Emergence and Genomic Characterization of Multidrug Resistant Candida auris in Nigeria, West Africa

Abstract

Candida auris is an emerging multidrug-resistant fungal pathogen that has become a worldwide public health threat due to the limitations of treatment options, difficulty in diagnosis, and its potential for clonal transmission. Four ICU patients from three different healthcare facilities in Southern Nigeria presented features suggestive of severe sepsis and the blood cultures yielded the growth of Candida spp., which was identified using VITEK 2 as C. auris. Further confirmation was performed using whole genome sequencing (WGS). From the genomic analysis, two had mutations that conferred resistance to the antifungal azole group and other non-synonymous mutations in hotspot genes, such as ERG2, ERG11, and FKS1. From the phylogenetic analysis, cases 2 and 4 had a confirmed mutation (ERG11:Y132F) that conferred drug resistance to azoles clustered with clade 1, whilst cases 1 and 3 clustered with clade 4. Three of the patients died, and the fourth was most likely a case of colonization since he received no antifungals and was discharged home. These first cases of C. auris reported from Nigeria were most likely introduced from different sources. It is of public health importance as it highlights diagnostic gaps in our setting and the need for active disease surveillance in the region.

Epidemiology, Clinical Features and Antifungal Resistance Profile of <i>Candida auris</i> in Africa: Systematic Review

“…[27]- [48]. Three countries (Algeria, Egypt and Nigeria) reported fewer than 10 C. auris cases [44] [45] [46] [47] [48]. In Sudan and Kenya, 26 and 86 C. auris cases were reported respectively [41] [42] [43].…”

“…This CFR in the specific group of patients with C. auris bloodstream infection (BSI) was 38.97%. Out of 5 case reports of C. auris infection with outcome data reported in Africa, 4 died (Table 5) [44] [48].…”

Strategies to Prevent Transmission of Candida auris in Healthcare Settings

“…Soon afterwards, several invasive isolates were identified in India [ 25 ], and the first outbreak was reported from the UK [ 26 •]. The epidemiology of C. auris infections has witnessed dramatic changes over the past 10 years as several thousand sporadic or outbreak isolates have been recovered from blood and other specimens mostly from hospitalized patients in > 50 countries/territories from Asia (Japan, South Korea, India, Kuwait, Israel, Oman, Pakistan, United Arab Emirates, China, Malaysia, Saudi Arabia, Iran, Thailand, Singapore, Bangladesh, Lebanon, Qatar, Taiwan, and Vietnam), Europe (Great Britain, Spain, Norway, France, Belgium, Germany, Russia, Austria, Switzerland, Italy, Greece, Netherlands, Poland, and Denmark), North/South Americas (USA, Venezuela, Canada, Colombia, Panama, Chile, Costa Rica, Brazil, Guatemala, Mexico, and Peru), Africa (South Africa, Kenya, Egypt, Sudan, Algeria, and Nigeria), and the Oceania (Australia) [ 19 ••, 20 •, 21 , 27 – 29 ].…”

Synergistic Anticandidal Activities of Greenly Synthesized ZnO Nanomaterials with Commercial Antifungal Agents against Candidal Infections

“…is one of the furthermost common opportunistic microbes and is found to be the main cause of 90–100% of mucosal infections [ 1 ]. It is also the fourth most common cause of hospital acquired infections, including candidemia and invasive candidiasis, which have a high mortality rate among immunocompromised patients, reaching 35–50% [ 2 ]. Additionally, vaginal candidiasis is a prevalent complication of fungal infections in women, affecting almost 70% while 20% experience recurrent vaginal candidiasis [ 3 ].…”