Background and Purpose: The predominant cause of candidiasis was CANDIDA albicans which has recently changed to non-CANDIDA albicans CANDIDA (NCAC) (i. e., CANDIDA spp. other than the C. albicans). The NCAC spp., earlier considered non-pathogenic or minimally virulent, are now considered a primary cause of morbidity and mortality in immunocompromised individuals. Given the NCAC spp. has become more common in clinical cases, this study aimed to determine the prevalence of NCAC spp. in different clinical specimens and assess a few of their virulence factors. Materials and Methods: Routine samples for bacterial culture and sensitivity that showed colony characteristics, like CANDIDA on Blood Agar and microscopic features resembling CANDIDA spp., were processed further. CANDIDA isolates underwent tests for chlamydospore formation and biochemical tests, including sugar fermentation and sugar assimilation tests. These were grown at 42oC, and their colony color was identified using HiCrome™ CANDIDA Differential Agar (HiMedia Laboratories Pvt. Ltd., Mumbai, India), HiCANDIDATM Identification Kit (HiMedia Laboratories Pvt. Ltd., Mumbai, India), and VITEK-2® Compact (Biomé rieux, France). Virulence factors, such as adherence to buccal epithelial cells (ABEC), biofilm formation, hemolytic activity, and production of coagulase enzyme were also tested. Results: Mean age of the patients was 38. 46 years with a male-female ratio of 1. 36: 1. In total, 137 CANDIDA isolates were recovered; 45. 3%, 19. 7%, and 13. 9% of the isolates were isolated from urine, vaginal swabs, and oropharyngeal swabs, respectively. Moreover, 55 (40. 1%) isolates were those of C. albicans and 82 (59. 9%) isolates belonged to NCAC spp., with C. tropicalis (23. 4%) contributing highest among NCAC SPECIES. Furthermore, C. albicans (3; 50%) was the most common spp. in cases of candidemia. Haemolysin production (85. 5%) and ABEC (78. 2%) were the major virulence factors in C. albicans. C. tropicalis (59. 4%) and C. dubliniensis (50%) showed maximum ABEC. Biofilm forming capacity was higher in C. tropicalis (78. 1%) than C. albicans (67%). Conclusion: Results of this study suggest varied prevalence and virulence based on geographical locations, even within a subcontinent. It clearly indicates the emergence of the NCAC spp. and their predominance in different body fluids. Identification of CANDIDA to the spp. level should become a routine in all laboratories.

The incidence of CANDIDA vulvovaginitis caused by non-albicans CANDIDA SPECIES is dramatically rising. Most non-albicans SPECIES have higher azole MICs and infections caused by them are often difficult to treat. Accurate diagnosis depends on cultures methods that will yield correct identification of CANDIDA SPECIES. Vaginal discharges were obtained from 122 women with acute (n=61) and recurrent (n=61) CANDIDA vulvovagintis. All specimens were inoculated on CHROM agar medium to identify CANDIDA SPECIES and detection of mixed infection. In order to confirm the diagnosis, all isolates also plated on cornmeal agar and identified by carbohydrate assimilation using API20C cards.A total of 127 isolates were obtained from 122 vaginal specimens cultured on CHROM agar medium. 5 patients had mixed infection with two SPECIES. CANDIDA albicans was the most common isolated SPECIES from acute (82.7%) and recurrent (57.8%) patient groups and the most common non-albicans SPECIES identified by this method was CANDIDA krusei. Cornmeal agar test showed that 22.2% and 45.3% of the isolates were non-albicans SPECIES in acute and recurrent cases respectively. But API20C test revealed that CANDIDA glabrata was the most common non-albicans SPECIES isolated in this study.Infection with non-albicans CANDIDA SPECIES is more common in recurrent CANDIDA vulvovaginitis. CHROM agar is a useful medium in detection of mixed CANDIDA infection. But in spite of its ability in identifying CANDIDA albicans and non-albicans SPECIES in some situation, this medium is not reliable for definite diagnosis of CANDIDA SPECIES.

Background: CANDIDA SPECIES are opportunistic pathogens that can cause local or systemic invasive infections in patients hospitalized in intensive care units (ICUs). The present study aimed to rapidly and precisely identify CANDIDA SPECIES, especially CANDIDA auris, from patients hospitalized in high-risk units using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Materials and Methods: In this study, 136 clinical samples were prospectively collected from different organs of patients hospitalized in high-risk units recruited from three tertiary care training hospitals in Isfahan. Direct microscopic analysis using potassium hydroxide 10% followed by culturing on Sabouraud dextrose agar and CHROMagar culture media was primarily used to screen CANDIDA SPECIES. Molecular detection of clinical isolates was mainly done using the PCR-RFLP method. Then, all the isolates were subjected to confirmatory diagnosis again through amplification of the C. auris-specific PCR. Results: CANDIDA albicans was the most prevalent isolate (48. 8%), followed by CANDIDA glabrata (17. 6%), CANDIDA tropicalis (16. 1%), CANDIDA parapsilosis (6. 6%), CANDIDA krusei (5. 8%), CANDIDA famata (4. 4%), CANDIDA kefyr (2. 9%), and CANDIDA guilliermondii (1. 4%). Therefore, the prevalence of non-albicans CANDIDA SPECIES was higher than C. albicans isolates. No C. auris isolates were identified among 136 patients. However, according to the positive control, C. auris had no restriction enzyme cleavage site for MspI, and its PCR and digestion products were the same size (401 bp). Conclusions: The simple and reliable PCR-RFLP assay used in the study has the potential to identify rare yeasts such as C. auris. It can reduce turnaround times and costs if applied in developing countries.