EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS

Abstract

Background of study: Oral candidiasis is the most common opportunistic infection in HIV seropositive patients, also predictive of immunosuppression. Though Candida albicans is the predominant isolate in oral candidiasis, there is rise in non albicans Candida infection coupled with high levels of antifungal resistance. There is urgent need for rapid, simple and reliable method to identify yeast isolates. Hicrome agar-Candida is a selective and differential medium for identification of yeasts directly from clinical samples. This medium allows selective isolation of yeasts and simultaneously identifies certain species of Candida. Aim / Objective: To evaluate the utility of Hicrome agar-Candida in identification of C. albicans and non albicans Candida. Research Methodology: Two oral swabs obtained from 100 HIV seropositive patients having oral candidiasis were subjected to identification and characterization by standard conventional methods. Simultaneously direct inoculation was done on Hicrome agar-Candida plate. Conclusion: Of the total 100 samples 103 species were obtained. C. tropicalis was the most common species isolated followed by C. guilliermondi, C. parapsilosis, C. kefyr, C. albicans, C. krusei, C. glabrata, C. fomata and C. pelliculosa. Hicrome agar showed selective growth of all Candida species with distinguishing color for each species. C. tropicalis showed blue color with sensitivity (68%) and specificity (98.72%). C. albicans showed green colored colonies with 100% sensitivity and specificity respectively. C. kefyr showed pink color with sensitivity (61%) and specificity (92%). C. guilliermondi showed 95% sensitivity and 59% specificity. Hicrome agar differentiated mixed culture with all samples. Keywords: Hicrome agar-Candida, C. albicans, C. tropicalis. INTRODUCTION Oropharyngeal candidiasis continues to be a common opportunistic infection in patients infected with Human Immunodeficiency Virus (HIV) and it is the predictive of increasing immunosuppression. 1 Though Candida albicans is the predominant isolate, rise in frequency of isolation of non albicans Candida species is observed. Rapid and reliable identification of these Candida species is essential as they differ in their virulence and sensitivity to antifungal drugs. Routine identification of Candida species in the clinical microbiology laboratory is based upon the morphological characteristics such as the formation of pseudohyphae and terminal chlamydospores, clusters of blastoconidia at septa when grown on Corn meal agar at room temperature and the formation of germ tube in serum at 37 0 C. In addition, carbon source assimilation and fermentation tests or commercially available kits are also used as additional diagnostic tests. 2 Despite the

Full text

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 53
IJCRR
Vol 04 issue 23
Section: General Sciences
Category: Research
Received on: 01/10/12
Revised on: 27/10/12
Accepted on: 07/11/12
EVALUATION OF HICROME AGAR – CANDIDA, A NEW
DIFFERENTIAL MEDIUM FOR ISOLATION OF CANDIDA SPECIES
FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Shyamala R., P. K. Parandekar, Aparna Y. Takpere
Department of Microbiology, BLDEU’s Sri B M Patil Medical College and Research
Centre, Bijapur, Karnataka, India
E-mail of Corresponding Author: drshyamalar@gmail.com
ABSTRACT
Background of study: Oral candidiasis is the most common opportunistic infection in HIV
seropositive patients, also predictive of immunosuppression. Though Candida albicans is the
predominant isolate in oral candidiasis, there is rise in non albicans Candida infection coupled with
high levels of antifungal resistance. There is urgent need for rapid, simple and reliable method to
identify yeast isolates. Hicrome agar- Candida is a selective and differential medium for identification
of yeasts directly from clinical samples. This medium allows selective isolation of yeasts and
simultaneously identifies certain species of Candida.
Aim / Objective: To evaluate the utility of Hicrome agar-Candida in identification of C. albicans and
non albicans Candida.
Research Methodology: Two oral swabs obtained from 100 HIV seropositive patients having oral
candidiasis were subjected to identification and characterization by standard conventional methods.
Simultaneously direct inoculation was done on Hicrome agar- Candida plate.
Conclusion: Of the total 100 samples 103 species were obtained. C. tropicalis was the most common
species isolated followed by C. guilliermondi, C. parapsilosis, C. kefyr, C. albicans, C. krusei, C.
glabrata, C. fomata and C. pelliculosa. Hicrome agar showed selective growth of all Candida species
with distinguishing color for each species. C. tropicalis showed blue color with sensitivity (68%) and
specificity (98.72%). C. albicans showed green colored colonies with 100% sensitivity and specificity
respectively. C. kefyr showed pink color with sensitivity (61%) and specificity (92%). C. guilliermondi
showed 95% sensitivity and 59% specificity. Hicrome agar differentiated mixed culture with all
samples.
Keywords: Hicrome agar-Candida, C. albicans, C. tropicalis.
INTRODUCTION
Oropharyngeal candidiasis continues to be a
common opportunistic infection in patients
infected with Human Immunodeficiency Virus
(HIV) and it is the predictive of increasing
immunosuppression.
1
Though Candida albicans is
the predominant isolate, rise in frequency of
isolation of non albicans Candida species is
observed. Rapid and reliable identification of these
Candida species is essential as they differ in their
virulence and sensitivity to antifungal drugs.
Routine identification of Candida species in the
clinical microbiology laboratory is based upon the
morphological characteristics such as the
formation of pseudohyphae and terminal
chlamydospores, clusters of blastoconidia at septa
when grown on Corn meal agar at room
temperature and the formation of germ tube in
serum at 37
0
C. In addition, carbon source
assimilation and fermentation tests or
commercially available kits are also used as
additional diagnostic tests.
2
Despite the

