Molecular Analysis of Candida species with Emphasis on Predisposing Factors in Cutaneous Candidiasis Patients

Abstract

Background: Candida species are known as the most common fungal pathogens isolated from clinical specimens that can develop complications ranging from cutaneous to systemic diseases. Objectives: The present study was conducted to evaluate the diversity and distribution of Candida species in various kinds of cutaneous candidiasis in Tehran, Iran. In addition, the critical effects of several predisposing factors on the induction and progression of the disease were considered. Methods: A total of 3000 samples were taken from March 2014 to 2015. The samples were examined using direct microscopy and culturing method. The polymorphism analysis was performed by using polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) technique. The internal spacer region (ITS) of the fungal rRNA genes was recruited for PCR amplification of target sequences and Msp1 enzyme was employed to digest PCR amplicons. Results: Out of 3000 samples, yeast was recovered in 290 (9.67%) cases. Onychomycosis was observed predominantly in 164 nail samples (56.5%). The majority of patients were within the age range of 51 -60 years (22.14%). Women working at home (housewives) showed the highest percentage of people at risk (n = 135, 46.5%). Among patients with underlying diseases, diabetic patients with 46 cases (14.2 %) had the highest susceptibility to candidiasis. Genotypic identification showed that Candida albicans is the most common species (n = 132, 45.5 %) recovered from clinical samples, followed by C. parapsilosis (n = 77, 26.5%), C. glabrata (n = 22, 7.5 %), C. krusei (n = 16, 5.5 %), C. tropicalis (n = 37, 12.7 %), and C. guilliermondii (n = 6, 2%). Conclusions:The results of the present study, compared to the previous studies, showed a significantly lower prevalence of cutaneous candidiasis. Among Candida species, C. albicans was still the most common infectious agent isolated from clinical samples. Shifting toward non-albicans Candida species was not confirmed in this study. In addition, our study revealed that there is a direct correlation between some predisposing factors including age of patients, and existence of some non-infectious diseases (e.g. metabolic disorder) and occurrence of Candida infection.

Study of Skin and Nail Candida Species as a Normal Flora Based on Age Groups in Healthy Persons in Tehran-Iran (2016)

“…Considering further chance for hands in contact with pollution sources and the effect of some epidemiological elements such as occupational factors, the increased chance of yeasts isolation from this anatomical site is explainable. Isolation of C. parapsilosis as the commonest species (35%) in all sites of the skin in our study was noteworthy which was consist with other studys about candida colonization [13,14]. As other surveys that determined C. albicans seldom lives saprophitically on the skin [7] we found that C. albicans is one of the least inhabitants of the skin, whereas new studied showed among Candida species, C. albicans is still the most common infectious agent isolated from clinical samples in Iran and the word [13,15].…”

Multicenter Identification and Antifungal Susceptibility Patterns of Candida Species Isolated from Clinical Samples

“…Candida albicans was reported as the most isolated species from infected patients in this study and other studies in Asian, European, and American countries (3,5,(11)(12)(13)(14). A global increase was seen in the number of infections caused by species other than C. albicans, including C. tropicalis, C. parapsilosis, C. glabrata, and C. krusei (8,15).…”

Molecular Identification of Clinically Common and Uncommon Yeast Species

“…In epidemiological studies, most of the yeast isolates belong to Candida species, especially C. albicans (1,4,5,17,18). Previous studies in different regions of Iran show that Candida species were isolated from various clinical samples rather than other yeasts (2,5,(18)(19)(20)(21)(22)(23). As already mentioned in most studies, among Candida species, C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, and C. krusei were the most common causes of candidiasis in Iran.…”

“…The prevalence of fungal infections caused by yeasts and yeast-like species, particularly the genus of Candida, significantly increased due to extensive application of immunosuppressive drugs, predisposing factors, and particular conditions. Some rare and uncommon yeast species emerged as a cause of outbreak with high mortality or mixed infections non-responsive to routine antifungals (1,2). Clinical manifestations of yeasts and yeast-like infections ranging from mild superficial to systemic infections are frequently and usually benign in immunocompetent individuals (3).…”

“…Non-albicans Candida species, e g, C. tropicalis, C. para-psilosis, C. krusei, C. glabrata and some uncommon yeast species such as Trichosporon and more specifically C. auris complex (C. auris, C. haemulonii, C. pseudohaemulonii, C. duobushaemulonii, and C. haemulonii var. vulnera) with a reduced susceptibility to antifungal agents become a serious clinical challenge and thus the isolates need to be properly identified (1,2,(5)(6)(7). Candida auris and its closely related C. haemulonii emerged as a causative agent of invasive candidiasis that were extensively drug-resistant in hospital outbreaks (8,9).…”