Candida dubliniensis in clinical specimens and possibilities for identification

Česká verzia

Authors: M. Mahelová; F. Růžička
Authors place of work: Mikrobiologický Ústav, Lékařská fakulta, Masarykova univerzita a FN u sv. Anny v Brně
Published in the journal: Epidemiol. Mikrobiol. Imunol. 63, 2014, č. 2, s. 125-129
Category: Souhrnná sdělení, původní práce, kazuistiky

Summary

Study objective:
The species Candida dubliniensis shares a wide range of phenotypic characteristics with Candida albicans, the most common yeast species isolated from clinical specimens. This is a considerable complication for the detection and identification of Candida dubliniensis from clinical specimens. The lack of data on the incidence of C. dubliniensis in the Czech Republic was the motivation behind the efforts to detect this pathogen in specimens analyzed at the Institute for Microbiology, Faculty of Medicine Masaryk University and St. Anne's Faculty Hospital in Brno. Another aim was to test the reliability of the culture methods used.

Material and methods:
Altogether 2260 yeast isolates initially identified as C. albicans were analysed. To differentiate C. dubliniensis from C. albicans, four phenotypic methods were used: colour-based differentiation on CHROMagar Candida medium, culture on medium with 6.5% of NaCl, growth at 42 °C, and colony characteristics on Staib agar. To verify the results, the Bichro-Dubli Fumouze latex agglutination test and species-specific polymerase chain reactions (PCR) were used.

Results:
Using phenotypic methods, latex agglutination, and PCR, 50 (2.2%) strains from the study set were assigned to C. dubliniensis. Most (31) C. dubliniensis isolates were recovered from the respiratory tract and the remaining others were three urine isolates, four stool isolates, one central venous catheter isolate, and one blood isolate. With the exception of colour-based differentiation on CHROMagar Candida medium showing a specificity of 85.5%, all the culture methods used have a high sensitivity and a high specificity.

Conclusion:
Identification of C. dubliniensis as C. albicans was confirmed in various clinical specimens, most often from the upper respiratory tract. The colour-based differentiation of C. dubliniensis from C. albicans on chromogenic CHROMagar Candida medium can only be recommended as a screening test for the differentiation of C. dubliniensis from other species of the genus Candida. The remaining three methods are highly reliable. The final identification should be based on a combination of these methods, with the species-specific PCR or latex agglutination test used for verification.

Keywords:
Candida dubliniensis – phenotypic methods – identification – clinical specimens

Zdroje

1. Sullivan DJ, Westerneng TJ, Haynes KA, Bennett DE, Coleman DC. Candida dubliniensis sp. nov.: phenotypic and molecular characterization of a novel species associated with oral candidosis in HIV-infected individuals. Mikrobiology, 1995;141:1507–1521.

2. Jackson AP, Gamble JA, Yeomans T, Moran GP, Saunders D, et al. Comparative genomics of the fungal pathogens Candida dubliniensis and Candida albicans. Genome Res, 2009;19:2231–2244.

3. Loreto ES, Scheid LA, Nogueira CW, Zeni G, et al. Candida dubliniensis: epidemiology and phenotypic methods for identification. Mycopathologia, 2010;169:431–443.

4. Sullivan DJ, Moran GP, Coleman DC. Candida dubliniensis: ten years on. FEMS Microbiol Lett, 2005;253:9–17.

5. Nunn MA, Schäefer SM, Petrou MA, Brown JR. Environmental source of Candida dubliniensis. Emerg Infect Dis, 2007;13:747–750.

6. Pfaller MA, Woosley LN, Messer SA, Jones RN, Castanheira M. Significance of molecular identification and antifungal susceptibility of clinically significant yeasts and moulds in a global antifungal surveillance programme. Mycopathologia, 2012;174:259–271.

7. Moran GP, Sullivan DJ, Henman MC, McCreary CE, et al. Antifungal drug susceptibilities of oral Candida dubliniensis isolates from human immunodeficiency virus (HIV)-infected and non-HIV-infected subjects and generation of stable fluconazole-resistant derivatives in vitro. Antimicrob Agents Chemother, 1997;41:617–623.

