Candida haemulonii species complex: an emerging species in India and its genetic diversity assessed with multilocus sequence and amplified fragment-length polymorphism analyses

Abstract

The epidemiology of Candida species-associated invasive fungal infections is evolving, and many uncommon Candida species have recently emerged as etiologic agents of bloodstream and other invasive infections. This emergence is attributable to the use of antifungal drugs, such as azoles, for prophylaxis and echinocandins among high-risk populations. Notably, these species exhibit decreased in vitro susceptibility to the antifungals used for therapy.1 In the last few years, clinical treatment failures for Candida haemulonii infections associated with resistance to amphotericin B (AMB) and reduced susceptibility to azoles and echinocandins have been reported.2, 3, 4 Members of the Candida haemulonii species complex are uncommon yeasts that cause bloodstream and deep-seated infections, and consist of two genotypically distinguishable species, that is, C. haemulonii and C. duobushaemulonii, and a variety, C. haemulonii var. vulnera.2 These species and other relatives of C. haemulonii, that is, Candida auris and Candida pseudohaemulonii, cannot be differentiated by the commercial yeast identification methods used in microbiology laboratories; thus, the true distributions of C. haemulonii and sibling species remain unknown.