Candidiasis, caused by various species of the genus Candida, is one of the most common opportunistic fungal infections worldwide. Candida albicans is the predominant etiological agent, existing normally as a commensal on mucocutaneous surfaces, gastrointestinal tract, and genital mucosa. However, under conditions such as altered immunity, uncontrolled diabetes, prolonged antibiotic or corticosteroid therapy, or increased humidity, it transforms into a pathogenic organism capable of causing localized or disseminated disease. Globally, the burden of candidiasis is on the rise due to the upsurge of immunosuppressive disorders including HIV infection, malignancies, and widespread use of broad spectrum antibiotics. Moreover, in hospital settings, non albicans Candida (NAC) species like C. tropicalis, C. glabrata, and C. krusei have emerged as notable pathogens with increased antifungal resistance [4–6]. In India, high humidity, low socioeconomic conditions, overcrowding, and diabetes contribute significantly to the prevalence of mucocutaneous candidiasis. Regional studies from southern India have shown variable species distribution, emphasizing the need for localized epidemiological data. This study aims to analyze clinicomycological profiles among candidiasis patients in a tertiary care hospital, elucidating the relationship between clinical patterns, risk factors, and laboratory diagnosis.

This hospital based prospective observational study was carried out in collaboration between the Departments of Microbiology and Dermatology, Venereology & Leprosy (DVL), Kakatiya Medical College, Warangal, Telangana, over one year. Study Population A total of 100 consecutive patients with clinical evidence of candidiasis attending outpatient or inpatient departments were enrolled after obtaining written informed consent. Inclusion Criteria • Patients with lesions clinically suggestive of candidiasis involving skin, mucosa, nails, or genitalia. • Subjects aged above 1 year, irrespective of gender. Exclusion Criteria • Patients already on antifungal therapy for more than seven days. • Uncooperative patients or those declining consent. Data Collection A detailed record of demographic information, clinical findings, duration of lesions, history of diabetes, use of antibiotics or steroids, and presence of immunosuppressive conditions (including HIV) was obtained through a structured proforma. Specimen Collection and Laboratory Procedures Samples such as skin scrapings, vaginal swabs, nail clippings, or oral swabs were collected under aseptic conditions. Each specimen underwent: 1. Microscopy: 10% KOH mount and Gram stain for yeast cells, pseudohyphae, or budding forms. 2. Culture: Samples inoculated on Sabouraud’s Dextrose Agar (SDA) with chloramphenicol, incubated at 37 °C for five days. Colony morphology, color, and microscopic features were noted. Germ tube tests were also performed for species identification. Statistical Analysis Descriptive statistics were applied using Microsoft Excel. Data were represented as frequency and percentage, correlating demographic and clinical variables with laboratory findings. Ethical Considerations The Institutional Ethics Committee granted approval before commencing the study. Confidentiality was maintained, and standard clinical management was provided to all participants.

Table 1. Age Distribution Age Group (Years) No. of Cases % < 10 1 1.0 11–20 5 5.0 21–30 23 23.0 31–40 30 30.0 > 40 41 41.0 Interpretation: Most patients (53%) were aged 21–40 years. Table 2. Sex Distribution Sex No. % Male 45 45 Female 55 55 Interpretation: Slight female predominance linked to hormonal factors Table 3. Clinical Types Type No. % Vulvovaginal 29 29 Balanoposthitis 28 28 Intertrigo 27 27 Oral 11 11 Nail/Paronychia 5 5 Table 4. Predisposing Factors Predisposing Factor No. % Diabetes mellitus 22 22 Moisture exposure 14 14 HIV infection 9 9 Antibiotics 4 4 Steroids 2 2 Pregnancy 2 2 Others / Unknown 47 47 Table 5. Laboratory Findings Test Positive % KOH Mount 32 32 Gram Stain 34 34 Culture 24 24 Among 100 patients studied, the age group 21–40 years constituted the majority with 53% of cases, followed by those above 40 years at 41%. Pediatric cases (<10 years) were rare (1%). A slight female predominance (55%) was noted, reflecting higher vulvovaginal candidiasis incidence. The clinical spectrum was diverse, with vulvovaginal candidiasis (29%) most prevalent. Balanoposthitis affected 28% (mainly males), intertrigo 27%, oral candidiasis 11%, and nail involvement 5%. Diabetes mellitus emerged as the chief predisposing factor in 22%, followed by moisture exposure (14%) and HIV infection (9%). Antibiotic use, steroid therapy, and pregnancy were less frequent. Notably, 47% of patients exhibited no identifiable risk factors. Laboratory diagnosis showed positivity rates of 32% for KOH mount, 34% for Gram stain, and 24% for culture. Combined use of diagnostic modalities enhanced confirmation. Preliminary data suggest predominance of Candida albicans

This study underscores the multifactorial etiology and polymorphic presentation of candidiasis. The preponderance in adults aged 21–40 years aligns with global patterns . Higher female involvement corresponds with reproductive age hormonal influences and increased likelihood of antibiotic and contraceptive use . Clinical Spectrum Vulvovaginal candidiasis, the predominant type, accounted for 29% of cases. Warm humid climates and tight clothing foster overgrowth of Candida species in genital regions. Balanoposthitis in males (28%) often occurred in diabetics or individuals with poor hygiene. Intertriginous candidiasis (27%) was common among overweight individuals and those exposed to moisture. Oral candidiasis in HIV positive patients corroborates its role as an early marker of immunosuppression [11–13]. Predisposing Factors Diabetes mellitus remains one of the strongest risk determinants. Elevated glucose levels invite fungal proliferation, while immunologic impairment in diabetics predisposes to recurrent infection. HIV infection was another significant contributor, associated with frequent oral and esophageal involvement. Diagnostic Yield The correlation between KOH, Gram stain, and culture demonstrates that direct microscopy, though rapid, misses some cases detectable by culture. Combining all three methods improves diagnostic accuracy. Species identification guides therapeutic choice, especially given emerging resistance among non albicans Candida. Emerging Trends Recent decades show a global shift from C. albicans to NAC species, notably C. glabrata and C. tropicalis. These species exhibit decreased fluconazole susceptibility, underscoring the importance of antifungal stewardship and periodic resistance surveillance. Additionally, inappropriate over the counter antifungal use and patient non compliance have aggravated resistance. Comparison with Other Studies Findings here resemble those of Rajendran et al. (2019), where vulvovaginal candidiasis and intertrigo were leading presentations. Kaur et al. (2022) noted similar resistance patterns among isolates from South India. Such congruity across Indian cohorts validates the representativeness of current results. Public Health Implications Educating diabetic patients on glycemic control, hygiene, and preventive care can markedly reduce disease recurrence. Regular surveillance of antifungal sensitivity patterns should be institutionalized in tertiary centers.

Candidacies demonstrates diverse presentations, mostly affecting adults and females of reproductive age. Diabetes mellitus and immune suppression are major determinants. Timely clinico mycological evaluation, culture confirmation, and species identification are indispensable for rational therapy. Preventive strategies—hygiene maintenance, sugar control, and judicious drug use—remain pivotal in reducing disease incidence and recurrence.

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