8. Fotedar R, Al Hedaithy SS. Prevalence of Candida dubliniensis among germ tube-positive yeasts recovered from the respiratory specimens in HIV-negative patients. Mycoses, 2004;47:150–155.

9. Scheid LA, Mario DA, Kubiça TF, Santurio JM, Alves SH. In vitro activities of antifungal agents alone and in combination against fluconazole-susceptible and -resistant strains of Candida dubliniensis. Braz J Infect Dis, 2012;16:78–81.

10. Alvarez MI, Suárez BL, Caicedo LD. Isolation of Candida dubliniensis for the first time in Cali, Colombia, and its identification with phenotyping methods. Mycopathologia, 2009; 167:19-24.

11. Staib P, Morschhäuser J. Chlamydospore formation on Staib agar as a species-specific characteristic of Candida dubliniensis. Mycoses, 1999;42:521–524.

12. Khan ZU, Ahmad S, Mokaddas E, Chandy R. Simplified sunflower (Helianthus annuus) seed agar for differentiation of Candida dubliniensis from Candida albicans. Clin Microbiol Infect, 2004;10:590–592.

13. Girish Kumar CP, Menon T, Prabu D, Nandhakumar B. Chlamydosporulation of Candida albicans and Candida dubliniensis on mustard agar. Mycoses, 2007;50:71–73.

14. Khan ZU, Ahmad S, Mokaddas E, Chandy R. Tobacco agar, a new medium for differentiating Candida dubliniensis from Candida albicans. J Clin Microbio, 2004;42:4796–4798.

15. Chowdhary A, Randhawa HS, Kowshik T, Kathuria S, et al. Application of hypertonic Sabouraud glucose agar for differentiation of Candida dubliniensis from Candida albicans. Diagn Microbiol Infect Dis, 2011;69:440–442.

16. Khan Z, Ahmad S, Chandy R, Joseph L. A simple xylose-based agar medium for the differentiation of Candida dubliniensis and Candida albicans. Diagn Microbiol Infect Dis, 2012;72:285–287.

17. Chryssanthou E, Fernandez V, Petrini B. Performance of commercial latex agglutination tests for the differentiation of Candida dubliniensis and Candida albicans in routine diagnostics. APMIS, 2007;115:1281–1284.

18. Kurzai O, Heinz WJ, Sullivan DJ, Coleman DC et al. Rapid PCR test for discriminating between Candida albicans and Candida dubliniensis isolates using primers derived from the pH-regulated PHR1 and PHR2 genes of C. albicans. J Clin Microbiol, 1999;37:1587–1590.

19. Romeo O, Racco C, Criseo G. Amplification of the hyphal wall protein 1 gene to distinguish Candida albicans from Candida dubliniensis. J Clin Microbiol, 2006;44:2590–2592.

20. Mähnß B, Stehr F, Schäfer W, Neuber K. Comparison of standard phenotypic assays with a PCR method to discriminate Candida albicans and C. dubliniensis. Mycoses, 2005;48:55–61.

21. Hof H, Eigner U, Maier T, Staib P. Differentiation of Candida dubliniensis from Candida albicans by means of MALDI-TOF mass spectrometry. Clin Lab, 2012;58:927–931.

22. Horká M, Růzicka F, Holá V, Slais K. Separation of similar yeast strains by IEF techniques. Electrophoresis, 2009;30:2134–2141.

23. Akgül O, Cerikçioğlu, N. Hypertonic sabouraud dextrose agar as a substrate for differentiation of Candida dubliniensis. Mycopathologia, 2009;167:357–379.

24. Hospenthal, DR, Beckius, ML, Floyd, KL, Horvath, LL, Murray, CK. Presumptive identification of Candida species other than C. albicans, C. krusei, and C. tropicalis with the chromogenic medium CHROMagar Candida. Ann Clin Microbiol Antimicrob, 2006;5:1.

