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Morales-López S, Ustate K, Pedrozo Z, Torres Y. Biochemical typing and evaluation of pathogenicity in vulvovaginal isolates of Candida albicans complex. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:194-205. [PMID: 37721915 PMCID: PMC10588967 DOI: 10.7705/biomedica.6861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/06/2023] [Indexed: 09/20/2023]
Abstract
Introduction Candida albicans, C. dubliniensis, and C. africana form the Candida albicans complex. Objective To identify the phenotypic and pathogenic characteristics of isolates of the C. albicans complex preserved in a collection. Materials and methods Three hundred presumptive strains of the C. albicans complex were evaluated using CHROMagarTM Candida. Germ tube production was determined by three methods, chlamydospores formation was assessed and colonies were characterized in artisanal agars (Rosmarinus officinalis and Nicotiana tabacum). MALDI-TOF was used as the gold standard identification test. To detect pathogenicity factors, we evaluated the hemolytic activity of each isolate and cocultured with Staphylococcus aureus, coagulase enzyme production, and biofilm formation. Results Out of the 300 isolates, 43.7% produced germ tube in the heart-brain infusion broth and 47% of the isolates produced chlamydospores. In the artisan media, 6% of the isolates produced brown colonies on rosemary agar and 5% did so on tobacco agar. None of the strains hemolyzed the blood agar alone or cocultured with S. aureus. However, 50% of the isolates hemolyzed the potato dextrose agar supplemented with blood. All strains were coagulase producers, and biofilm production was variable. For germ tube production, the human serum method showed the same positivity as the milk broth method. All isolates were identified as C. albicans by MALDI-TOF. Conclusions The use of proteomics, molecular tests or a combination of methods is required for species identification.
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Affiliation(s)
- Soraya Morales-López
- Grupo CINBIOS, Programa de Microbiología, Universidad Popular del Cesar, Valledupar, Colombia; Laboratorios Nancy Flórez García S.A.S., Valledupar, Colombia.
| | - Keiner Ustate
- Grupo CINBIOS, Programa de Microbiología, Universidad Popular del Cesar, Valledupar, Colombia.
| | - Zulay Pedrozo
- Grupo CINBIOS, Programa de Microbiología, Universidad Popular del Cesar, Valledupar, Colombia.
| | - Yulibeth Torres
- Grupo CINBIOS, Programa de Microbiología, Universidad Popular del Cesar, Valledupar, Colombia.
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Klesiewicz K, Mrowiec P, Kania K, Skiba-Kurek I, Białecka J, Namysł M, Małek M. Prevalence of Closely Related Candida albicans Species among Patients with Vulvovaginal Candidiasis in Southern Poland Based on the hwp1 Gene Amplification. Pol J Microbiol 2023; 72:69-77. [PMID: 36929889 DOI: 10.33073/pjm-2023-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Candida albicans remains the most common species isolated from women with vulvovaginal candidiasis. However, closely related species such as Candida africana and Candida dubliniensis may also occur, although they are often misidentified. The aim of the study was to confirm the phenotypic identification of C. albicans and its closely related species isolated from women with genital tract infections by amplification of the hwp1 (hyphal wall protein 1) gene in a PCR assay. We report a detailed molecular identification of C. albicans and its closely related species among 326 patients in the Małopolska region, Poland. Initial phenotypic identifications were confirmed by amplification of the hwp1 gene. Based on molecular analysis, we revealed 307 strains (94.17%) as C. albicans and 17 as C. dubliniensis (5.22%). No strain of C. africana was detected. Two patients h ad co-infection with C. albicans and C. dubliniensis (0.61%). A PCR assay targeting the hwp1 gene was reliable for correctly identifying species among the C. albicans complex.
