Genetic Diagnosis and Prevalence of Urinary Tract Fungal Pathogen with Antifungal Susceptibility Pattern in Iraq

Background: Urinary tract infection (UTI) is considered as one of the frequent diseases affecting humans. Usually, emphasis has been on bacteriological etiologies but this study focuses on fungal etiologies.
Aims: The aim of this study is isolation and characterisation of fungal spp. from urine of patients diagnosed of urinary tract infections genetically and phenotypically. Secondly, to evaluate antifungal sensitivity of isolated fungi against 5 antifungals in Iraq.
Methods: A total of 150 urine specimens were collected from 150 UTI suspects patients attending Marrjan hospital in Babylon province from October 2012 to October 2013. Fungal organisms were isolated, virulence of Candida was detected and both genetic analysis of isolates and antifungal susceptibility test, using 5 antifungals were performed on the most frequent isolate.
Results: Candida albicans (32.7%) and Aspergillus fumigatus (10.9%) were the most frequent fungal isolates. Other isolated fungi from the urinary tract of patients include: Acremonium polychromium, Penicillium digitatum, A. fumigatus, A. niger and some other Candida species including C. albicans, Geotrichum capitatum, C. glabrata, C. guilliermondii and C. famata. Most Candida spp. produced proteinase and lipase. Candida spp. has the ability to ferment most of sugar types under interest except lactose. Clotrimazole, Fluconazole, Ketoconazole, and Amphotercin B showed high activity while Miconazole showed low activity to the most frequent isolate of C. albicans, C. guilliermondii, C. famata. The range of antifungal activity concentration for Amphotericin B was 10-100 mg while for Fluconazole, Miconazole and Ketoconazole was 100-1000 mg. Females (39 cases) aged 18-30 years showed frequency of 26% while males (21cases) aged 30-40 years showed frequency of 14%. Eighteen isolates were genetically analyzed and identified as Candida genus with PCR product size of 210 bp.
Conclusion: Fungal organisms are common etiological agents of UTI patients. Candida spp. and Aspergillus spp. showing highest frequency in our study. All isolates of yeast were genetically diagnosed as Candida except Geotrichum isolates. The common antifungals like Clotrimazole, Fluconazole, Ketoconazole and Amphotericin B are still effective in eradicating these pathogens in Iraq.