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 54
availability of these tests, the identification of
Candida species is laborious, time consuming and
sometimes difficult to interpret. These tests at
times may be inadequate or less sensitive and may
yield inaccurate identification especially when
atypical strains defying classical identification
characteristics are encountered.
Mixed growth having C. glabrata, C. krusei, C.
parapsilosis and other non albicans Candida are
associated with increasing frequency in these
patients. There is not only difficulty in their
identification, but also clinical therapeutic failure
to azoles as these organisms shows increased
resistance to azole group of drugs. This is due to
selective pressure or increased usage of
Fluconazole as prophylactic drug.
3, 4
Although
Automated systems are available to accurately
identify the isolates to species level and derive
their antifungal susceptibility pattern. These
automated systems proved to be considerably
expensive and are limited to few sophisticated
laboratories.
Several CHROMagar-Candida, a chromogen
based culture medium has been commercially
developed for rapid and reliable identification of
C. albicans, as these strains produce β-N-
acetylgalactosaminidase enzyme interacting on
chromophore substrate incorporated in the media
and gives green colored colonies.
3, 5
This media
also allows identification of mixed yeast isolates
from clinical samples, permitting presumptive
identification of C. albicans from other Candida
species.
Hicrome agar- Candida (Himedia, Mumbai, India)
is one such chromogenic medium employs the
same principle and helps in identifying Candida
isolates based on colony color and morphology.
Hicrome agar identifies C. albicans by imparting
green color to the colonies, C. tropicalis shows
blue color, C. glabrata showing green-purple
color, C. parapsilosis shows pink colored
colonies.
5, 6
Although the manufacturer claim that this media
shows better performance with good accuracy in
identifying Candida species, there is need to
establish its ability in selective isolation and
presumptive identification of Candida species,
before replacing conventional methods.
Thus the present study was carried out with the
objective to prove the utility of Hicrome agar in
identification of C. albicans and non albicans
Candida in quicker time as compared to
identification by conventional methods.
RESEARCH METHODOLOGY
The present study was carried out at the
Department of Microbiology, BLDEU’S Sri B M
Patil Medical college and Research centre,
Bijapur, Karnataka. The study was reviewed and
approved by the Institutional Ethical Committee.
Patients were included in the study if they were
HIV seropositive irrespective of duration of
infection of either sex and of all age group with
oral lesion characterized by cream- white, curdy
patches or erythematous lesions on dorsum of
tongue / buccal mucosa/ pharyngeal wall.
7
Those
patients who received antifungal treatment within
one month duration were excluded. After taking
written informed consent, specimens were
collected by firmly swabbing the lesion with two
sterile cotton swabs. One swab was used for
identification of yeasts by conventional methods
and the other swabbed directly on the Hicrome
agar plate. Hicrome agar was prepared according
to the manufacturer’s instructions.
Total 100 swabs showing positive for yeasts on
microscopy were subjected to culture on Emmon’s
modified Sabourauds Dextrose Agar (SDA)
supplemented with antibiotics (gentamicin 5µg
and chloramphenicol 50µg) and on Hicrome agar
plate, incubated at 37
0
C. Cream colored pasty
yeast colonies on SDA were subjected to Germ
Tube Test for two hours, morphology on Corn
meal agar (Dalmau Plate Culture method) read
after 48 hours and Auxonographic sugar
assimilation test incubated for 7 days for
identification of yeasts up to species level.
8
Hicrome agar plates were visualized daily at