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Affiliation(s)
- Karolina Klesiewicz
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Paulina Mrowiec
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Kania
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Iwona Skiba-Kurek
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Białecka
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
- 2Centre of Microbiological Research and Autovaccines, Cracow, Poland
| | | | - Marianna Małek
- 1Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Cracow, Poland
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Overview on the Infections Related to Rare Candida species. Pathogens 2022; 11:pathogens11090963. [PMID: 36145394 PMCID: PMC9505029 DOI: 10.3390/pathogens11090963] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
Atypical Candida spp. infections are rising, mostly due to the increasing numbers of immunocompromised patients. The most common Candida spp. is still Candida albicans; however, in the last decades, there has been an increase in non-Candida albicans Candida species infections (e.g., Candida glabrata, Candida parapsilosis, and Candida tropicalis). Furthermore, in the last 10 years, the reports on uncommon yeasts, such as Candida lusitaniae, Candida intermedia, or Candida norvegensis, have also worryingly increased. This review summarizes the information, mostly related to the last decade, regarding the infections, diagnosis, treatment, and resistance of these uncommon Candida species. In general, there has been an increase in the number of articles associated with the incidence of these species. Additionally, in several cases, there was a suggestive antifungal resistance, particularly with azoles, which is troublesome for therapeutic success.
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Shokoohi G, Javidnia J, Mirhendi H, Rasekh-Jahromi A, Rezaei-Matehkolaei A, Ansari S, Maryami F, Goodarzi S, Romeo O. Molecular identification and antifungal susceptibility profiles of Candida dubliniensis and Candida africana isolated from vulvovaginal candidiasis: A single-centre experience in Iran. Mycoses 2021; 64:771-779. [PMID: 33811780 PMCID: PMC8251901 DOI: 10.1111/myc.13280] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022]
Abstract
Background Vulvovaginal candidiasis (VVC) is a common and debilitating long‐term illness affecting million women worldwide. This disease is caused mainly by Candida albicans and a lesser extent by other species, including the two phylogenetically closely related pathogens Candida africana and Candida dubliniensis. Objectives In this study, we report detailed molecular epidemiological data about the occurrence of these two pathogenic yeasts in Iranian patients affected by VVC, or its chronic recurrent form (RVVC), and provide, for the first time, data on the antifungal activity of two new drugs, efinaconazole (EFN) and luliconazole (LUL). Methods A total of 133 vaginal yeast isolates, presumptively identified as Calbicans by phenotypic and restriction analysis of rDNA, were further analysed by using a specific molecular method targeting the HWP1 gene. All Cafricana and Cdubliniensis isolates were also tested for their in vitro susceptibility to a panel of modern and classical antifungal drugs. Results and Conclusions Based on the molecular results, among 133 germ‐tube positive isolates, we identify 119 Calbicans (89.47%), 11 Cafricana (8.27%) and 3 Cdubliniensis (2.26%) isolates. Cafricana and Cdubliniensis showed low MIC values for most of the antifungal drugs tested, especially for EFN and LUL, which exhibited a remarkable antifungal activity. High MIC values were observed only for nystatin and terbinafine. Although Calbicans remains the most common Candida species recovered from Iranian VVC/RVVC patients, our data show that its prevalence may be slightly overestimated due to the presence of difficult‐to‐identify closely related yeast, especially Cafricana.
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Affiliation(s)
- Gholamreza Shokoohi
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.,Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Javad Javidnia
- Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Athar Rasekh-Jahromi
- Department of Obstetrician and Gynecology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Ali Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saham Ansari
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faeze Maryami
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.,Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Sahand Goodarzi
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.,Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Orazio Romeo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
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Distribution, antifungal susceptibility pattern and intra-Candida albicans species complex prevalence of Candida africana: A systematic review and meta-analysis. PLoS One 2020; 15:e0237046. [PMID: 32817677 PMCID: PMC7440629 DOI: 10.1371/journal.pone.0237046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022] Open
Abstract
Candida africana is a pathogenic species within the Candida albicans species complex. Due to the limited knowledge concerning its prevalence and antifungal susceptibility profiles, a comprehensive study is overdue. Accordingly, we performed a search of the electronic databases for literature published in the English language between 1 January 2001 and 21 March 2020. Citations were screened, relevant articles were identified, and data were extracted to determine overall intra-C. albicans complex prevalence, geographical distribution, and antifungal susceptibility profiles for C. africana. From a total of 366 articles, 41 were eligible for inclusion in this study. Our results showed that C. africana has a worldwide distribution. The pooled intra-C. albicans complex prevalence of C. africana was 1.67% (95% CI 0.98–2.49). Prevalence data were available for 11 countries from 4 continents. Iran (3.02%, 95%CI 1.51–4.92) and Honduras (3.03%, 95% CI 0.83–10.39) had the highest values and Malaysia (0%) had the lowest prevalence. Vaginal specimens were the most common source of C. africana (92.81%; 155 out of 167 isolates with available data). However, this species has also been isolated from cases of balanitis, from patients with oral lesions, and from respiratory, urine, and cutaneous samples. Data concerning the susceptibility of C. africana to 16 antifungal drugs were available in the literature. Generally, the minimum inhibitory concentrations of antifungal drugs against this species were low. In conclusion, C. africana demonstrates geographical variation in prevalence and high susceptibility to antifungal drugs. However, due to the relative scarcity of existing data concerning this species, further studies will be required to establish more firm conclusions.
