Original Article

Caspofungin-Non-Susceptible Candida orthopsilosis Isolated from Onychomycosis in Iran


Background: Although Candida albicans remains the most common fungal isolate from clinical specimens, many studies have detected a shift towards non-albicans Candida species. Despite worrying clinical pictures associated with latter species, there is little information regarding its susceptibility patterns against currently available antifungal agents, with only a small number of strains having been studied.

Methods: We evaluated the in vitro antifungal susceptibilities of clinical isolates of C. orthopsilosis already identified by two-steps PCR-RFLP and reconfirmed by sequence analysis of entire ITS rDNA region, to six antifungal drugs.

Results: The resulting MIC50 and MIC90 for all strains (n=18) were in increasing order, as follows: posaconazole (0.016 & 0.063 μg/ml); itraconazole (0.031 & 0.125 μg/ml); amphotericin B (0.5 & 1 μg/ml); fluconazole (0.25 & 0.5 μg/ml) and caspofungin (4 & 8 μg/ml). A uniform pattern of the MIC ranges was seen for amphotericin B, fluconazole, itraconazole, and posaconazole, while a widest range and the highest MICs were observed for caspofungin.

Conclusion: Although we emphasis on the careful species designation of the clinical isolates of Candida, the antifungal susceptibility patterns of these clinically important organisms may have an application in clinical and epidemiological setting and deserve the implementation of local surveillance programs to monitor.



Sardi JCO, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJS (2013). Candida species: current epidemi-ology, pathogenicity, biofilm formation, natural antifungal products and new ther-apeutic options. J Med Microbiol, 62(Pt 1):10-24.

Afsarian SM, Badali H, Shokohi T, Najafipour S. (2015). Molecular Diversity of Candida albicans Isolated from Im-munocompromised Patients, Based on MLST Method. Iran J Public Health, 44(9):1262-9.

Sandven P (2000). Epidemiology of can-didemia. Rev Iberoam Micol, 17:73-81.

Tavanti A, Davidson AD, Gow NAR, Maiden MCJ, Odds FC (2005). Candida orthopsilosis and Candida metapsilosis spp. nov. to Replace Candida parapsilosis Groups II and III. J Clin Microbiol, 43(1):284–92.

Pfaller MA, Jones RN, Doern GV, et al. (2000). Bloodstream infections due to Candida species: SENTRY antimicrobial surveillance program in North America and Latin America, 1997-1998. Antimicrob Agents Chemother, 44 (3):747-51.

Pfaller MA, Diekema DJ (2007). Epidemiol-ogy of Invasive Candidiasis: a Persistent Public Health Problem. Clin Microbiol Rev, 20 (1):133–63.

Fesharaki SH, Haghani I, Mousavi B, et al. (2013). Endocarditis due to a co-infection of Candida albicans and Candida tropicalis in a drug abuser. J Med Microbiol, 62(Pt 11):1763-7.

Mohammadi R, Mirhendi H, Rezaei-Matehkolaei A, et al. (2013). Molecular identification and distribution profile of Candida species isolated from Iranian pa-tients. Med Mycol, 51(6):657-63.

Gonçalves SS, Amorim CS, Nucci M, et al. (2010). Prevalence rates and antifungal susceptibility profiles of the Candida para-psilosis species complex: results from a na-tionwide surveillance of candidaemia in Brazil. Clin Microbiol Infect, 16 (7):885-7.

Garcia-Effron G, Park S, Perlin DS (2009). Correlating echinocandin MIC and kinet-ic inhibition of fks1 mutant glucan syn-thases for Candida albicans: implications for interpretive breakpoints. Antimicrob Agents Chemother, 53 (1):112-22.

Van Asbeck E, Clemons KV, Martinez M, Tong AJ, Stevens DA (2008). Significant differences in drug susceptibility among species in the Candida parapsilosis group. Diagn Microbiol Infect Dis, 62 (1):106-9.

Mirhendi H, Bruun B, Schønheyder HC, et al. (2010). Molecular screening for Candida orthopsilosis and Candida metapsilosis among Danish Candida parapsilosis group blood culture isolates: proposal of a new RFLP profile for differentiation. J Med Microbiol, 59 (Pt 4):414-20.

Yazdanparast SA, Khodavaisy S, Fakhim H, et al. (2015). Molecular Characterization of Highly Susceptible Candida africana from Vulvovaginal Candidiasis. Mycopatho-logia. 180(5-6):317-23.

CLSI. M27-A3. Reference method for broth dilution antifungal susceptibility testing of yeasts. 3rd ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2008

Clinical and Laboratory Standards Institute. Reference method for broth dilution anti-fungal susceptibility testing of yeasts: fourth informational supplement M27-S4 (2012). CLSI, Wayne, PA, USA.

