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Current Scenario of Geriatric Fungal Infections: a Prevalence Study from East Delhi *Bineeta Kashyap1, Shukla Das1, Kavita Gupta1, Tanu Sagar2

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Current Scenario of Geriatric Fungal Infections: a Prevalence Study from East Delhi *Bineeta Kashyap1, Shukla Das1, Kavita Gupta1, Tanu Sagar2 Aging Medicine and Healthcare 2019;10(1):46-50. doi:10.33879/AMH.2019.1762 Aging Medicine and Healthcare http://www.agingmedhealthc.com Original Article Current Scenario of Geriatric Fungal Infections: A Prevalence Study from East Delhi *Bineeta Kashyap1, Shukla Das1, Kavita Gupta1, Tanu Sagar2 1Department of Microbiology, UCMS & GTB Hospital, New Delhi, India 2Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India ABSTRACT Background/Purpose: Elderly persons are highly susceptible to any infectious agents and they acquire infectious diseases easily, compared with the general population. Normal physiological changes of aging, coexistence of chronic diseases, alteration of host defense mechanisms and environmental exposure are the major factors associated with increased frequency and poorer prognosis of infectious diseases in these patients. the study was undertaken to study the prevalence and the current status of fungal infections in the geriatric population from a tertiary care hospital located in East Delhi. Methods: A retrospective study was conducted over a period of one year among geriatric patients presenting with clinically suspected fungal infections from various clinical departments in the mycology laboratory. All samples were analysed on direct microscopy by 40% KOH in nails and 10% KOH for other samples and Gram staining for yeast. For fungal culture all samples were inoculated on two isolation media; one sabouraud’s dextrose agar (SDA) without antibiotics and the other SDA with chloramphenicol and *Correspondence cycloheximide. Dr. Bineeta Kashyap Department of Total of 429 samples were received from 420 Microbiology, UCMS & GTB Results and Conclusions: geriatric patients; 6.90% patients belonged to age group 60-65 years and Hospital, New Delhi, India only 2.85% were 81 years onwards; 71.42% were males. The most frequent E-mail: received sample was nail 60.09%. A total of 196 samples were positive for [email protected] fungal elements, of which 43 (21.93%) were yeasts and 153 (78.06%) were positive for presence of hyphae on direct examination; 36.66% and 67% Received 13 August 2016 Accepted 14 February 2017 were Trichophyton species and Aspergillus flavus respectively. Among yeasts Candida albicans was isolated in 79% cases. Keywords Copyright © 2019, Asian Association for Frailty and Sarcopenia and Taiwan Association for geriatric, fungal, infection. Integrated Care. Published by Full Universe Integrated Marketing Limited. 1. INTRODUCTION process influenced by both genetic and environmental parameters. Size of the elderly population (persons Aging is now becoming a foremost concern for health- >60 years) is fast growing in India (from 5.6% in 1961 related policy makers all over the world both for it is projected to rise to 12.4% of population by the developed and developing countries as the geriatric year 2026) although it constituted only 7.4% of total population has limited regenerative abilities and population at the turn of the new millennium (5.2% is more prone to disease. Aging is a multi-factorial geriatric share for Delhi).1 This share of the aged in the 46 Aging Medicine and Healthcare 2019;10(1):46-50. doi:10.33879/AMH.2019.1762 total population is increasing further due to significant 25°C and 37°C and examined daily upto 4 weeks. improvement in life expectancy throughout the world Presumptive identification of fungi was done by together with steadily declining birth rate and fertility colony characterstics, lactophenol cotton blue mount trends especially in a developing country like India. and by slide culture technique. The characteristics considered for fungus identification were macroscopic Elderly persons are highly susceptible to any infectious aspects of texture, colour, growth rate and microscopic agents and they acquire infectious diseases easily, aspects such as mycelium and conidium types, compared with the general population. Normal relationship between hyphae and fructification physiological changes of aging, coexistence of chronic organs by lactophenol cotton blue mount. The yeast diseases, alteration of host defense mechanisms isolates were identified by standard tests like germ and environmental exposure are the major factors tube, different spore production on corn meal agar associated with increased frequency and poorer (CMA), colour on Hi chrome agar, sugar fermentation prognosis of infectious diseases in these patients. and assimilation tests. In case of clinical suspicion of Cryptococcus, india ink preparation, antigen detection Fungal infections frequently observed in the elderly