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Candida africana vulvovaginitis: Prevalence and geographical distribution. J Mycol Med 2020; 30:100966. [PMID: 32317216 DOI: 10.1016/j.mycmed.2020.100966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/26/2019] [Accepted: 03/29/2020] [Indexed: 02/07/2023]
Abstract
Candida africana has been recovered principally as a causative agent of vulvovaginal candidiasis (VVC) from different countries, which is likely to be misidentified as the typical Candida albicans or Candida dubliniensis. The current study aimed to characterize C. albicans species complex obtained from VVC based on conventional and molecular assays. Furthermore, in vitro antifungal susceptibility testing was performed based on CLSI documents. Additionally, due to low knowledge concerning C. africana infections, we reviewed all published papers from 1991 to 2019. One hundred forty-four out of 287 patients were identified with Candida infection, among whom 151 isolates of Candida were obtained. Candida albicans 109 (72.1%), Candida glabrata 21 (13.9%), Candida krusei 8 (5.2%), Candida tropicalis 5 (3.3%), Candida africana 3 (1.9%), Candida parapsilosis 3 (1.9%) and C. dubliniensis 2 (1.3%) were isolated from patients. MIC results showed that C. africana isolates were susceptible to all tested antifungal drugs. Candida africana infections were more prevalent in Africa. One hundred fifteen (40.6%) of patients with C. africana candidiasis were from seven African countries, and Madagascar and Angola had the majority of cases. The epidemiological data, phenotypic, clinical features, ecologic similarity, and antifungal susceptibility profiles for better understanding of the pathogenic mechanisms and optimal treatment underlying non-CandidaalbicansCandida vulvovaginitis are highly recommended.
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Differentiation of Candida albicans Species Complex by Tobacco Agar Obtained from Different Cigarette Brands Available in Colombia. Int J Microbiol 2020; 2020:5438967. [PMID: 32280345 PMCID: PMC7114770 DOI: 10.1155/2020/5438967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/18/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction. The Candida albicans complex is formed by Candida albicans, Candida dubliniensis, and a biovar of C. albicans named Candida africana. These yeasts are recognized as globally distributed clinical pathogens and share most phenotypic characteristics, which makes their discrimination by conventional methods difficult. Aim. To evaluate the efficacy of different brands of cigarettes in the preparation of tobacco agar, for the differentiation of these related yeasts. Methodology. Tobacco agar was prepared using six brands and four varieties of cigarettes, and 125 clinical isolates previously identified by PCR and Maldi-Tof were used. To determine whether the results of the microbiological tests were associated with similarities in the chemical components of cigarettes, thin-layer chromatography was performed. Results. Candida dubliniensis colonies presented hue differences according to the incubation temperature and the brand or variety of cigarette used, except in the tobacco agar produced with Marlboro Xpress cigarette, where its differentiation was not possible. The chromatograms showed few differences among apolar and medium polarity extract components. Conclusions. Tobacco agar is a low-cost tool used for the differentiation of Candida dubliniensis; however, incubation temperature and cigarette brand affect the performance of the media. No relationship was found between the microbiological results and the chemical similarity of the extracts of the cigarettes by chromatography.
