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Molecular Identification, Genotypic Diversity, Antifungal Susceptibility, and Clinical Outcomes of Infections Caused by Clinically Underrated Yeasts, Candida Orthopsilosis, and Candida Metapsilosis: An Iranian Multicenter Study (2014–2019) Publisher Pubmed



Arastehfar A1 ; Khodavaisy S2, 3 ; Daneshnia F1 ; Najafzadeh MJ4 ; Mahmoudi S3, 5 ; Charsizadeh A6 ; Salehi MR7 ; Zarrinfar H8 ; Raeisabadi A4 ; Dolatabadi S9 ; Zare Shahrabadi Z10 ; Zomorodian K10 ; Pan W11 ; Hagen F1, 12, 13 Show All Authors
Authors
  1. Arastehfar A1
  2. Khodavaisy S2, 3
  3. Daneshnia F1
  4. Najafzadeh MJ4
  5. Mahmoudi S3, 5
  6. Charsizadeh A6
  7. Salehi MR7
  8. Zarrinfar H8
  9. Raeisabadi A4
  10. Dolatabadi S9
  11. Zare Shahrabadi Z10
  12. Zomorodian K10
  13. Pan W11
  14. Hagen F1, 12, 13
  15. Boekhout T1, 11, 14

Source: Frontiers in Cellular and Infection Microbiology Published:2019


Abstract

Despite the increasing occurrence of Candida orthopsilosis and Candida metapsilosis in clinical settings, little is known about their microbiological and clinical properties. Herein, we conducted a national retrospective study (2014–2019) from multiple centers in Iran. Among the 1,770 Candida isolates collected, we identified 600 Candida parapsilosis species complex isolates. Isolate identification was performed by 9-plex PCR, matrix-assisted laser desorption-time of flight mass spectrometry (MALDI-TOF MS), and rDNA sequencing, and antifungal susceptibility testing (AFST) followed CLSI M27-A3/S4; genotyping was performed by amplified fragment length polymorphism (AFLP) analysis; and clinical information was mined. Thirty-one isolates of C. orthopsilosis from various clinical sources, one mixed sample (blood) concurrently containing C. orthopsilosis and C. parapsilosis and one isolate of C. metapsilosis from a nail sample were identified. Although both 9-plex PCR and MALDI-TOF successfully identified all isolates, only 9-plex PCR could identify the agents in a mixed sample. For the C. orthopsilosis isolates, resistance (non-wild type) was noted only for itraconazole (n = 4; 12.5%). Anidulafungin and fluconazole showed the highest and voriconazole had the lowest geometric mean values. AFLP analysis showed three main and four minor genotypes. Interestingly, 90% of nail isolates clustered with 80% of the blood isolates within two clusters, and four blood isolates recovered from four patients admitted to a hospital clustered into two genotypes and showed a high degree of similarity (>99.2%), which suggests that C. orthopsilosis disseminates horizontally. Supported by our data and published case studies, C. orthopsilosis and C. metapsilosis can be linked to challenging clinical failures, and successful outcomes are not always mirrored by in vitro susceptibility. Accordingly, conducting nationwide studies may provide more comprehensive data, which is required for a better prognosis and clinical management of patients. © Copyright © 2019 Arastehfar, Khodavaisy, Daneshnia, Najafzadeh, Mahmoudi, Charsizadeh, Salehi, Zarrinfar, Raeisabadi, Dolatabadi, Zare Shahrabadi, Zomorodian, Pan, Hagen and Boekhout.
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