Cutaneous candidiasis in Tehran-Iran: from epidemiology to multilocus sequence types, virulence factors and antifungal susceptibility of etiologic Candida species

Golnar  Sadeghi; Mina   Ebrahimi-Rad; Masoomeh   Shams-Ghahfarokhi; Zahra  Jahanshiri; Esmat   Mirabzadeh Ardakani; Ali  Eslamifar; Seyed Fazlollah  Mousavi; Mehdi  Razzaghi-Abyaneh

doi:10.18502/ijm.v11i4.1463

Golnar Sadeghi
Mina Ebrahimi-Rad
Masoomeh Shams-Ghahfarokhi
Zahra Jahanshiri
Esmat Mirabzadeh Ardakani
Ali Eslamifar
Seyed Fazlollah Mousavi
Mehdi Razzaghi-Abyaneh

DOI: https://doi.org/10.18502/ijm.v11i4.1463

Keywords: Candida species, Candidiasis, Molecular epidemiology, Virulence factors, Antifungal susceptibility, Multilocus sequence typing

Abstract

Background and Objectives: Cutaneous candidiasis is a multipicture fungal infection caused by members of the genus Candida which is considered as a public health problem all over the world with urgency of effective treatment and control. This study was performed to analyze the clinical epidemiology and molecular aspects of cutaneous candidiasis in Tehran-Iran in relation to antifungal susceptibility and virulence factors of etiologic Candida species.

Materials and Methods: Candida species were isolated from skin (27.3%) and nail scrapings (72.7%) of suspected patients and identified by ITS sequencing. Phylogeny of the isolates was evaluated using multilocus sequence typing (MLST) and antifungal susceptibility and virulence factors of the isolates were determined in relation to clinical presentation.

Results: Candida albicans was the most prevalent species (39.8%), followed by C. parapsilosis (32.9%), C. orthopsilosis (10.4%), C. tropicalis (7.9%), C. glabrata and C. guilliermondii, each (4.5%). Molecular typing of 35 C. albicans isolates by MLST revealed 28 novel sequence types with 11 singletons with 80.0% new diploid sequence types (DSTs). Majority of the isolates were susceptible to amphotericin B (91.5%), followed by posaconazole (90.3%), fluconazole (84.3%), itraconazole (74.1%), caspofungin (53.6%), and voriconazole (26.8%). Biofilm formation, yeast-to-hyphae transformation and phospho- lipase activity were reported species-dependent.

Conclusion: Our results demonstrated clinical epidemiology of various Candida species from cutaneous candidiasis dis- tributed in new molecular types with increasing importance of drug resistant of non-albicans Candida species. Our results showed that drug susceptibility and genetic variability of Candida species may be attributed to their clinical features and source of isolation.