cThe Candida parapsilosis complex is composed of Candida parapsilosis sensu stricto, Candida orthopsilosis, Candida metapsilosis, and the closely related species Lodderomyces elongisporus. An exon-primed intron-crossing PCR assay was developed here to distinguish the members of the species complex on the basis of the distinct sizes of amplicons, and Candida orthopsilosis and Candida metapsilosis were further discriminated by restriction enzyme analysis.
The Candida parapsilosis complex has been reported as the second most common species isolated from patients with invasive candidiasis such as candidemia or superficial candidiasis in many studies (1-5). On the basis of genetic analysis, the C. parapsilosis complex consists of three genetically distinct species, namely, C. parapsilosis sensu stricto, C. orthopsilosis, and C. metapsilosis, which are phenotypically indistinguishable from each other (6). The three species exhibit differences in epidemiology, virulence, biofilm formation, and antifungal susceptibility (7-17). C. metapsilosis has been demonstrated to be the least virulent member of the complex (7,8). Lodderomyces elongisporus, a closely related species, has also been verified as a cause of infection in case reports and epidemiologic studies (2,(18)(19)(20). Thus, a four-species complex has been suggested to replace the three-species complex (19). Thus, it is clinically important to distinguish among the members of this species complex.So far, various molecular approaches, such as PCR-restriction fragment length polymorphism (RFLP), random amplified polymorphic DNA, real-time PCR, PCR with specific primers, matrixassisted laser desorption ionization-time of flight mass spectrometry, sequencing analysis, and a simple PCR developed recently, were established to differentiate the former three-species complex (6,(21)(22)(23)(24)(25)(26)(27). Although turquoise blue colonies on BBL CHROMagar Candida medium (Becton, Dickinson and Company, Sparks, MD) or sequence analysis could be used to distinguish L. elongisporus from the three-species complex (19), no other molecular tool has been well established. PCR analyses based on intron size differences or intron loss have been used to easily differentiate closely related clinically important yeast species, and exon-primed intron-crossing (EPIC) PCR analyses of intron length polymorphisms were also widely used as a molecular typing tool for multiple eukaryotes (28-31). Herein, an EPIC PCR combined with restriction enzyme analysis was developed to differentiate the present four-species complex and verified to be a simple, inexpensive, and reliable method.Genomic sequence data for the type strains C. parapsilosis CDC 317, C. orthopsilosis Co90-125, and L. elongisporus YB-4239 (available at http://www.ncbi.nlm.nih.gov/genome) were aligned and analyzed by LAGAN as described previously (28). C. metapsilosis was not included in the analysis because of unavailability of the genomic data online until now. The gene for manganese superoxide dismutase (MnSOD), a phylogenetic m...