title: Candida nivariensis as an etiologic agent of vulvovaginal candidiasis in a tertiary care hospital of New Delhi, India.
abstract: Candida nivariensis is a cryptic species, phenotypically indistinguishable from Candida glabrata and identified by molecular methods. Aside its isolation from broncho-alveolar lavage, we report for the first time the etiologic role of C. nivariensis in 4 patients with vulvovaginal candidiasis. Of 100 phenotypically identified C. glabrata isolates originating from vaginal swabs, 4 were identified as C. nivariensis by polymerase chain reaction and confirmed by sequencing. All of the C. nivariensis isolates exhibited white colonies on CHROMagar. Phylogenetic analysis revealed genotypic diversity in the C. nivariensis isolates originating from within or outside of India. Barring a solitary C. nivariensis isolate with MIC, 16 μg/mL of fluconazole, the rest were susceptible to voriconazole, itraconazole, posaconazole, isavuconazole, amphotericin B, and echinocandins. The patient with high fluconazole MIC did not respond to fluconazole therapy. It is suggested that the prevalence of this species is likely to be much higher than apparent from the sporadic published reports.
authors.affiliation: Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India.
authors.forename: Cheshta
authors.initials: C
authors.lastname: Sharma
authors.forename: Sandeep
authors.initials: S
authors.lastname: Wankhede
authors.forename: Sumathi
authors.initials: S
authors.lastname: Muralidhar
authors.forename: Anupam
authors.initials: A
authors.lastname: Prakash
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Singh
authors.forename: Shallu
authors.initials: S
authors.lastname: Kathuria
authors.forename: Deepa Anil
authors.initials: DA
authors.lastname: Kumar
authors.forename: Nilofar
authors.initials: N
authors.lastname: Khan
authors.forename: Harbans S
authors.initials: HS
authors.lastname: Randhawa
authors.forename: Jacques F
authors.initials: JF
authors.lastname: Meis
authors.forename: Anuradha
authors.initials: A
authors.lastname: Chowdhary
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D002181:Candidiasis, Vulvovaginal / Q000175:diagnosis* / Q000188:drug therapy; D004271:DNA, Fungal / Q000235:genetics; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005838:Genotype; D006801:Humans; D007194:India; D017964:Itraconazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D009570:Nitriles / Q000627:therapeutic use; D010641:Phenotype; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D011725:Pyridines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D017422:Sequence Analysis, DNA; D062606:Tertiary Care Centers; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D054714:Echinocandins; D009570:Nitriles; D011725:Pyridines; D011743:Pyrimidines; D014230:Triazoles; D017964:Itraconazole; C508735:isavuconazole; C101425:posaconazole; D000666:Amphotericin B; D015725:Fluconazole; D065819:Voriconazole