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 55
24hrs, 72 hrs and followed up to 7 days to check
for colonial growth, characteristic color, color
intensification and for variation in colony
morphology .
6
Statistical analysis: Parameters like sensitivity
(true positive/true positive + false positive),
specificity (true negative/true negative+ false
positive) were determined.
RESULTS
The study group consists of 100 HIV seropositive
patients, comprised 71% male and 29% females.
Majority of the patients belong to age group
between 31-45 years(50%) followed by age
group16- 30 years(26%) and age group 46-60
years(20%). Mean age of the study group is 36
years. In our study, Non albicans Candida was the
most common species isolated accounting for
88.35% and Candida albicans accounting for
11.65%. Species distribution is given in table 1.
Out of 100 samples 103 Candida species were
obtained. All the isolates showed growth on
Hicrome within 24-36 hours, of size 1-3mm and it
was difficult to identify Candida species based on
color as the exact color and colony morphology
was not able to recognize easily within 24-36
hours. Increased Colony size and well
differentiated color and colony morphology were
well appreciated between 36-48 hours. But in
some rare species like C. pelliculosa , C. fomata
and one strain of C. tropicalis were observed with
well differentiated color after 72 hours, hence
there was statistical difference (P<0.01) between
time of growth and time for intensification of
color. Hicrome agar-Candida was able to
distinguish green, blue, pink and cream color
clearly after incubation up to 48hours. Sensitivity
and Specificity of each species is represented in
figure 1.
There was absolutely no batch- batch variation, as
tested by C. albicans ATCC 90028.
Three mixed cultures having six isolates were
identified based on colony color, size and texture.
All six isolates were obvious with their characters
and they could be easily identified (table 2).
While on SDA it needed lot of experience to
identify mixed growth, except for colony size,
there were no other defining variations with
different isolates.
There was no significant change in color after 72
hours on further incubation up to 7 days in almost
all strains.
DISCUSSION
In the present study, majority of the HIV patients
were in the age group of 31-45 years with mean
age 36 years with male preponderance accounting
for 71% which correlates well with other studies.
9,
10, 11, 12
Out of 103 Candida isolates obtained in our study,
species identification revealed that 91(88.35%)
were non albicans Candida, whereas remaining 12
(11.65%) were the C. albicans. In contrast to
studies of Lattiff et al.
13
and Enwuru CD et al.
14
who reported 86% and 40.5% of C. albicans
respectively. Challocombe SJ et al.
15
and Enwuru
CD et al.
14
reported 54% and 59.5% of Non
albicans Candida respectively, whereas our study
depicted non albicans Candida at much higher
prevalence revealing change in trend of infectious
agent replacing C. albicans. Perhaps, this may be
due to regional differences or selective pressure of
antifungal drug usage.
All 12 isolates of C. albicans showed green
colonies having sensitivity and specificity 100%
which correlated with Odd s et al.
16
Green colored
colonies, particularly distinctive for C. albicans
were easily identified.
C. tropicalis having sensitivity of 68% goes in
agreement with Hiroshi et al.
4
who reported 71%,
whereas Odds et al.
16
and Howarth et al.
17
had
sensitivity of more than 95%. This sensitivity in
our study is less as compared to others.
C. guilliermondi showed 95.72% sensitivity on
this medium which is comparable with Hospenthal
et al.
6
(96%). Only three isolates of C. parapsilosis
showed exact color as described having sensitivity
23.8%, Hospenthal et al.
6
also reported wide range

