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Background  The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient’s leads to the selection of strain resistant to these therapies and a shift in the spectrum of  Candida  species. This study determines the species diversity and  in vitro  susceptibility of  Candida  isolates from late presenting AIDS patients in northwest Ethiopia.    Methods  Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and  Candida  species identification were made following standard microbiological techniques.  In vitro  drug susceptibility tests were made using broth microdilution method.    Results  The colonization rate of  Candida  species was found to be 82.3% (177/215).  C. albicans  was the predominant species isolated from 139 (81%) patients but there was a diversity of other species.  C. glabrata was  the most frequent non- albicans  species isolated in 22.5% (40/177) of the patients followed by  C. tropicalis  14.1% (27/177),  C. krusei  5.6% (10) and other unidentifiable  Candida  species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non- albicans  species. Irrespective of the  Candida  species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent.    Conclusion  HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans  Candida  species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining  Candida  epidemiology and resistance to antifungal drugs.

Frequent detection of ‘azole’ resistant Candida species among late presenting AIDS patients in northwest Ethiopia