by commercially available kits as per standard population. Superficial/cutaneous infections are laboratory techniques and culture on SDA was done common presentations seen in this age group. Age- for its identification. related changes heighten the risk of cutaneous infections in elderly patients. The skin of older 3. RESULTS persons is drier, thinner, fragile and possesses fewer hair follicles and sweat glands than that of young or Total of 453 samples were received from 420 geriatric middle-aged persons. Hence, it is more susceptible patient’s in the Mycology Division of Department of to any injury that leads to penetration and spread of Microbiology of UCMS and GTB Hospital. Among the microorganisms. Therefore, both superficial and the 420 subjects, 66.90% (281/420) patient’s were deep fungal infections are common in older people. from age group 60-65 yrs of age followed by 15% Candida, a normal skin flora can give rise to superficial (63/420) in 66-70 yrs , 11.19% (47/420) in 71-75 yrs and deep fungal infections in these conditions.2 Now of age, 4.04% (17/420) in 76-80 yrs of age and only a days because many older patients undergo frequent 2.85% (12/420) were from 81 yrs onwards. A total and prolonged treatment in hospitals and in the 71.42% (300/420) were males as compared to females intensive care unit opportunistic fungal infections are 28.57% (120/420) only. very common in this population.3 The frequency distribution of samples from clinically They are also less able to handle Prognosis of any suspected fungal infections in geriatric patients are invasive endemic opportunistic infections is very poor listed in Table 1. The most frequent obtained sample in older patients as they are less able to handle it.4 was nail 57.17% followed by skin, corneal scraping, There is a paucity of data regarding the prevalence sputum and blood in 18.10%, 7.72%, 6.62% and of the fungal infections in the older population. This 5.29% respectively. A total of 197 samples were study was undertaken to know the current status of positive for fungal elements, of which yeast were 44 fungal infections in the geriatric population. (22.33%) and 153 (77.66%) were hyphae positive. 2. METHODS Table 1. Frequency distribution of clinical specimens & microscopic fungal findings in elderly patients. A retrospective study was conducted in the Mycology Division of Department of Microbiology of UCMS and KOH Examination GTB Hospital over a period of one year. Total of 453 Sample Number (%) samples were received from 420 geriatric patients Hyphae Yeast presenting with clinically suspected fungal infections Nail 259 (57.17) 121 30 from various clinical departments in the mycology Skin 82 (18.10) 12 0 laboratory. All samples were collected in separate Hair 6 (1.32) 2*, 2** sterile containers and analyzed by direct microscopy Sputum 30 (6.62) 9 11 and culture. Cornea 35 (7.72) 6 1 For direct microscopy 40% KOH in nails and 10% CSF 5 (1.10 ) 0*** KOH for other samples was used to visualize presence Pus 3 (0.66) 1 1 of any fungal element. Gram staining was done for Oral tissue 3 (0.66) 0 0 any suspected yeast infection. For fungal culture all Urine 6 (1.32) 0 1 samples were inoculated on two isolation media; one Blood 24 (5.29) - - sabouraud’s dextrose agar (SDA) without antibiotics and the other SDA with chloramphenicol and Total 453 149+4 44 cycloheximide. The culture tubes were incubated at *Endothrix, **Ectothrix, ***India ink. 47 Aging Medicine and Healthcare 2019;10(1):46-50. doi:10.33879/AMH.2019.1762 All samples were subjected to cuture, 66 fungal predominantly caused by Trichophyton spp. (22/41) isolates (14.56%) recovered from 453 samples. Table followed by Candida (7/41) in our study. Trichophyton 2 depicts frequency distribution of fungal isolates in mentagrophyte was the most common dermatophyte different clinical specimens. Out of total 66 fungal isolate closely followed by Trichophyton rubrum isolates obtained from all samples, 22 isolates and Trichophyton verrucosum. Similar finding was (33.33%) were with Trichophyton, 13 isolates with observed by Gupta et al. that Trichophyton rubrum Candida spp. (20/66) 30.30% and 6 isolates with and Trichophyton mentagrophytes were responsible Aspergillus spp. (9.09%) as the most frequent growth. more than 90% of onychomycosis cases.9 Bhatia et al. reported Tricophyton spp. (98.6%) as most Among dermatophytes,Trichophyton mentagrophytes common fungal agent compared to Microsporum 50% (16), Tricophyton rubrum 47% (5) and Tricophyton species (1.35%) in dermatophytosis. Hot and humid verrucosum 3% (1) were isolated. Among Candida environment of our country gives a favourable climate spp., C. albicans was the most common isolate 40% for growth of dermatophyte infections. Besides, the (8) followed by C. tropicalis, C. parasilosis and C. use of effective and prolonged antifungal therapy to glabrata as 30% (6), 20% (4) and 10% (2) respectively. treat
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