Antifungal resistance and herbal sensitivity of oral Candida isolates from HIV-infected patients in a rural community in Western Uttar Pradesh, India

Drug-resistant Candida species in HIV-infected patients are the result of the selective pressure of currently used azoles. In the course of screening for active plant products against drug-resistant Candida species, we paid special attention on the effects of commonly available herbal plants. A total of 123 oral Candida isolates which were previously isolated from 172 HIV-infected patients were included in this study. In vitro antifungal susceptibility to fluconazole (FCZ), itraconazole (ITZ) and amphotericin B (AMB) was evaluated using Clinical and Laboratory Standard Institute (CLSI) guidelines. Antifungal potency of garlic, neem, Aloe, Calendula, Citrus, mint, tea and ginger extracts were tested against drug-resistant isolates. Out of 123 isolates, 26.8% were resistant to FCZ, 21.9% to ITZ and 8.1% to AMB. All drug-resistant isolates tested, were completely inhibited by garlic and neem leaves extracts with minimum fungicidal concentration (MFC) of 0.781 and 1.562 mg/ml, respectively. Aloe and Calendula extracts were also found to be effective with MFC of 3.125 mg/ml each. The observed growth inhibition zones and minimum inhibitory concentrations (MICs) showed that the isolates exhibited susceptibility. Our results provided scientific justification for the use of garlic, neem, Aloe and Calendula extracts in health products and herbal remedies against multidrug-resistant candidiasis.   Key words: Oral lesions, antifungal susceptibility, drug resistant, herbal, Candida albicans.