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8
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Farahyar S, Izadi S, Razmjou E, Falahati M, Roudbary M, Ashrafi-Khozani M, Ansari S, Fattahi A, Ghahri-Mobaser Z, Rahimi M. Low prevalence of antifungal resistant Candida africana, in the C. albicans complex causing vulvovaginal candidiasis. Heliyon 2020; 6:e03619. [PMID: 32215332 PMCID: PMC7090347 DOI: 10.1016/j.heliyon.2020.e03619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/24/2019] [Accepted: 03/13/2020] [Indexed: 01/31/2023] Open
Abstract
The Candida (C.) albicans complex includes C. albicans, C. dubliniensis, C. stellatoidea, and C. africana, with the last mentioned as an important emerging agent of vulvovaginal candidiasis (VVC). The aim of the study was to identify C. africana and C. dubliniensis and assess their drug susceptibility in vaginitis. One-hundred Candida isolates of the C. albicans complex from women diagnosed with vaginitis and from vaginal samples in the culture collection of a medical mycology laboratory were examined. Species of the C. albicans complex were identified with conventional and molecular methods using polymerase chain reaction (PCR) for amplification and sequencing of the internal transcribed spacer (ITS) region, PCR for partial amplification of hyphal wall protein 1 (HWP1) gene and duplex PCR. The effects of antifungal drugs were evaluated according to standard broth microdilution protocols. Ninety-seven C. albicans (97%) and three C. africana (3%) isolates were identified. Results of susceptibility testing revealed one isolate of C. africana to be resistant to both clotrimazole and fluconazole, and one showed reduced susceptibility to itraconazole. Identification of Candida species especially C. africana in vaginitis is crucial, there are varying levels of resistance to antifungal drugs.
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Affiliation(s)
- Shirin Farahyar
- Microbial Biotechnology Research Center (MBiRC), Iran University of Medical Sciences, Tehran, Iran.,Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Izadi
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Razmjou
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehraban Falahati
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Roudbary
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahtab Ashrafi-Khozani
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saham Ansari
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti, University of Medical Sciences, Tehran, Iran
| | - Azam Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Rahimi
- Department of Gynecology, Shahid Akbar Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
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Identification of Cryptic Species of Four Candida Complexes in a Culture Collection. J Fungi (Basel) 2019; 5:jof5040117. [PMID: 31861048 PMCID: PMC6958398 DOI: 10.3390/jof5040117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 01/11/2023] Open
Abstract
Candida spp. are one of the most common causes of fungal infections worldwide. The taxonomy of Candida is controversial and has undergone recent changes due to novel genetically related species. Therefore, some complexes of cryptic species have been proposed. In clinical settings, the correct identification of Candida species is relevant since some species are associated with high resistance to antifungal drugs and increased virulence. This study aimed to identify the species of four Candida complexes (C. albicans, C. glabrata, C. parapsilosis, and C. haemulonii) by molecular methods. This is the first report of six cryptic Candida species in Honduras: C. dubliniensis, C. africana, C. duobushaemulonii, C. orthopsilosis, and C. metapsilosis, and it is also the first report of the allele hwp1-2 of C. albicans sensu stricto. It was not possible to demonstrate the existence of C. auris among the isolates of the C. haemulonii complex. We also propose a simple method based on PCR-RFLP for the discrimination of the multi-resistant pathogen C. auris within the C. haemulonii complex.
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10
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Zhu YX, Shi Y, Fan SR, Liu XP, Yang J, Zhong SL. Multilocus sequence typing analysis of Candida africana from vulvovaginal candidiasis. BMC Infect Dis 2019; 19:461. [PMID: 31117966 PMCID: PMC6532261 DOI: 10.1186/s12879-019-4071-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/07/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Candida africana is distributed worldwide and colonized in human genitalia and cause mainly vulvovaginal candidiasis (VVC). We report the multilocus sequence typing (MLST) analysis of C. africana from VVC. METHODS MLST analysis of 43 strains of C. africana, which were isolated from vaginal specimens of patients with VVC, was performed. The enzymatic activity of phospholipase, esterase and haemolysis enzyme production was evaluated.The level of virulent genes and resistant genes mRNA expression was determined by using real-time PCR. Antifungal susceptibilities of the isolates were assayed by using the broth microdilution method. The statistical of the results was determined by the T test and Pearson chi-squared test. RESULTS The MLST analysis revealed a substantial degree of genetic homogeneity. The DST782 and DST182 were the main MLST genotypes in C. africana. All the patients were symptomatic and with a high mycological cure rate when treated with commonly used antifungal agents.There were statistically significant differences in biofilm formation and phospholipase activity between C. africana and C.albicans. The level of virulent genes and resistant genes mRNA expression was higher in fluconazole-resistant strains. All C. africana isolates were susceptible to fluconazole, itraconazole, voriconazole, caspofungin, and micafungin. These isolates also exhibited low MICs to amphotericin B, flucytosine, and posaconazole. CONCLUSIONS Candida africana appear to be with a low level of sequence variation in MLST loci. Candida africana, a lower virulence candida, is susceptible to commonly used antifungal agents. This paper was presented at the conference of 8th Trend in Medical Mycology (6-9 October 2017, Belgrade, Serbia) and was published on conference abstract.
