Species distribution and antifungal susceptibility patterns of oral Candida colonization and infection in β-thalassemia major patients

Patients with β-thalassemia major often have immune dysfunctions that heighten their risk of oral Candida colonization and infection. This study aimed to assess the prevalence of oral Candida, including Candida albicans and non-Candida albicans, and evaluate their antifungal susceptibility profiles. A total of 270 patients were enrolled, and oral swabs were collected from the gums, teeth, tongue, palate, and cheek mucosa. Species identification was performed by combined phenotypic characteristics (CHROM agar Candida) and molecular assay (PCR-RFLP and sequencing), and antifungal susceptibility testing was performed by CLSI M38 broth microdilution. A study of 270 patients revealed that 17 (6.29%) had oral candidiasis, and 22 (8.14%) showed Candida colonization. The most common species were Candida albicans (52.38%), Pichia kudriavzevii (38.09%), and Nakaseomyces glabratus (9.52%). In colonization cases, the predominant species were C. albicans (92%) and P. kudriavzevii (8%). Notably, multidrug-resistant C. auris was absent. Voriconazole and ketoconazole were the most effective antifungals, while nystatin and fluconazole had lower efficacy. The increasing use of prophylactic antifungal agents, together with emerging resistance among Candida species, underscores the importance of early detection and effective management of fungal infections in high-risk populations such as patients with ß-thalassemia. Regular oral examinations and the use of reliable diagnostic methods are essential for timely identification and treatment. Although multidrug-resistant Candida isolates have not yet been reported in this group, continued surveillance remains crucial for infection control within healthcare settings. Further research is needed to clarify the epidemiology of fungal colonization and infection in ß-thalassemia patients and to determine the clinical significance of isolating these organisms.