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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Cell. Infect. Microbiol. | doi: 10.3389/fcimb.2019.00264

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)

  • 1Westerdijk Fungal Biodiversity Institute, Netherlands
  • 2Department of Parasitology and Medical Mycology, Tehran University of Medical Sciences, Iran
  • 3Department of Medical Mycology and Parasitology, School of Medicine,, Mashhad University of Medical Sciences, Iran
  • 4Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Iran
  • 5Department of infectious diseases and Tropical Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Iran
  • 6Allergy Research Center, Mashhad University of Medical Sciences, Iran
  • 7Department of Medical Mycology and Parasitology, School of Medicine, Mashhad University of Medical Sciences, Iran
  • 8Faculty of Engineering, Sabzevar University of New Technologies, Iran
  • 9Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Iran
  • 10Shanghai Changzheng Hospital, China
  • 11Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Netherlands

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 1770 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 (nonwild 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 required for a better prognosis and clinical management of patients.

Keywords: Iran, AFLP genotyping, AFST, Candida orthopsilosis, Candida metapsilosis, clonality, Candida parapsilosis species complex

Received: 11 Mar 2019; Accepted: 08 Jul 2019.

Edited by:

Max MAURIN, Université Grenoble Alpes, France

Reviewed by:

Elisa Borghi, University of Milan, Italy
Elena Eraso, University of the Basque Country, Spain  

Copyright: © 2019 Arastehfar, Khodavaisy, Daneshnia, Najafzadeh, Mahmoudi, Charsizadeh, Salehi, Zarrinfar, Raeisabadi, Dolatabadi, Zare Shahrabadi, Pan, Zomorodian, Hagen and Boekhout. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Dr. Weihua Pan, Shanghai Changzheng Hospital, Shanghai, China, panweihua@smmu.edu.cn
Dr. Kamiar Zomorodian, Shiraz University of Medical Sciences, Basic Sciences in Infectious Diseases Research Center, Shiraz, 71348-14336, Fars, Iran, zomorodian2@yahoo.com