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Affiliation(s)
- Y X Zhu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Y Shi
- Clinical College of Peking University Shenzhen Hospital, Anhui Medical University, Hefei, Anhui, China
| | - S R Fan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China. .,Clinical College of Peking University Shenzhen Hospital, Anhui Medical University, Hefei, Anhui, China. .,Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen, China.
| | - X P Liu
- Department of Laboratory Science, Peking University Shenzhen Hospital, Shenzhen, China
| | - J Yang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - S L Zhong
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
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11
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Makanjuola O, Bongomin F, Fayemiwo SA. An Update on the Roles of Non- albicans Candida Species in Vulvovaginitis. J Fungi (Basel) 2018; 4:E121. [PMID: 30384449 PMCID: PMC6309050 DOI: 10.3390/jof4040121] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 02/08/2023] Open
Abstract
Candida species are one of the commonest causes of vaginitis in healthy women of reproductive age. Vulvovaginal candidiasis (VVC) is characterized by vulvovaginal itching, redness and discharge. Candida albicans, which is a common genito-urinary tract commensal, has been the prominent species and remains the most common fungal agent isolated from clinical samples of patients diagnosed with VVC. In recent times, however, there has been a notable shift in the etiology of candidiasis with non-albicans Candida (NAC) species gaining prominence. The NAC species now account for approximately 10% to as high as 45% of VVC cases in some studies. This is associated with treatment challenges and a slightly different clinical picture. NAC species vaginitis is milder in presentation, often occur in patients with underlying chronic medical conditions and symptoms tend to be more recurrent or chronic compared with C. albicans vaginitis. C. glabrata is the most common cause of NAC-VVC. C. tropicalis, C. krusei, C. parapsilosis, and C. guilliermondii are the other commonly implicated species. Treatment failure is common in NAC-VVC, since some of these species are intrinsically resistant or show low susceptibilities to commonly used antifungal agents. This article reviews the etiology, pathogenesis, clinical features, diagnosis, and management of NAC vulvovaginitis.
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Affiliation(s)
- Olufunmilola Makanjuola
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Gulu University, Gulu P.O. Box 166, Uganda.
| | - Samuel A Fayemiwo
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan 200284, Nigeria.
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
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Hazirolan G, Altun HU, Gumral R, Gursoy NC, Otlu B, Sancak B. Prevalence of Candida africana and Candida dubliniensis, in vulvovaginal candidiasis: First Turkish Candida africana isolates from vulvovaginal candidiasis. J Mycol Med 2017. [PMID: 28641919 DOI: 10.1016/j.mycmed.2017.04.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Candida africana and C. dubliniensis are closely related species of C. albicans. Current phenotypic methods are not suitable to accurately distinguish all the species belonging to the C. albicans complex. Several molecular-based methods have recently been designed for discriminating among closely related Candida species. The aim of this study was to establish the prevalence of C. dubliniensis and C. africana in vulvovaginal samples with phenotypic and genotypic methods. MATERIALS AND METHODS We re-examined 376 vulvovaginal C. albicans complex isolates. All the isolates were identified with morphological features and HWP1 gene polymorphisms. ITS and D1/D2 sequencing, carbohydrate assimilation, MALDI-TOF MS profiles and antifungal susceptibilities were evaluated for C. africana and C. dubliniensis isolates. RESULTS Of the 376 isolates, three C. africana and three C. dubliniensis isolates (0.8% and 0.8% prevalence, respectively) were identified by molecular methods (HPW1, ITS and D1/D2) Phenotypically, C. africana differed from C. albicans and C. dubliniensis by formation of no/rare pseudohyphae, absence of chlamydospores and, the development of turquoise green colonies on CHROMagar. MALDI-TOF MS and API ID 32C could not revealed C. africana isolates. C. africana and C. dubliniensis isolates showed very low MIC values for all the tested antifungals. DISCUSSION This first report of C. africana from Turkey provides additional data for epidemiological, phenotypic features and antimicrobial susceptibility profiles. This study also highlights the importance of using genotypic methods in combination with phenotypic methods.
