CHAPTER ONE

                                                      INTRODUCTION

1.1 Background of Study

Antifungal susceptibility remains an area of intense interest. Susceptibility testing can be used for drug discovery and epidemiology, but this review will focus on use of antifungal susceptibility testing to predict therapeutic outcome. With the demonstration that susceptibility of Candida spp. to azole antifungal agents (particularly fluconazole) generated correlations with clinical outcome for some forms of candidiasis that were qualitatively similar to that seen for antibacterial agents and the steady introduction of new drugs of both preexisting and new classes (9), the interest in and need for clinically relevant susceptibility testing has increased (Lamoth F,et al, 2018). The need extends beyond testing Candida spp. With resistance demonstrated among such diverse fungi as Cryptococcus neoformans (1, 150, 167, 185, 227), Aspergillus fumigatus (40, 47, 96, 104, 130), Aspergillus terreus (207, 216), Histoplasma capsulatum (224), Pseudallescheria boydii (Scedosporium apiospermum) (219), and Trichosporon spp. (217, 218), it is clear that the need for meaningful susceptibility test results is as great for the fungi as it is for the bacteria (Pappas PG, et al, 2016).

Although antifungal susceptibility testing remains less well developed and utilized than antibacterial testing, the scientific support for its validity has benefited greatly by extrapolation from antibacterial testing. Knowledge of mechanisms of antifungal resistance has been valuable in identifying resistant isolates and using them to validate in vitro measurement systems (Skiada A, et al, 2018).

1.2 Aim

1. To conducting antifungal susceptibility testing for skin infections is to determine the most effective antifungal treatment for a particular fungal strain.

2.  To help professionals and dermatologists to choose an appropriate health care antifungal medication that will effectively target and eliminate the specific fungal infection.

3. It involves exposing the isolated fungus to different antifungal agents and monitoring its growth in the presence of each drug.

4. The results of these tests provide valuable information about the fungi's susceptibility or resistance to various antifungal medications.

1.3 Objectives of the study

i. Antifungal susceptibility testing is to identify the appropriate antifungal drug and dosage for effective treatment of fungal infections.

ii. Antifungal resistance is becoming increasingly prevalent, highlighting the need for accurate and reliable methods of antifungal susceptibility testing.

iii. Antifungal susceptibility testing is to provide clinicians with the information they need to make informed treatment decisions, and recent advancements in methodology and technology are helping to improve the accuracy and reliability of this testing.

1.4 Significance of the study

It guides clinicians in selecting the most appropriate treatment, contributes to the surveillance of drug resistance, and supports research in developing new antifungal drugs. By understanding the susceptibility patterns of fungal pathogens, we can better combat these infections and improve patient care.

1.5 Statement of problem:

Antifungal susceptibility, or the ability of fungi to be effectively treated with antifungal drugs, is a critical issue in the management and prevention of fungal infections. Fungal infections can range from mild skin infections to life-threatening systemic infections, and the emergence of antifungal resistance has become a major concern. The overuse of antifungal agents, the lack of new antifungal drugs, and the spread of resistant strains all contribute to the problem of antifungal susceptibility.

1.6 Justification of the study

The susceptibility testing process involves obtaining a sample from the affected area of the skin. Depending on the type of infection suspected, the sample can be collected using various methods, such as swabs or scraping. The sample is then cultured in a laboratory setting to grow the fungus, which is later exposed to different concentrations of antifungal drugs. By observing the growth of the fungus in the presence of varying drug concentrations, the minimum inhibitory concentration (MIC) of the antifungal drug can be determined. This MIC value represents the lowest concentration of the drug that successfully inhibits the growth of the fungus.