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 56
of colors for this species. Many of our isolates
showed cream colored colonies with defined
morphology instead of pink color which were not
included as true positives hence sensitivity of the
species reduced in our study. Hence it’s not only
the color but also the colonial morphology has to
be included for accurate interpretation.
C. kefyr and C. krusei had sensitivity of 61% and
44% respectively correlates with the study of
Pfaller et al.
18
who reported 66% each. We found
it difficult in identifying these species by their
colonial morphology as it was showing variation
in its appearance except for few which showed
typical morphology.
Even the secondary species like C. glabrata and C.
pelliculosa showed variation in their shades of
color and appearance as in study like Hovrth et
al.
17
This was the major limitations of the medium
where it was bit less accurate in identifying
uncommon species. This may be due to less
number of uncommon isolates obtained from our
study. This remarks us to carry out further
research on secondary species to prove their
distinctive character on Hicrome agar- Candida.
Recovery rate found on Hicrome agar was
equivalent on SDA in isolation of Candida species.
Hicrome agar Candida was slightly superior to the
Sabouraud agar in terms of its ability to suppress
bacterial contamination. Whereas, the CFU on
Hicrome agar were not only less as compared on
SDA but also the time taken to show exact growth
to be differentiated by color is prolonged with
mean duration 39 hours.
Our study found that colonial pigmentation and
typical morphology persisted throughout a seven-
day period as described by others and the
manufacturer of Hicrome agar. Hicrome agar-
Candida can readily be applied to identify colonies
after the 48 hours of incubation. The present study
highlights the fact that, Hicrome agar - Candida
differential medium proved to be very effective
for identification of four major Candida species
i.e. C. albicans, C. tropicalis, C. guilliermondi and
C. parapsilosis. As these isolates were readily
identified when isolated directly from oral thrush
patients in this study.
Its overall superiority has been self-evident in our
hands in its ability to reveal mixtures of yeast
species present in cultures. Hicrome agar not only
gave clue of mixed growth but also alerts to check
for mixed growth on SDA.
Routine use of chromogenic media carries the
potential for cost savings in the clinical
microbiology laboratory. Use of these media could
potentially save the time and expense of
performing assimilation tests and other
fermentative or biochemical testing. In addition,
use of CHROM agar Candida can also improve
the ability of the mycology laboratory to rapidly
identify mixed yeast infections. This capability
will also enable clinicians to more rapidly make
appropriate antifungal choices, decreasing patient
morbidity and mortality.
CONCLUSION
The Hicrome agar- Candida is adequately sensitive
to grow most of the important yeasts. C. albicans,
C. tropicalis, C. parapsilosis, C. krusei can be
identified rapidly and also ability to detect mixed
growth shows the usage of this media to higher
level. Hicrome agar-Candida can be readily used
for selective and differential isolation of Candida
species at quicker time.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received
from the scholars whose articles are cited and
included in references of this manuscript. The
authors are also grateful to authors / editors /
publishers of all those articles, journals and books
from where the literature for this article has been
reviewed and discussed.
REFERENCES
1. Shobha D Nadiger, Sneha K Chunchanur, LH
Halesh, K Yasmeen, MR Chandrashekar and
Patil BS. Significance of isolation and drug
susceptibility testing of non- Candida albicans

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 57
species causing oropharyngeal candidiasis in
HIV patients. J Clin Microbiol 2008;
39(3):492-495.
2. Fotedar R and Al-Hedaithy S. S. A.
Identification of chlamydospore-negative
Candida albicans using CHROMagar Candida
medium. Mycoses 2003;46:96-103
3. Ainscough S and Kibbler CC. An evaluation
of the cost-effectiveness of using
CHROMagar for yeast identification in a
routine microbiology laboratory. J Med
Microbiol 1998; 47: 623-628.
4. Hiroshi Isogai, Mulu A, Diro E, H
Tekleselassie, Kassu A, Kimura K et al.
Identification of Candida species from Human
Immunodeficiency Virus-infected Patients in
Ethiopia by Combination of CHROMagar,
Tobacco agar and PCR of Amplified
Internally Transcribed rRNA Spacer
Region. J Applied Research 2010; 10 (1):2-8.
5. Baradkar V P, Mathur M, Kumar S. Hicrome
Candida agar for identification of Candida
species. Ind J Patho and Microbiol 2010;
53(1): 93-95.
6. Duane R Hospenthal, Miriam L Beckius,
Karon L Floyd, Lynn L Horvath and Clinton
K Murrar. Presumptive identification of
Candida species other than C. albicans, C.
krusei and C. tropicalis with the chromogenic
medium CHROMagar Candida. Ann of Clin
Microbiol and Antimicrobials 2006; 5:1-5.
7. Omar JM Hamza, Mecky IN Matee, Mainen J
Moshi, Elison NM Simon, Ferdinand Mugusi,
Frans HM Mikx et al. Species distribution and
invitro antifungal susceptibility of oral yeast
isolates from Tanzanian HIV-infected patients
with primary and recurrent oropharyngeal
candidiasis. BMC Microbiology 2008; 8:135.
8. Esther Segal and Daniel Eland. Topley and
Wilson’s Microbiology and Microbial
infection, Medical Mycology. In: William
GM, Roderick J Hay, editors. Candidiasis. 10
th
ed. Arnold publishers; p.577-578.
9. Vargas LOS and Lopez MGU. Oral isolates
colonizing of infecting Human
Immunodeficiency Virus infected and healthy
persons on Mexico. J Clin Microbiol 2005;
43(8):4159-62.
10. Anupriya A, Ravinder Kaur, Satish Kumar
Agarwal, Shyama Jain and Preena Bhalla.
AIDS related opportunistic mycoses seen in a
tertiary career hospital in North India. J Med
Microbiol 2007; 56:1101-6.
11. Mario Tumberllo, Germana Caldarola, Evelina
Tacconelli, Giulia Morace, Brunella P, Robert
Cauda et al. Analysis of the factors associated
with the emergence of azole resistant oral
candidiasis in the course of HIV infection. J
Antimicrobial Chemotherapy 1996; 38: 691-
699.
12. Ranganathan K, Narasimhan P and Vidya P.
Oral Candida species in Healthy and HIV
infected subjects in Chennai. Trop Med and
Health 2008; 3(2):101.
13. Lattif AA and Banerjee U. Susceptibility
pattern and molecular type of species, specific
Candida in oropharyngeal candidiasis of
Indian HIV positive patient. J Clin Microbiol
2004; 42(3):1260-2.
14. Enwuru CA, Ogunledin A, Idika N and
Ogbonna F. Fluconazole resistant
opportunistic oropharyngeal and non-Candida
yeast like isolates from HIV infected patient
attending to ART clinic in Lagos. African
Health Services 2008; 8(3):142-3.
15. Sweet SP, Challocombe SJ and Cookson S.
Candida albicans isolates from H IV-infected
and AlDS patients exhibit enhanced adherence
to epithelial cells. J Gen Microbiol 1995;
43:27-29.
16. Odds F C and R Bernaerts, CHROMagar
Candida, a new differential isolation medium
for presumptive identification of clinically
important Candida species. J Clin Microbiol
1994; 32(8):1923.
17. Lynn L. Horvath, Duane R. Hospenthal,
Clinton K Murray and David PD. Direct

