TY - JOUR
T1 - Molecular characterization and antifungal susceptibility testing of Candida nivariensis from blood samples - an Iranian multicentre study and a review of the literature
AU - Arastehfar, Amir
AU - Daneshnia, Farnaz
AU - Salehi, Mohammad-Reza
AU - Zarrinfar, Hossein
AU - Khodavaisy, Sadegh
AU - Haas, Pieter-Jan
AU - Roudbary, Maryam
AU - Najafzadeh, Mohammad-Javad
AU - Zomorodian, Kamiar
AU - Charsizadeh, Arezoo
AU - Brouwer, Carlo
AU - Pan, Weihua
AU - Hagen, Ferry
AU - Boekhout, Teun
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
KW - Adolescent
KW - Aged
KW - Amphotericin B/pharmacology
KW - Amplified Fragment Length Polymorphism Analysis
KW - Antifungal Agents/pharmacology
KW - Bronchoalveolar Lavage
KW - Candida/drug effects
KW - Candidemia/diagnosis
KW - Candidiasis/blood
KW - Caspofungin/pharmacology
KW - DNA, Intergenic
KW - Fatal Outcome
KW - Female
KW - Fluconazole/pharmacology
KW - Genotype
KW - Humans
KW - Iran
KW - Male
KW - Microbial Sensitivity Tests
KW - Middle Aged
KW - Polymerase Chain Reaction
KW - Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
KW - Vagina/microbiology
KW - Voriconazole/pharmacology
U2 - 10.1099/jmm.0.000963
DO - 10.1099/jmm.0.000963
M3 - Book/Film/Article review
C2 - 30924763
SN - 0022-2615
VL - 68
SP - 770
EP - 777
JO - Journal of Medical Microbiology
JF - Journal of Medical Microbiology
IS - 5
ER -