Distribution, antifungal susceptibility pattern and intra-Candida albicans species complex prevalence of Candida africana: A systematic review and meta-analysis.

Sanaz Aghaei Gharehbolagh,Andrew M. Borman,Zeinab Sadeghi Ardestani,Alireza Izadi,Shahram Mahmoudi,Pooneh Malekifar,Bahareh Fallah,Joy Sturtevant

doi:10.1371/journal.pone.0237046

Abstract

Candida africana is a pathogenic species within the Candida albicans species complex. Due to the limited knowledge concerning its prevalence and antifungal susceptibility profiles, a comprehensive study is overdue. Accordingly, we performed a search of the electronic databases for literature published in the English language between 1 January 2001 and 21 March 2020. Citations were screened, relevant articles were identified, and data were extracted to determine overall intra-C. albicans complex prevalence, geographical distribution, and antifungal susceptibility profiles for C. africana. From a total of 366 articles, 41 were eligible for inclusion in this study. Our results showed that C. africana has a worldwide distribution. The pooled intra-C. albicans complex prevalence of C. africana was 1.67% (95% CI 0.98-2.49). Prevalence data were available for 11 countries from 4 continents. Iran (3.02%, 95%CI 1.51-4.92) and Honduras (3.03%, 95% CI 0.83-10.39) had the highest values and Malaysia (0%) had the lowest prevalence. Vaginal specimens were the most common source of C. africana (92.81%; 155 out of 167 isolates with available data). However, this species has also been isolated from cases of balanitis, from patients with oral lesions, and from respiratory, urine, and cutaneous samples. Data concerning the susceptibility of C. africana to 16 antifungal drugs were available in the literature. Generally, the minimum inhibitory concentrations of antifungal drugs against this species were low. In conclusion, C. africana demonstrates geographical variation in prevalence and high susceptibility to antifungal drugs. However, due to the relative scarcity of existing data concerning this species, further studies will be required to establish more firm conclusions.

Highlights

The medically important polyphyletic genus Candida contains more than 300 different yeast species, around 20 of which are regularly reported from human infections ranging in spectrum from superficial mycoses to deep-seated and disseminated infections [1,2,3]
The pooled prevalence of C. africana within the C. albicans complex was 1.67% (Fig 2)
C. africana is a minor species within the C. albicans complex with a pooled prevalence of 1.67%

Summary

Introduction

The medically important polyphyletic genus Candida contains more than 300 different yeast species, around 20 of which are regularly reported from human infections ranging in spectrum from superficial mycoses to deep-seated and disseminated infections [1,2,3]. C. africana, which was first isolated in Africa in 1995, was proposed as a new species within the C. albicans complex in 2001 [9, 10]. C. africana has been isolated from diverse clinical specimens (mucous membranes, cutaneous samples, specimens from the urinary and respiratory tracts, blood) and has been reported to cause a wide variety of human infections including vulvovaginal candidiasis, oral thrush, and blood stream infections. Unlike the other members of C. albicans complex, C. africana is unable to form chlamydospores and cannot assimilate glucosamine, N-acetylglucosamine, trehalose, or DL-lactate. Differentiation of C. africana from the other members of C. albicans complex using conventional identification techniques is difficult [19, 20]

Methods

Results

Discussion

Conclusion