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Gade L, Muñoz JF, Sheth M, Wagner D, Berkow EL, Forsberg K, Jackson BR, Ramos-Castro R, Escandón P, Dolande M, Ben-Ami R, Espinosa-Bode A, Caceres DH, Lockhart SR, Cuomo CA, Litvintseva AP. Understanding the Emergence of Multidrug-Resistant Candida: Using Whole-Genome Sequencing to Describe the Population Structure of Candida haemulonii Species Complex. Front Genet 2020; 11:554. [PMID: 32587603 PMCID: PMC7298116 DOI: 10.3389/fgene.2020.00554] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
The recent emergence of a multidrug-resistant yeast, Candida auris, has drawn attention to the closely related species from the Candida haemulonii complex that include C. haemulonii, Candida duobushaemulonii, Candida pseudohaemulonii, and the recently identified Candida vulturna. Here, we used antifungal susceptibility testing and whole-genome sequencing (WGS) to investigate drug resistance and genetic diversity among isolates of C. haemulonii complex from different geographic areas in order to assess population structure and the extent of clonality among strains. Although most isolates of all four species were genetically distinct, we detected evidence of the in-hospital transmission of C. haemulonii and C. duobushaemulonii in one hospital in Panama, indicating that these species are also capable of causing outbreaks in healthcare settings. We also detected evidence of the rising azole resistance among isolates of C. haemulonii and C. duobushaemulonii in Colombia, Panama, and Venezuela linked to substitutions in ERG11 gene as well as amplification of this gene in C. haemulonii in isolates in Colombia suggesting the presence of evolutionary pressure for developing azole resistance in this region. Our results demonstrate that these species need to be monitored as possible causes of outbreaks of invasive infection.
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Affiliation(s)
- Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jose F Muñoz
- Infectious Disease and Microbiome Program, Broad Institute, Cambridge, MA, United States
| | - Mili Sheth
- Biotechnology Core Facility Branch, DSR/NCEZID - Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Darlene Wagner
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States.,IHRC, Inc., Atlanta, GA, United States
| | - Elizabeth L Berkow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kaitlin Forsberg
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ruben Ramos-Castro
- Department of Clinical and Molecular Microbiology, Instituto Conmemorativo Gorgas de Estudios de La Salud, Panama City, Panama
| | - Patricia Escandón
- Grupo de Microbiologia, Instituto Nacional de Salud, Bogotá, Colombia
| | - Maribel Dolande
- Departamento de Micología, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Ronen Ben-Ami
- Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrés Espinosa-Bode
- DGHP (Division of Global Health Protection), Central America Region Office, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Christina A Cuomo
- Infectious Disease and Microbiome Program, Broad Institute, Cambridge, MA, United States
| | - Anastasia P Litvintseva
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
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