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 58
Isolation of Candida spp. from Blood Cultures
on the Chromogenic Medium CHROMagar
Candida. J Clin Microbiol 2003; 41(6): 2629–
2632.
18. Pfaller MA, Houstan A and Coffman S.
Application of CHROM agar Candida for
rapid screening of clinical specimens for
Candida albicans, Candida tropicalis, Candida
krusei and Candida glabrata. J Clin Microbiol
1996; 34(1):58-61.
Table I: Species distribution
Sl No
Species
Isolates (n)
Percentage
1
C. albicans
12
11.65%
2
C. tropicalis
25
24.27%
3
C. glabrata
21
20.39%
4
C. parapsilosis
13
12.62%
5
C. kefyr
13
12.62%
6
C.krusei
8
7.77%
7
C. glabrata
6
5.83%
8
C. fomata
3
2.91%
9
C. pelliculosa
1
0.97%
Total
103
100%
Table I: shows C. albicans 11.65%, among non
albicans Candida it is the Candida tropicalis
(24.27%) was frequently isolated species followed
by Candida guilliermondi (20.39%), Candida
parapsilosis (12.62%). Candida kefyr (12.62%),
Candida krusei (7.77%) were isolated. Rare
species like Candida glabrata (5.83%), Candida
fomata (2.91%) and Candida pelliculosa (0.97%)
were also isolated.
Table II: Mixed growth
SL
NO
SPECIES
On
SDA
On
Hicrome
COLOR
1
C.
guilliermondi
+
C. tropicalis
2
2
Green,
Pink
2
C. tropicalis +
C. parapsilosis
1
2
Blue,
Cream
3
C. fomata +
C. krusei
1
2
Cream,
Pink
Table II: shows three mixed cultures identified on
Hicrome agar plate with two species each and only
one mixed growth identified on SDA plate.

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 59
C. albicans
C.
tropicalis
C.
guilliermo
ndi
C.
parapsilos
is
C. kefyr
C. krusei
C.
glabrata
C.fomata
C.pelliculo
sa
Sensitivity
100
68
95.23
23.08
61.73
44.4
66.67
100
73.21
Specificity
100
98.72
59.75
86.66
92.22
70.21
86.5
100
86.49
0
20
40
60
80
100
120
PERCENTAGE
Figure 1: Sensitivity and Specificity of Candida
species on Hichrome agar
Figure 2: Candida albicans- Green colored colonies on Hicrome agar .

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 60
Figure 3: Candida tropicalis- Blue colored colonies on Hicrome agar
Figure 4: Candida parapsilosis- Pink colored colonies on Hicrome agar
Figure 5: Candida kefyr- Cream- Pink colonies on Hicrome agar

Shyamala R. et al
EVALUATION OF HICROME AGAR – CANDIDA, A NEW DIFFERENTIAL MEDIUM FOR
ISOLATION OF CANDIDA SPECIES FROM ORAL TRUSH IN HIV SEROPOSITIVE PATIENTS
Int J Cur Res Rev, Dec 2012 / Vol 04 (23)
Page 61
Figure 6: Candida krusei- Pink colored colonies on Hicrome agar
Figure 7: Candida guilliermondi- Greenish purple colonies on Hicrome agar