25. Ge, YP, He, GX, Lin, T, Lu, GX et al. First isolation of Candida dubliniensis from oral cavities of dermatological patients in Nanjing, China. Mycopathologia, 2011;172:465–471.

26. Marcos-Arias C, Vicente JL, Sahand IH, Eguia A, De-Juan A et al. Isolation of Candida dubliniensis in denture stomatitis. Arch Oral Biol, 2009;54:127–131.

27. Blignaut E, Pujol C, Joly S, Soll DR. Racial distribution of Candida dubliniensis colonization among South Africans. J Clin Microbiol, 2003;41:1838–1842.

28. Peltroche-Llacsahuanga H, Döhmen H, Haase G. Recovery of Candida dubliniensis from sputum of cystic fibrosis patients. Mycoses, 2002;45:15–18.

29. Willis AM, Coulter WA, Sullivan DJ, Coleman DC et al. Isolation of C. dubliniensis from insulin-using diabetes mellitus patients. J Oral Pathol Med, 2000;29:86–90.

30. Mokaddas E, Khan ZU, Ahmad. Prevalence of Candida dubliniensis among cancer patients in Kuwait: a 5-year retrospective study. Mycoses, 2011;54:29–34.

31. Meis JF, Ruhnke M, De Pauw BE, Odds FC, et al. Candida dubliniensis candidemia in patients with chemotherapy-induced neutropenia and bone marrow transplantation. Emerg Infect Dis, 1999;5:150–153.

32. Owotade FJ, Patel M, Ralephenya TR, Vergotine G. Oral Candida colonization in HIV-positive women: associated factors and changes following antiretroviral therapy. J Med Microbiol, 2013;62:126–132.

33. Růžička F, Holá V, Mahelová M, Procházková A. Kvasinková kolonizace močových katétrů a význam tvorby biofilmu. Klin Mikrobiol Infekc Lek, 2012;18:115–119.

34. Rimek D. Prevalence, phenotypic identification, and antimycotic susceptibility of Candida dubliniensis from fecal samples of outpatients in Thuringia/Germany. In The 17th Congress of The International Society for Human and Animal Mycology, Tokyo, 2009:57.

35. Lai Cc, Tsai HY, Chang TC, Hsueh PR. Catheter-related fungemia caused by Candida dubliniensis. J MicrobioL Immunol Infect, 2012;46:306–308.

36. van Hal SJ, Stark D, Harkness J, Marriott D. Candida dubliniensis meningitis as delayed sequela of treated C. dubliniensis fungemia. Emerg Infect Dis, 2008;14:327–329.

37. Carr MJ, Clarke S, O’Connell F, Sullivan DJ, et al. First reported case of endocarditis caused by Candida dubliniensis. J Clin Microbiol, 2005;43:3023–3026.

38. Wellinghausen N, Moericke A, Bundschuh S, Friedrich W, et al. Multifocal osteomyelitis caused by Candida dubliniensis. J Med Microbiol, 2009;58:386–390.

39. Pasligh J, Radecke C, Fleischhacker M, Ruhnke M. Comparison of phenotypic methods for the identification of Candida dubliniensis. J Microbiol Immunol Infect, 2010;43:147–154.

40. Us E, Cengiz SA. Prevalence and phenotypic evaluation of Candida dubliniensis in pregnant women with vulvovaginal candidosis in a university hospital in Ankara. Mycoses, 2007;50:13–20.

41. Pinjon E, Sullivan D, Salkin I, Shanley D, Coleman D. Simple, inexpensive, reliable method for differentiation of Candida dubliniensis from Candida albicans. J Clin Microbiol, 1998;36:2093–2095.

42. Gales AC, Pfaller MA, Houston AK, Joly S, Sullivan DJ, et al. Identification of Candida dubliniensis based on temperature and utilization of xylose and alpha-methyl-D-glucoside as determined with the API 20C AUX and vitek YBC systems. J Clin Microbiol, 1999;37:3804–3808.