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Affiliation(s)
- G Hazirolan
- Department of microbiology, Ankara Numune training and research hospital, Ulku Mahallesi Talatpasa Bulvari No:5 Altindag, 06100 Ankara, Turkey.
| | - H U Altun
- Department of medical microbiology, Turgut Ozal university faculty of medicine, Ayvalı Mah.,Gazze Cad No:7, 06010 Etlik-Keçiören-Ankara, Turkey
| | - R Gumral
- Department of microbiology, Gulhane military medical academy, GATA, 06010 Keçiören-Ankara, Turkey
| | - N C Gursoy
- Department of microbiology, faculty of medicine, university of Inönü, 44000 Üzümlü-Malatya Merkez-Malatya, Turkey
| | - B Otlu
- Department of microbiology, faculty of medicine, university of Inönü, 44000 Üzümlü-Malatya Merkez-Malatya, Turkey
| | - B Sancak
- Department of microbiology, faculty of medicine, university of Hacettepe, Hacettepe university medicine, faculty Sıhhiye, 06100, Ankara, Turkey
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Chowdhary A, Hagen F, Sharma C, Al-Hatmi AMS, Giuffrè L, Giosa D, Fan S, Badali H, Felice MR, de Hoog S, Meis JF, Romeo O. Whole Genome-Based Amplified Fragment Length Polymorphism Analysis Reveals Genetic Diversity in Candida africana. Front Microbiol 2017; 8:556. [PMID: 28421052 PMCID: PMC5377543 DOI: 10.3389/fmicb.2017.00556] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/16/2017] [Indexed: 01/12/2023] Open
Abstract
This study aimed at investigating the genetic diversity of a panel of Candida africana strains recovered from vaginal samples in different countries. All fungal strains were heterozygous at the mating-type-like locus and belonged to the genotype A of Candida albicans. Moreover, all examined C. africana strains lack N-acetylglucosamine assimilation and sequence analysis of the HXK1 gene showed a distinctive polymorphism that impair the utilization of this amino sugar in this yeast. Multi-locus sequencing of seven housekeeping genes revealed a substantial genetic homogeneity among the strains, except for the CaMPIb, SYA1 and VPS13 loci which contributed significantly to the classification of our set of C. africana strains into six existing diploid sequence types. Amplified fragment length polymorphism fingerprint analysis yielded greater genotypic heterogeneity among the C. africana strains. Overall the data reported here show that in C. africana genetic diversity occurs and the existence of this intriguing group of C. albicans strains with specific phenotypes associated could be useful for future comparative studies in order to better understand the genetics and evolution of this important human pathogen.
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Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of DelhiNew Delhi, India
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina HospitalNijmegen, Netherlands
| | - Cheshta Sharma
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of DelhiNew Delhi, India
| | - Abdullah M S Al-Hatmi
- Westerdijk Fungal Biodiversity InstituteUtrecht, Netherlands.,Directorate General of Health Services, Ministry of Health, Ibri HospitalIbri, Oman
| | - Letterio Giuffrè
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of MessinaMessina, Italy
| | - Domenico Giosa
- Scientific Institute for Research, Hospitalization and Health Care - Centro Neurolesi "Bonino-Pulejo",Messina, Italy
| | - Shangrong Fan
- Department of Obstetrics and Gynecology, Peking University Shenzhen HospitalShenzhen, China
| | - Hamid Badali
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical SciencesSari, Iran
| | - Maria Rosa Felice
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of MessinaMessina, Italy
| | - Sybren de Hoog
- Westerdijk Fungal Biodiversity InstituteUtrecht, Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina HospitalNijmegen, Netherlands.,Center of Expertise in Mycology Radboudumc/Canisius-Wilhelmina ZiekenhuisNijmegen, Netherlands
| | - Orazio Romeo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of MessinaMessina, Italy.,Scientific Institute for Research, Hospitalization and Health Care - Centro Neurolesi "Bonino-Pulejo",Messina, Italy
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