegh Khodavaisy

Research output: Contribution to journal/periodicalArticleScientificpeer-review


BACKGROUND: Emergence of coronavirus disease 2019 (COVID-19) is a major healthcare threat. Apparently, the novel coronavirus (SARS-CoV-2) is armed by special abilities to spread and dysregulate the immune mechanisms. The likelihood of oropharyngeal candidiasis (OPC) development in COVID-19 patients with a list of attributable risk factors for oral infections has not yet been investigated.

OBJECTIVES: We here aim to investigate the prevalence, causative agents and antifungal susceptibility pattern of OPC in Iranian COVID-19 patients.

PATIENTS AND METHODS: A total of 53 hospitalised COVID-19 patients with OPC were studied. Relevant clinical data were mined. Strain identification was performed by 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, amphotericin B, caspofungin, micafungin and anidulafungin was performed according to the CLSI broth dilution method.

RESULTS: In 53 COVID-19 patients with OPC, cardiovascular diseases (52.83%) and diabetes (37.7%) were the principal underlying conditions. The most common risk factor was lymphopaenia (71%). In total, 65 Candida isolates causing OPC were recovered. C albicans (70.7%) was the most common, followed by C glabrata (10.7%), C dubliniensis (9.2%), C parapsilosis sensu stricto (4.6%), C tropicalis (3%) and Pichia kudriavzevii (=C krusei, 1.5%). Majority of the Candida isolates were susceptible to all three classes of antifungal drugs.

CONCLUSION: Our data clarified some concerns regarding the occurrence of OPC in Iranian COVID-19 patients. Further studies should be conducted to design an appropriate prophylaxis programme and improve management of OPC in critically ill COVID-19 patients.

Original languageEnglish
Pages (from-to)771-778
Number of pages8
Issue number8
Publication statusPublished - Aug 2020


  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents/pharmacology
  • COVID-19
  • Candida/classification
  • Candidiasis, Oral/complications
  • Coronavirus Infections/complications
  • Female
  • Humans
  • Iran
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Pandemics
  • Phenotype
  • Pneumonia, Viral/complications
  • Time Factors


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