1Assistant Professor, Department of Microbiology, American Internaonal Instute of Medical Sciences, Udaipur, Rajasthan, India2Consultant, Department of Pathology, American Internaonal Instute of Medical Sciences, Udaipur, Rajasthan, India 3Tutor, Department of Microbiology, Autonomous State Medical College, Gonda, Uar Pradesh, India
*Corresponding Author:
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Date of Submission: 31/05/2025 Date of Review: 19/06/2025 Date of Acceptance: 30/09/2025
Introducon: Candida species are yeast-like fungi that normally inhabit humans as harmless commensals but can become opportunisc pathogens when host resistance is compromised. Among the Candida species, Candida albicans is typically regarded as the main pathogen. Over the past few decades, there has been a noceable rise in the prevalence of non-albicans species. Species-level idenficaon of Candida spp. is of clinical significance due to the variability in virulence and anfungal resistance among them. Objecve: The objecve of this research is to isolate and idenfy the species of Candida from diverse clinical samples within a terary care hospital, to ascertain the range of Candida infecons present in clinical specimens, and to characterize the Candida species that have been isolated. Methods: Candida isolates from various clinical samples like urine, sputum, tracheal swab, vaginal swab, and endotracheal secreons were included in this study. Aer inial idenficaon of Candida species by convenonal methods, Candida spp. were inoculated onto CHROM agar and incubated at 37◦C for 48 to 72 hours, with species idenficaon based on the type and colour of colonies on the CHROM agar medium. Results: In this present study, a total of 45 Candida species were isolated from various clinical specimens, 20 from urine, 12 from sputum, 6 from tracheal swab, 6 from vaginal swab and 1 from endotracheal secreons as shown in Table 2 . Among 45 Candida isolates, 25 (55.56%) were of Candida albicans, 13 (28.89%) of Candida tropicalis, 6 (13.33%) of Candida galbrata and 1(2.22%) of Candida krusei. Conclusion: In addion to Candida albicans, non-albicans Candida species such as C. tropicalis, C. krusei, C. glabrata, and C. dubliniensis are being more frequently obtained from clinical specimens. Accurate species idenficaon of Candida is crucial for effecve treatment, as not all species respond uniformly to therapy, and there is a growing concern over anfungal resistance.
Keywords: Candida; Chrome agar; C. Tropicalis; C. Glabrata
Candida species are yeast-like fungi that typically exist as harmless commensals on mucosal surfaces of the human body, parcularly in the gastrointesnal and genitourinary tracts. However, under certain condions such as immunosuppression, invasive procedures, or anbioc use, they can become opportunisc pathogens, causing a spectrum of infecons ranging from superficial candidiasis to invasive, life-threatening disease. [ 1 – 3 ] The genus Candida comprises over 170 species, of which more than 17 are known to cause human infecons. [ 1 ]Candida albicans is tradionally the most common species implicated in candidiasis. However, in recent decades, there has been a notable shiL toward non-albicans Candida (NAC) species, such as C. tropicalis, C. parapsilosis, C. glabrata, andC.krusei.[ 4 – 7 ]Among these, C. tropicalis is frequently isolated in clinical sengs in India. [ 1 ,
8 ] Risk factors for candidiasis include prolonged hospitalisaon, the use of indwelling medical devices, immunosuppressive therapy (e.g., corcosteroids, chemotherapy), broad-spectrum anbioc use, and HIV/AIDS. [ 1 , 9 ] C. krusei is intrinsically resistant to fluconazole, while C. glabrata exhibits reduced suscepbility. C. tropicalis is noted for its biofilm-forming ability on catheters and prosthec devices, contribung to its resistance profile. Resistance to azoles, parcularly fluconazole, has been increasingly reported in both C. albicans and C. tropicalis. [ 1 , 10 ] Species-level idenficaon is crucial due to the varying anfungal resistance paerns and virulence among Candida species. [ 11 ] Addionally, disnguishing between colonisaon and true infecon—especially in non-sterile specimens such as sputum or endotracheal secreons—is essenal for accurate diagnosis and effecve treatment. The present study aims to isolate and idenfy Candida species from a range of clinical specimens in a terary care hospital, assess their pathogenic potenal, and correlate findings from sugar assimilaon tesng with CHROMagar idenficaon.
Study Design and Seng
A retrospecve study was conducted in the Department of Microbiology, GBH Hospital, Udaipur, from 16th September 2024 to 16th November 2024, aer approval from the Instuonal Ethics Commiee [AIIMSUDR/2025/6392].
Sample Collecon: In the present study, a total of 45 Candida isolates were recovered from various clinical specimens. The majority were obtained from urine samples (n=20), followed by sputum (n=12), tracheal swabs (n=6), vaginal swabs (n=6), and endotracheal secreons (n=1)
To address the concern regarding sample quality: Bartle’s grading was performed for sputum samples to ensure specimen adequacy. Endotracheal secreons were evaluated alongside clinical signs, duraon of intubaon, and radiological findings to differenate colonizaon from infecon. Although tracheal swabs are not rounely recommended, they were included in this retrospecve analysis and are reported with limitaons.
Isolaon and Culture: Clinical specimens were first examined by Gram stain. Samples were inoculated onto Sabouraud Dextrose Agar (SDA) and incubated at 37◦C for 48–72 hours, following standard guidelines for fungal culture to ensure adequate recovery of yeast colonies.
Germ tube test was conducted on all isolates. Germ tube– posive isolates were presumpvely idenfied as C. albicans or C. dubliniensis.
