Abstract
No study in Cameroon has been undertaken to check for the presence of the cryptic species belonging to the <i>Candida glabrata</i> complex, which have varying antifungal susceptibility profiles. In this regard, we analyzed a collection of 54 clinical isolates of <i>C. glabrata</i> sensu lato obtained from 1551 samples of 490 participants. These participants included 80 diabetic patients, 323 HIV-infected subjects, 73 pregnant women and 14 of some other patients who had none of the aforementioned conditions. Our study aimed at identifying <i>Candida glabrata</i> cryptic species among clinical isolates of <i>Candida glabrata</i> sensu lato from the West region of Cameroon and to evaluate their susceptibility pattern to some antifungals. Conventional tests such as culture on CHROMagar™ <i>Candida</i>, germ tube formation and chlamydospore formation tests were used for the 1<sup>st</sup> line identification of our isolates, while the matrix assisted laser desorption ionisation – time of flight mass spectrometry (MALDI-TOF) was used for second line identification and confirmation of identifications. The minimal inhibitory concentrations (MICs) of Ketoconazole (Sigma Aldrich, China), Nystatine (Sigma Aldrich, China), Amphotericin B (Dominique Dutscher), Itraconozole (Sigma Aldrich, China), Voriconazole (Acros organics, China), and Clotrimazole (Acros organics, China) vis-à-vis 43 isolates, were determined according to the protocol proposed by the Clinical and Laboratory Standards Institute (CLSI) M27-A3 and M27-S4, with slight modifications. Of the 54 isolates, none was identified as <i>C. nivariensis</i> or <i>C. bracarensis</i> by MALDI-TOF, all the 54 (100%) isolates were confirmed to be <i>C. glabrata</i> stricto sensu. CLO (MIC range: 0.25 - >4 µg/mL) was most resisted by our isolates (95.35%), while 32.56% were resistant to KET (range of MICs: 0.03 - >4 µg/mL). On the other hand, ECVs showed that AMB (MIC range: 0.03 - 4 µg/mL) and ICZ (MIC range: 0.25 - 4 µg/mL) had very good activities against our isolates, as 81.4% of the isolates were wild type for both antifungals. On the other hand, VOR (range of MICs: 0.125 - >4 µg/mL) showed a poor activity, as most of our isolates (93.02%) were non-wild type for the antifungal. The number of isolates used in this study was not enough to conclude that <i>C. nivariensis</i> and <i>C. bracarensis</i> isolates are absent in the West Region or other parts of Cameroon, so we recommend that more of such studies be carried out in Cameroon, as this could help detect the presence of any of these emerging species with varying antifungal susceptibility profiles.
Highlights
Candidiasis caused by Candida species is one of the most common fungal infections that lead to a range of life-threatening invasive to non-life-threatening mucocutaneous diseases [1]
These cryptic species of the C. glabrata complex likely cause similar disease manifestations as C. glabrata sensu stricto, the knowledge of their presence or absence within a given geographical area is very important due to differences in antifungal susceptibility, whereby, both C. nivariensis and C. bracarensis have been reported to be more resistant to the azoles and amphotericin B compared to C. glabrata [10, 11]
Our antifungal susceptibility test conducted in this study reveals a very high resistance profile of our isolates to clotrimazole (95.35%), and a 93.02% non-wild type phenotype to voriconazole, with varying minimal inhibitory concentrations (MICs) ranges of 0.25 - >4 μg/mL and 0.125 - >4 μg/mL respectively
Summary
Candidiasis caused by Candida species is one of the most common fungal infections that lead to a range of life-threatening invasive to non-life-threatening mucocutaneous diseases [1]. It has been grouped together with two other new, rare and emerging cryptic species called, C. nivariensis and C. bracarensis, to form the Candida glabrata complex [8], referring to closely related but distinct species that had been erroneously classified under the species name, “glabrata” [9] These cryptic species of the C. glabrata complex likely cause similar disease manifestations as C. glabrata sensu stricto, the knowledge of their presence or absence within a given geographical area is very important due to differences in antifungal susceptibility, whereby, both C. nivariensis and C. bracarensis have been reported to be more resistant to the azoles and amphotericin B compared to C. glabrata [10, 11]
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