Molecular characterization and antifungal susceptibility testing of Candida nivariensis from blood samples - an Iranian multicentre study and a review of the literature

Amir Arastehfar, Farnaz Daneshnia, Mohammad-Reza Salehi, Hossein Zarrinfar, Sadegh Khodavaisy, Pieter-Jan Haas, Maryam Roudbary, Mohammad-Javad Najafzadeh, Kamiar Zomorodian, Arezoo Charsizadeh, Carlo Brouwer, Weihua Pan, Ferry Hagen, Teun Boekhout

Research output: Contribution to journal/periodicalBook/Film/Article reviewScientific

9 Citations (Scopus)


PURPOSE: Identification of the emerging yeast species Candida nivariensis among presumptively identified Iranian Candida glabrata isolates.

METHODOLOGY: Clinical C. glabrata species complex isolates from blood (n=71; 33.3 %), urine (n=100; 46.9 %), vaginal swabs (n=20;9.4 %), BAL (n=10; 4.7 %), and sputum (n=12; 5.6 %) from Iran were investigated. Isolates were characterized by CHROMagar, multiplex PCRs, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), amplified fragment length polymorphism (AFLP) fingerprinting, internal transcribed spacer (ITS)/large subunit (LSU) rDNA and FKS1/FKS2 sequencing, and the European Committee on Antimicrobial Susceptibility Testing broth microdilution method. A comprehensive literature review was conducted and all the relevant clinical and microbiological data were collected.

RESULTS: Four C. nivariensis isolates were recovered from blood samples of three subjects and were all consistently identified by nine-plex PCR, Bruker MALDI-TOF MS, and LSU and ITS rDNA sequencing. AFLP genotyping clustered the isolates into two groups. Sequencing of the FKS1 and FKS2 hotspots showed no accountable amino acid substitutions. All isolates were susceptible to amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole, anidulafungin and micafungin.

CONCLUSION: In total, 4 out of 213 clinical C. glabrata species complex candidemia isolates were C. nivariensis. Improvement of the BioMerieux Vitek MS database is required to accurately identify C. nivariensis and it is advised to alternatively use CHROMagar and/or PCR-based techniques. As other species within the Nakaseomyces clade may cause infection and showed high MIC values for antifungals, inclusion of their spectra into the MALDI-TOF MS database seems relevant. Due to developing resistance to fluconazole and insufficient efficacy of caspofungin, the combination of catheter removal plus treatment with caspofungin, or voriconazole, or micafungin might be effective for patients.

Original languageEnglish
Pages (from-to)770-777
Number of pages8
JournalJournal of Medical Microbiology
Issue number5
Publication statusPublished - May 2019


  • Adolescent
  • Aged
  • Amphotericin B/pharmacology
  • Amplified Fragment Length Polymorphism Analysis
  • Antifungal Agents/pharmacology
  • Bronchoalveolar Lavage
  • Candida/drug effects
  • Candidemia/diagnosis
  • Candidiasis/blood
  • Caspofungin/pharmacology
  • DNA, Intergenic
  • Fatal Outcome
  • Female
  • Fluconazole/pharmacology
  • Genotype
  • Humans
  • Iran
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Polymerase Chain Reaction
  • Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
  • Vagina/microbiology
  • Voriconazole/pharmacology


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