Pfaller MA, Diekema DJ (2012). Progress in antifungal susceptibility testing of Can-dida spp. by use of Clinical and Labora-tory Standards Institute broth microdilu-tion methods, to 2012. J Clin Microbiol, 50(9):2846–56.

Mohammadi R, Badiee P, Badali H, et al. (2015).Use of restriction fragment length polymorphism to identify Candida spe-cies, related to onychomycosis. Adv Bio-med Res, 4:95.

Silva AP, Miranda IM, Lisboa C, Pina-Vaz C, Rodrigues AG (2009). Prevalence, dis-tribution, and antifungal susceptibility profiles of Candida parapsilosis, C. orthopsilo-sis, and C. metapsilosis in a tertiary care hos-pital. J Clin Microbiol, 47 (8):2392-97.

Tavanti A, Hensgens LAM, Ghelardi E, Campa M, Senesi S (2007). Genotyping of Candida orthopsilosis clinical isolates by amplification fragment length polymor-phism reveals genetic diversity among in-dependent isolates and strain mainte-nance within patients. J Clin Microbiol, 45 (5):1455–62.

Pryce TM, Palladino S, Price DM, et al. (2006). Rapid identification of fungal pathogens in BacT/ALERT, BACTEC, and BBL MGIT media using polymerase chain reaction and DNA sequencing of the internal transcribed spacer regions. Diagn Microbiol Infect Dis, 54 (4):289-97.

Kocsubé S, Tóth M, Vágvölgyi C, et al. (2007). Occurrence and genetic variability of Candida parapsilosis sensu lato in Hunga-ry. J Med Microbiol, 56 (Pt 2):190-5.

Hensgens LA, Tavanti A, Mogavero S, Ghelardi E, Senesi S (2009). AFLP geno-typing of Candida metapsilosis clinical iso-lates: evidence for recombination. Fungal Genet Biol, 46 (10):750-8.

Tay ST, Na SL, Chong J (2009). Molecular differentiation and antifungal susceptibili-ties of Candida parapsilosis isolated from patients with bloodstream infections. J Med Microbiol, 58 (Pt 2):185-91.

de Toro M, Torres MJ, Maite R, Aznar J (2011). Characterization of Candida para-psilosis complex isolates. Clin Microbiol Infect, 17 (3):418-24.

Treviño-Rangel RJ, Garza-González E, González JG, Bocanegra-García V, Llaca JM, González GM (2012). Molecular characterization and antifungal suscepti-bility of the Candida parapsilosis species complex of clinical isolates from Monter-rey, Mexico. Med Mycol, 50 (7):781-4.

Feng X, Ling B, Yang G, Yu X, Ren D, Yao Z (2012). Prevalence and distribution profiles of Candida parapsilosis, Candida or-thopsilosis and Candida metapsilosis responsi-ble for superficial candidiasis in a Chinese university hospital. Mycopathologia, 173 (4):229-34.

Cantón E, Espinel-Ingroff A, Pemán J, del Castillo L (2010). In vitro fungicidal ac-tivities of echinocandins against Candida metapsilosis, C. orthopsilosis, and C. parapsilosis evaluated by time-kill studies. Antimicrob Agents Chemother, 54 (5): 2194–97.

Pfaller MA, Boyken L, Hollis RJ, Messer SA, Tendolkar S, Diekema DJ (2006). In vitro susceptibilities of Candida spp. to caspo-fungin: four years of global surveillance. J Clin Microbiol, 44 (3):760-3.

Sanguinetti M, Posteraro P, Posteraro B (2010). Echinocandin antifungal drug re-sistance in Candida species: a cause for concern? Curr Infect Dis Rep, 12 (6):437-43.

Fakhim H, Emami S, Vaezi A, Hashemi SM, Faeli L, Diba K, Dannaoui E, Badali H (2017). In Vitro Activities of Novel Azole Compounds (ATTAF-1 and ATTAF-2) Against Fluconazole-Susceptible and -Resistant Isolates of Candida species. An-timicrob Agents Chemother, 61 (1); e01106-16.

Pfaller MA, Boyken L, Hollis RJ, et al. (2008). In vitro susceptibility of invasive isolates of Candida spp. to anidulafungin, caspofungin, and micafungin: six years of global surveillance. J Clin Microbiol, 46 (1):150-6.

IssueVol 46 No 2 (2017) QRcode
SectionOriginal Article(s)
Candida orthopsilosis Onychomycosis Antifungal susceptibility Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
MOHAMMADI R, MIRHENDI H, Taghi HEDAYATI M, BADALI H. Caspofungin-Non-Susceptible Candida orthopsilosis Isolated from Onychomycosis in Iran. Iran J Public Health. 2017;46(2):235-241.