Species distribution of yeasts recovered from different clinical samples Addiss Ababa,Ethiopia

Background Currently, fungal diseases of humans are among the most problematic illnesses is the result of an increase in opportunistic fungal infections caused by rise in the number of immune-compromised patients. Particularly, yeasts are the most common cause of fungal infections leading to a range superficial type to life-threatening invasive infections. The aim of this study is to determine species distribution of yeasts particularly of Candida species recovered from different clinical samples. Method A cross sectional study was conducted from January 01, 2018 –September 30, 2018 in Addis Ababa, Arsho laboratory. Oropharengial swabs, nail scrapings, sputum, corneal scrapings, and vaginal swabs were collected from patients with signs and symptoms of infections. Identification and antifungal susceptibility testing was performed by using YST card through VITEK 2 compact system. Data was entered and analyzed using SPSS version 20. Result A total of 209 yeasts were recovered of which 49.8% were Candida albicans, 43.1% were non-albicans candida species and 7.2% were yeasts other than Candida species. The current study, eighteen (18) different types of yeast species were identified from different clinical samples. All recognized yeast considered as a causative agent of fungal infection in previously reported data in worldwide. Conclusion throughout

but most fungal infections occur in immune-compromised individuals (opportunistic fungal pathogens). Since risk-factors for opportunistic fungal infections continue to increase in frequency, it is likely that the incidence of opportunistic fungal infections will continue to increase in the future. An increase in opportunistic fungal infections are the result of an increase in the number of immune-compromised patients, thereby threaten the achievement of the newest medical advances in cancer care, solid organ and hematopoietic stem cell transplantation, neonatal medicine, autoimmune disease therapies, trauma and intensive care, and sophisticated surgery [1][2][3][4].
Fungi can cause infections ranging from easily treatable superficial type to lifethreatening invasive infections and it has the capability to infect humans of all age groups [12]. Particularly, yeasts are the most common cause of fungal infections, leading to a range of life-threatening invasive diseases such as blood stream candidiasis, pneumonia, and cryptococcal meningitis to non-life-threatening mucocutaneous candidiasis such as for culture testing by using the VITEK 2 compact system.

Study area, Study design and Period
The study was conducted at Arsho Medical laboratory, Addis Ababa, Ethiopia. Arsho is a brand of private diagnostic Laboratory practice in Ethiopia. It originated in 1972 in a small individual practice and grows up to internationally accredited big service and name. Their personnel specializing in a wide variety of disciplines including microbiology work to ensure best quality and quick delivery of medical result. Daily

Data Processing and Analysis
Results were compiled and entered in to SPSS version 20 Software and were analyzed to determine frequency, percentage and compare distribution of each etiologic agent by anatomic site of infection involved.

Ethical Consideration
All ethical considerations and obligations were duly addressed, and the study was conducted after the approval of the department of research and ethical review committee (DRERC) of the department of Medical Laboratory Sciences. Written informed consent was obtained from the participants before data collection. Each respondent was given the right to refuse to take part in the study and to withdraw at any time during the study period. All the information obtained from the study subjects were coded to maintain confidentially.
When the participants are found to be positive for fungal pathogen, they were informed to the hospital clinician and received proper treatment. An assent form was completed and was signed by a family member and/or adult guardian for participants under the age of less than 18 years.

Results
As shown in Table 1  Although the relative prevalence of the yeast species depends on the geographical location, patient population, and clinical settings [65], with a rise in the immunosuppressive patients, increased number of fungal infections has been reported worldwide. Simultaneously, the profile of human yeast pathogens has also been increasing [17].Whereas, In Ethiopia little is known regarding the distribution and the in vitro antifungal susceptibility profile of yeasts isolated from patients. The different types of yeast species were identified from clinical similar finding with previously published data, which reported considered as a causative agent of fungal infection, in worldwide [3,13]. There is no recognized information regarding the profile of yeast species from Ethiopian patient s similar result with this data.
albicans and C. krusei as the 1st and the 2nd predominate species were similar with a study conducted in Ethiopia [9] but, C. famata and C. rugosa two of the dominant species in the current study were not recovered at all by previous Ethiopian study [9], as well as in the world consider as rare finding of human pathogen [3]. Occurrence rate of Candida rugosa 4.8 % (10/209) isolated from sputum isolate followed by oropharengial, coneal discharge and nail. These data result compare to Ghana isolates reported 0.7% of total Candida isolates (4/600), which is similar to the reported incidence of 0.6% worldwide.
The variation arise may be due to regional and patient population of in this study [19] .Clinically, species of the C. rugosa complex have been isolated from a range of sources including blood, urine, sputum, and swabs from different anatomical sites [20]. Members of the Candida rugosa species complex have been described as emerging fungal pathogens and are responsible for a growing number of Candida infections [21].Studies are needed to better clarify the frequency of Candida rugosa infections in Ethiopian patients.
This deviation possibly arises from the study population difference and low number of sample size. In oropharengial, the incidence rate of non-albican candida yeasts were around 44 %( 22/50) and other yeast was not found which is similar with previously study [18,10].
guilliermondii. Fungal keratitis is one of the most challenging types of infectious keratitis which has been gradually increasing during the past few decades. It now accounts for approximately 50% of infectious corneal diseases [22] .
In the current study, the occurrence rate of non candida yeast isolates were 7.1% with highest frequency of Creptococcus laurenti 4.8 % (10/209) followed by Creptococcus neoformans 2% (4/209) and Trichosporn mucoides 0.5% (1/209). Cryptococcus laurenti and Trichosporn mucoides are a rare human pathogen, but Creptococcus neoformans as typical fungal pathogen to immunocompromised [13]. When comparing these data of Creptococcus laurenti 4.8 % (10/209) to previously one study showed 0.6%(1/155) recovered rate in Ethiopia from orophrengial [23].Other than Cryptococcus neoformans species have classically been considered to be non-pathogenic. However, Cryptococcus albidus , Cryptococcus laurentii , Cryptococcus luteolus ,Cryptococcus uniguttulatus , Cryptococcus curvatus, have emerged as opportunistic pathogens over the last few years [24]. They have been described as opportunistic pathogens in HIV positive individuals, as well as in patients with other predisposing factors [25]. Creptococcus laurentii has been implicated in 18 cases of opportunistic infection, predominantly of the skin, bloodstream, and central nervous system. Within the non-neoformans Cryptococcal species, Cryptococcal laurentii and Cryptococcal albidus account for 80% of pathogenic infections. Although C. laurentii is found worldwide and its natural habitat remains largely unknown [17,26], the occurrence rate (4.8%) of its current finding is higher.
Trichosporon spp are yeast-like fungi found in soil and water. Furthermore, they Ethics approval and consent to participate