Differentiation of Candida albicans complex species isolated from invasive and non-invasive infections using HWP1 gene size polymorphism

Document Type : Short Communication


1 Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Core Facilities Research Laboratory, Mycology Reference Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran

4 Immunology, Asthma, and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran



Background and Purpose: The taxonomy of Candida is controversial and has undergone changes due to the investigation of the novel species. Candida africana and Candida dubliniensis are new members of C. albicans complex that are currently gaining both clinical and epidemiologic significance. This study reports the prevalence of C. africana among the strains isolated from patients, by using HWP1 gene size polymorphism.
Materials and Methods: A total of 235 yeasts confirmed as C. albicans complex based on chromogenic media and ITS-sequencing isolated from various clinical forms of invasive and non-invasive candidiasis mainly candidemia, were re-identified based on HWP1 gene polymorphisms. The Hwp1-PCR amplicons were re-confirmed by sequencing and BLAST analysis.
Results: Based on the HWP1 gene size polymorphism, 223 strains were identified as C. albicans (94.89%) from which 7 isolates produced two DNA fragments (850 and 941 bp). C. dubliniensis (n=4, 1.7%), C. africana (n=1, 0.42%) and mix of C. albicans and C. africana (n=7, 2.97%) were also identified.
Conclusion: Although C. albicans remains the most common Candida species, C. dubliniensis and C. africana are rarely found among the patient isolates. Due to limited information on the molecular epidemiology of this novel yeast, more studies using molecular methods are recommended.