Cornmeal Agar (CMA) with Tween 80 was used to observe chlamydospores formaon, hyphae/Pseudohyphae and colonie morphology, which aided in species-level differenaon. Growth at 45◦C was used to differenate C. albicans (posive) from C. dubliniensis (negave).
The clinical importance of each isolate was evaluated by correlang:
Descripve stascs were used to calculate frequencies and percentages of each Candida species by specimen type. Species distribuon and associaon with sample types were evaluated. The correlaon between sugar assimilaon tests and CHROMagar colony morphology was analysed for accuracy. All data were compiled in MicrosoL Excel and analysed using SPSS version 26.0.
| Name of Candida species | Colour on CHROM agar |
| Candida albicans Candida tropicalis Candida krusei Candida glabrata Candida parapsilosis Candida dubliniensis | Light green Metallic blue Rose pink White Pale cream Dark green |
Table 1: Colour characteriscs of various Candida species on CHROM agar
Figure1:CHROMagarshowinggrowthofdifferentcoloniesofCandidaspecies
RESULTS
C.albicansremainedthepredominantspecies,butasignificantproporon(44.44%)ofisolateswerenon-albicans
Candida species, reflecng an emerging epidemiological trend. The distribuon of isolates was as follows: 20 from urine, 12 from sputum, 6 from tracheal swabs, 6 from vaginal swabs, and 1 from endotracheal secreons, as shown in Table 2. All specimens were incubated for 48–72 hours at 37◦C as per the recommended guidelines for Candida isolaon.” Among the 45 Candida isolates, 25 (55.56%) were idenfied as Candida albicans, 13 (28.89%) as Candida tropicalis, 6 (13.33%) as Candida glabrata, and 1 (2.22%) as Candida krusei, as shown in Table 3 . Gender-wise distribuon revealed a higher prevalence in females (n=32) compared to males (n=13). Quality control of sputum specimens was done using Bartle’s criteria. Isolates from endotracheal secreons and tracheal swabs were interpreted cauously, with clinical correlaon and available paent data considered to differenate colonisaon from infecon.
Species idenficaon was primarily performed using CHROMagar Candida. However, confirmatory idenficaon by sugar assimilaon test was done for representave isolates and correlated well with CHROMagar results, showing good concordance.
| Clinical Specimen | Total Candida Isolates |
| (n=45) | |
| Urine | 20 |
| Sputum | 12 |
| Tracheal Swab | 6 |
| Vaginal Swab | 6 |
| Endotracheal Secreons | 1 |
Table 2: Number of Candida isolates from various clinical specimens
| Candida Species | No. of Isolates (%) | Male | Female |
| Candida | 25 (55.56%) | 7 | 18 |
| albicans | |||
| Candida | 13 (28.89%) | 3 | 10 |
| tropicalis | |||
| Candida | 6 (13.33%) | 2 | 4 |
| glabrata | |||
| Candida krusei | 1 (2.22%) | 1 | 0 |
| Total | 45 | 13 | 32 |
Table 3: Distribuon of different Candida species and gender-wise distribuon DISCUSSION
The present study confirms the predominance of Candida albicans among clinical isolates, although a significant proporon (44.44%) consisted of non-albicans Candida (NAC) species, including C. tropicalis, C. glabrata, and C. krusei. This paern aligns with several recent studies indicang an ongoing epidemiological shi.
A study by Kaup et al. [ 12 ] reported 50% NAC isolates, with C. tropicalis accounng for 27.08%, closely matching our finding of 28.89%. Previous research by Manjunath et al. (2012) [ 13 ], Baradkar et al. (2010) [ 14 ], and Usharani et al. (2011) [ 15 ] also supports our observaon that C. albicans remains the most frequently isolated species. However, reports by Istalingam et al. [ 4 ] and Jayalakshmi L et al. [ 16 ] demonstrated higher NAC isolaon rates (56% and 68.57%, respecvely), suggesng regional variaon and an increasing prevalence of NAC species.
The presence of Candida in specimens such as sputum and endotracheal secreons must be interpreted cauously. In our study, specimen quality was ensured using Bartle’s scoring for sputum samples, and clinical history, radiological findings, and immune status were considered for invasive samples to disnguish colonisers from true pathogens.
CHROMagar Candida proved to be a useful preliminary tool for rapid species idenficaon. However, the absence of Cornmeal Agar (CMA) use is a limitaon. Sugar assimilaon tests were performed on a subset of isolates and showed concordance with CHROMagar-based idenficaon, supporng its reliability in our seng.
CONCLUSION
This study highlights a growing trend of non-albicans Candida species in clinical infecons, although Candida albicans remains predominant. Rapid presumpve idenficaon using CHROMagar Candida provides a praccal approach, parcularly in resource-limited sengs. However, incorporang confirmatory methods such as sugar assimilaon tests or CMA would enhance diagnosc accuracy.
Accurate species-level idenficaon is essenal for guiding anfungal therapy, especially given that some NAC species exhibit intrinsic resistance to commonly used anfungal agents. Furthermore, clinical correlaon and appropriate specimen validaon are crucial to disnguish colonisaon from true infecon, parcularly in respiratory and urinary samples.
Future studies should include a larger sample size, comprehensive stascal analysis, and clinical outcome data to beer understand the pathogenic role of various Candida species and their anfungal suscepbility paerns.
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How to cite this arcle: Jain S, Kalra D, Mishra S. Isolaon and Idenficaon of Various Candida Species from Clinical Samples at a Terary Care Hospital of Southern Rajasthan. Perspecves in Medical Research. 2025;13(3):138-141 DOI: 10.47799/pimr.1303.25.12