{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T08:38:13Z","timestamp":1772786293645,"version":"3.50.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T00:00:00Z","timestamp":1605744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nTuberculosis is one of the major causes of death globally. The problems become even more complicated with the rise in prevalence of multidrug resistant tuberculosis (MDR-TB). Many diseases have been reported to occur with tuberculosis making it more difficult to manage. Candida spp<\/jats:italic>., which are yeast-like fungi and a constituent of normal flora in humans, are notoriously reported to be one of the most common opportunistic nosocomial infections. This study aimed to measure the proportion of presumptive MDR-TB patients colonized with Candida spp<\/jats:italic>. and to characterize its susceptibility against azole group antifungal agents.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nSputum from presumptive MDR-TB patients were collected and examined for the presence of Mycobacterium tuberculosis<\/jats:italic> and its rifampicin resistant status using GeneXpert. It was further cultured on Sabouroud\u2019s Dextrose Agar<\/jats:italic> (SDA) to isolate the Candida spp<\/jats:italic>. The Candida species were determined using HiCrome\u2122 Candidal Differential Agar<\/jats:italic>. Antifungal susceptibility was tested using microbroth dilution methods. Checkerboard microdilution assays were performed to measure the interaction between rifampicin and fluconazole to C<\/jats:italic>. albicans<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThere were 355 presumptive MDR-TB patients enrolled. A total of 101 (28.4%) patients were confirmed to have M<\/jats:italic>. tuberculosis<\/jats:italic>. There were 113 (31.8%) sputum positive for Candida spp<\/jats:italic>., which corresponded to 149 Candida spp<\/jats:italic>. isolates. Candida albicans<\/jats:italic> was the most frequent (53.7%) species isolated from all patients. The susceptibility of Candida spp<\/jats:italic>. against fluconazole, itraconazole, and ketoconazole were 38.3%, 1.3%, and 10.7% respectively. There was significant association between rifampicin exposure history and susceptibility of Candida albicans<\/jats:italic> against fluconazole (Odds Ratio: 9.96; 95% CI: 1.83\u201354.19; p <0.01), but not for ketoconazole and itraconazole. The checkerboard microdilution assays showed that rifampicin decreased the fungicidal activity of fluconazole to C<\/jats:italic>. albicans<\/jats:italic> in a dose-dependent manner.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThere was high frequency of azole resistant Candida spp<\/jats:italic>. isolates colonizing the respiratory tract of presumptive MDR-TB patients. This presence might indicate the association of chronic exposure to rifampicin, the main drug for tuberculosis therapy, with the induction of azole resistance.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0242542","type":"journal-article","created":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T23:13:04Z","timestamp":1605827584000},"page":"e0242542","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["High frequency of azole resistant Candida spp. colonization among presumptive multidrug resistant tuberculosis (MDR-TB) patients"],"prefix":"10.1371","volume":"15","author":[{"given":"Surya","family":"Darma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9168-3147","authenticated-orcid":true,"given":"Angga","family":"Ambara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abu Tholib","family":"Aman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luthvia","family":"Annisa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Nurrokhman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Titik","family":"Nuryastuti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0477-4575","authenticated-orcid":true,"given":"Tri","family":"Wibawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,11,19]]},"reference":[{"key":"pone.0242542.ref001","volume-title":"Global tuberculosis report 2019","author":"WHO","year":"2019"},{"key":"pone.0242542.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1178636118813367","article-title":"Human Immunodeficiency Virus and Tuberculosis Coinfection in a Tertiary Hospital in Southern Brazil: Clinical Profile and Outcomes","volume":"11","author":"F Teixeira","year":"2018","journal-title":"Microbiol Insights"},{"key":"pone.0242542.ref003","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12890-019-0828-4","article-title":"Tuberculosis and other bacterial co-infection in Cambodia: a single center retrospective cross-sectional study","volume":"19","author":"EF Attia","year":"2019","journal-title":"BMC Pulm. 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