In Vitro Antifungal Activity of Crude Hydro-Alcoholic Extract of Petiveria alliacea L on Clinical Candida Isolates María Teresa Illnait-Zaragozí 1 , Rosario Esperanza Velar Martínez 1 , José Illnait Ferrer 2 , Carlos Manuel Fernández Andreu 1 , Gerardo Félix Martínez Machín 1 , Mayda Rosa Perurena Lancha 1 , Ernesto Xavier Monroy-Vaca 1 and Jacques F Meis 3* 1 Mycology Laboratory; Tropical Medicine Institute “Pedro Kourí” (IPK), Havana, Cuba 2 Natural Products Laboratory; National Centre for Scientific Research (CNIC), Havana, Cuba 3 Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ),Nijmegen, The Netherlands * Corresponding author: Jacques F. Meis, Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100 6532 SZ Nijmegen, Netherlands, Tel: 31 243657514; Fax: 31 243657516; E-mail: j.meis@cwz.nl Rec date: May 05, 2014; Acc date: Jul 07, 2014; Pub date: Jul 20, 2014 Copyright: © 2014 Illnait-Zaragozí, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: The global burden of infections due to Candida and the emerging resistance to antifungals has led to the search for new therapeutic alternatives. The aim of the present work it was to evaluate the in vitro antifungal activity of crude hydro-alcoholic extract of Petiveria alliacea L (HAEPAL) versus fluconazole against Candida isolates. Methods: In vitro antifungal activity was evaluated by broth microdilution method in front of 125 Candida isolates (60 C. albicans). Inoculum of 1.5×106 CFU/mL in sterile saline solution were incubated with five dilutions of the extract (128, 64, 32, 16 and 8 μg/mL). The minimum inhibitory concentration (MIC) was defined as the lowest concentration of HAEPAL showing ≤ 50% growth compared with the extract-free growth control estimated by counting the CFU/mL. Fluconazole susceptibility was assessed by ATB TM Fungus 3 and E-test according to manufacturer’s instructions. Results: HAEPAL showed higher antifungal activity compared to fluconazole. Only four isolates (one C. albicans, one C. glabrata and two C. krusei) exhibited high MICs (≥ 64 μg/mL) compared to 34 (19 C. albicans and 15 Candida non-albicans) which showed resistance to fluconazole. Conclusion: These results show the antifungal potentiality of HAEPAL, which could become a potential alternative for Candida treatment. Key words: Plant extract; Petiveria alliacea L, Candida; Fluconazole; Antifungal activity Abbreviations: HAEPAL: Hydro-Alcoholic Extract of Petiveria Alliacea L; CLSI: Clinical and Laboratory Standards Institute; SSS: Sterile Saline Solution; MIC: Minimum Inhibitory Concentration; MIC 50 : Lowest Extract Concentration able to Inhibit at Least 50% of Growth Compared with Culture Medium without HAEPAL; SDB: Sabouraud Dextrose Broth; SDA: Sabouraud Dextrose Agar; GM: Geometric Mean; SDD: Susceptible Dose Dependent Introduction The incidence of fungal infections has drastically increased over the past three decades and has become a major cause of morbidity and mortality [1]. Antifungal therapy failure depends on multiple factors including microbiological resistance. The use of fluconazole as standard prophylaxis in aids patients and the hematopoietic cell transplantation setting was simultaneously accompanied by increased acquired and innate resistance to antifungal drugs. Azole resistance was first noted in Candida species in patients with acquired immunodeficiency syndrome (of 348 isolates tested against fluconazole, and 33% were found to be resistant). With the advent of new azole and echinocandin agents, we have seen the emergence of more azole-resistant and echinocandin-resistant fungi [1,2]. This has stimulated a search for safe and more potent antifungal products. In this sense the plant kingdom has been an important source of large numbers of natural drugs over the years [1,3]. There are approximately 8000 species of Cuban medicinal plants and nearly half are endemic species. This is a rich source for the development of potential therapeutic agents [4]. Petiveria alliacea L, popularly known as anamú, is a native plant from Latin America that belongs to the family Phytolaccaceae. Because fresh leafs contain the similar chemical compounds also present in the rest of the plant, it is considered the richest vegetative organ responsible for different pharmacological activities [5]. There are few reports of antifungal activity of P. alliacea against fungal species [6-8]. However, literature on the evaluation of various preparations from this plant against yeasts does not provide conclusive results due to the scarce number of studied isolates [9,10]. Given the presence of substances with proven anti-fungal activity in this plant, this work aimed to determine the in vitro activity of a crude hydro- alcoholic extract of P. alliacea against Cuban clinical isolates of Clinical Microbiology: Open Access Illnait-Zaragozí, et al., Clin Microbial 2014, 3:4 DOI: 10.4172/2327-5073.1000159 Research Article Open Access Clin Microbial ISSN:2327-5073 CMO, an open access journal Volume 3 • Issue 4 • 1000159 C l i n i c a l M i c r o b i o l o g y : O p e n A c c e s s ISSN: 2327-5073