1. Aydin M, Kustimur S, Kalkanci A, Duran T. Identification of
medically important yeasts by sequence analysis of the internal
transcribed spacer and D1/D2 region of the large ribosomal
subunit. Rev Iberoam Micol. 2019; 36(3):129-38.
2. Nnadi NE, Ayanbimpe GM, Scordino F, Okolo MO, Enweani
IB, Criseo G, et al. Isolation and molecular characterization of
Candida africana from Jos, Nigeria. Med Mycol. 2012;
3. Sullivan DJ, Westerneng TJ, Haynes KA, Bennett DE, Coleman
Candida dubliniensis sp. nov.: phenotypic and molecular
characterization of a novel species associated with oral
candidosis in HIV-infected individuals. Microbiology (Reading).
1995; 141(Pt 7):1507-21.
4. Romeo O, Criseo G.
Candida africana and its closest relatives.
Mycoses. 2011; 54(6):475-86.
5. Gharehbolagh SA, Fallah B, Izadi A, Ardestani ZS, Malekifar P,
M Borman A, et al. Distribution, antifungal susceptibility pattern
and intra-
Candida albicans species complex prevalence of
Candida africana: a systematic review and meta-analysis. PLoS
One. 2020; 15(8):e0237046.
6. Moran GP, Sullivan DJ, Henman MC, McCreary CE, Harrington
BJ, Shanley DB, et al. Antifungal drug susceptibilities of oral
Candida dubliniensis isolates from human immunodeficiency
virus (HIV)-infected and non-HIV-infected subjects and
generation of stable fluconazole-resistant derivatives in vitro.
Antimicrob Agents Chemother. 1997; 41(3):617-23.
7. Farahyar S, Izadi S, Razmjou E, Falahati M, Roudbary M,
Ashrafi-Khozani M, et al. Low prevalence of antifungal resistant
Candida africana, in the C. albicans complex causing
vulvovaginal candidiasis. Heliyon. 2020; 6(3):e03619.
8. Lotfali E, Mardani M, Abolghasemi S, Darvishnia D, Rabiei
MM, Ghasemi R, et al. Isolation of
Candida africana in oral
candidiasis: first report among cancer patients in Iran. Curr Med
Mycol. 2020; 6(2):58-62.
9. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA,
Ostrosky-Zeichner L, et al. Clinical practice guideline for the
management of candidiasis: 2016 update by the infectious
diseases society of America. Clin Infect Dis. 2016; 62(4):e1-50.
10. Perlin DS. Echinocandin resistance, susceptibility testing and
prophylaxis: implications for patient management. Drugs. 2014;
11. Romeo O, Criseo G. First molecular method for discriminating
Candida africana, Candida albicans, and Candida
by using hwp1 gene. Diagn Microbiol Infect Dis.
2008; 62(2):230-3.
12. Nikmanesh B, Ahmadikia K, Getso MI, Gharehbolagh SA,
Aboutalebian S, Mirhendi H, et al.
Candida africana and
Candida dubliniensis as causes of pediatric candiduria: a study
using HWP1 gene size polymorphism. AIMS Microbiol. 2020;
13. Mirhendi H, Charsizadeh A, Eshaghi H, Nikmanesh B,
Arendrup MC. Species distribution and antifungal susceptibility
profile of
Candida isolates from blood and other normally sterile
foci from pediatric ICU patients in Tehran, Iran. Med Mycol.
2020; 58(2):201-6. .
14. Aboutalebian S, Mahmoudi S, Okhovat A, Khodavaisy S,
Mirhendi H. Otomycosis due to the rare fungi
purpurogenus, Naganishia albida
and Filobasidium magnum.
Mycopathologia. 2020; 185(3):569-75.
15. Aboutalebian S, Mahmoudi S, Mirhendi H, Okhovat A, Abtahi
H, Chabavizadeh J. Molecular epidemiology of otomycosis in
Isfahan revealed a large diversity in causative agents. Journal of
Medical Microbiology. 2019 ;68(6):918-23.
16. Ngouana TK, Krasteva D, Drakulovski P, Toghueo RK,
Kouanfack C, Ambe A, et al. Investigation of minor species
Candida africana, Candida stellatoidea and Candida
in the Candida albicans complex among Yaoundé
(Cameroon) HIV-infected patients. Mycoses. 2015; 58(1):33-9.
17. Pemán J, Cantón E, Quindós G, Eraso E, Alcoba J, Guinea J, et
al. Epidemiology, species distribution and in vitro antifungal
susceptibility of fungaemia in a Spanish multicentre prospective
survey. J Antimicrob Chemother. 2012; 67(5):1181-7.
18. Gil-Alonso S, Quindós G, Eraso E, Jauregizar N. Postantifungal
effect of anidulafungin against
Candida albicans, Candida
dubliniensis, Candida africana, Candida parapsilosis, Candida
and Candida orthopsilosis. Rev Esp Quimioter.
2019; 32(2):183-8.
19. Njunda LA, Assob JC, Nsagha SD, Kamga HL, Ndellejong EC,
Kwenti TE. Oral and urinary colonization of
Candida species in
HIV/AIDS patients in Cameroon. Basic Sci Med. 2013; 2(1):1-8.
20. Romeo O, De Leo F, Criseo G. Adherence ability of
: a comparative study with Candida albicans and
Candida dubliniensis. Mycoses. 2011; 54(4):e57-61.
21. Hana S, Latifa M, Camilia C, Boutheina J. Characterization of
the ‘
Candida albicans Complex’: first report of Candida
in Tunisia. J Med Microb Diagn. 2020; 9(307):2.
22. Mucci MJ, Cuestas ML, Landanburu MF, Mujica MT.
Prevalence of
Candida albicans, Candida dubliniensis and
Candida africana in pregnant women suffering from
vulvovaginal candidiasis in Argentina. Rev Iberoam Micol.
2017; 34(2):72-6.
23. Gajdács M, Dóczi I, Ábrók M, Lázár A, Burián K.
Epidemiology of candiduria and
Candida urinary tract infections
in inpatients and outpatients: results from a 10-year retrospective
survey. Cent European J Urol. 2019; 72(2):209-14.
24. Naeimi B, Mirhendi H, Khamisipour G, Sadeghzadeh F, Ahmadi
Candida africana in recurrent vulvovaginal candidiasis
(RVVC) patients: frequency and phenotypic and genotypic
characteristics. J Med Microbiol. 2018; 67(11):1601-7.
25. Nouraei H, Sheykhi S, ZareShahrabadi Z, Khodadadi H,
Zomorodian K, Pakshir K. Comparative analysis of virulence
factors of homozygous and heterozygous strains of
vaginal isolates. Int J Microbiol. 2020; 2020:8889224.
26. Shokoohi G, Javidnia J, Mirhendi H, Rasekh-Jahromi A, RezaeiMatehkolaei A, Ansari S, et al. Molecular identification and
antifungal susceptibility profiles of
Candida dubliniensis and
Candida africana isolated from vulvovaginal candidiasis: a
single-centre experience in Iran. Mycoses. 2021; 64(7):771-9.
27. Fakhim H, Vaezi A, Javidnia J, Nasri E, Mahdi D, Diba K, et al.
Candida africana vulvovaginitis: prevalence and geographical
distribution. J Mycol Med. 2020; 30(3):100966.
28. Hashemi SE, Shokohi T, Abastabar M, Aslani N, Ghadamzadeh
M, Haghani I. Species distribution and susceptibility profiles of
  Candida species isolated from vulvovaginal candidiasis,
emergence of C. lusitaniae. Curr Med Mycol. 2019; 5(4):26-34.
29. Theill L, Dudiuk C, Morano S, Gamarra S, Nardin ME, Méndez
E, et al. Prevalence and antifungal susceptibility of
and its related species Candida dubliniensis and
Candida africana isolated from vulvovaginal samples in a
hospital of Argentina. Rev Argent Microbiol. 2016; 48(1):43-9.
30. Rezazadeh E, Moazeni M, Sabokbar A. Use of cost effective and
rapid molecular tools for identification of Candida species,
opportunistic pathogens. Curr Med Mycol. 2016; 2(3):1-4.
31. Romeo O, Criseo G. Molecular epidemiology of
and its closely related yeasts Candida dubliniensis and
Candida africana. J Clin Microbiol. 2009; 47(1):212-4.
32. Petty LA, Gallan AJ, Detrick JA, Ridgway JP, Mueller J, Pisano
Candida dubliniensis pneumonia: a case report and review of
literature. Mycopathologia. 2016; 181(9-10):765-8.
33. Khan Z, Ahmad S, Joseph L, Chandy R.
Candida dubliniensis:
an appraisal of its clinical significance as a bloodstream
pathogen. PLoS One. 2012; 7(3):e32952.
34. Coleman DC, Sullivan DJ, Bennett DE, Moran GP, Barry HJ,
Shanley DB. Candidiasis: the emergence of a novel species,
Candida dubliniensis. AIDS. 1997; 11(5):557-67.
35. van Hal SJ, Stark D, Harkness J, Marriott D.
meningitis as delayed sequela of treated C.
fungemia. Emerg Infect Dis. 2008; 14(2):327-9.
36. Tavanti A, Davidson AD, Fordyce MJ, Gow NA, Maiden MC,
Odds FC. Population structure and properties of
, as determined by multilocus sequence typing. J Clin
Microbiol. 2005; 43(11):5601-13.
37. Yazdanpanah A, Khaithir TM. Issues in identifying germ tube
positive yeasts by conventional methods. J Clin Lab Anal. 2014;
38. Gumral R, Sancak B, Guzel AB, Saraçlı MA, Ilkit M. Lack of
Candida africana and Candida dubliniensis in vaginal Candida
isolates in Turkey using HWP1 gene polymorphisms.
Mycopathologia. 2011; 172(1):73-6.
Volume 7, Issue 2
June 2021
Pages 34-38
  • Receive Date: 02 May 2021
  • Revise Date: 20 July 2021
  • Accept Date: 31 July 2021
  • First Publish Date: 31 July 2021