title: Occurrence and characterization of Candida nivariensis from a culture collection of Candida glabrata clinical isolates in Malaysia.
abstract: BACKGROUND
  Candida nivariensis and C. bracarensis have been recently identified as emerging yeast pathogens which are phenotypically indistinguishable from C. glabrata. However, there is little data on the prevalence and antifungal susceptibilities of these species.
  
  
  OBJECTIVE
  This study investigated the occurrence of C. nivariensis and C. bracarensis in a culture collection of 185 C. glabrata isolates at a Malaysian teaching hospital.
  
  
  METHODS
  C. nivariensis was discriminated from C. glabrata using a PCR assay as described by Enache-Angoulvant et al. (J Clin Microbiol 49:3375-9, 2011). The identity of the isolates was confirmed by sequence analysis of the D1D2 domain and internal transcribed spacer region of the yeasts. The isolates were cultured on Chromogenic CHROMagar Candida (®) agar (Difco, USA), and their biochemical and enzymic profiles were determined. Antifungal susceptibilities of the isolates against amphotericin B, fluconazole, voriconazole and caspofungin were determined using E tests. Clotrimazole MICs were determined using a microbroth dilution method.
  
  
  RESULTS
  There was a low prevalence (1.1 %) of C. nivariensis in our culture collection of C. glabrata. C. nivariensis was isolated from a blood culture and vaginal swab of two patients. C. nivariensis grew as white colonies on Chromogenic agar and demonstrated few positive reactions using biochemical tests. Enzymatic profiles of the C. nivariensis isolates were similar to that of C. glabrata. The isolates were susceptible to amphotericin B, fluconazole, voriconazole and caspofungin. Clotrimazole resistance is suspected in one isolate.
  
  
  CONCLUSIONS
  This study reports for the first time the emergence of C. nivariensis in our clinical setting.
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia, tayst@um.edu.my.
authors.forename: Sun Tee
authors.initials: ST
authors.lastname: Tay
authors.forename: Azadeh
authors.initials: A
authors.lastname: Lotfalikhani
authors.forename: Negar Shafiei
authors.initials: NS
authors.lastname: Sabet
authors.forename: Sasheela
authors.initials: S
authors.lastname: Ponnampalavanar
authors.forename: Sofiah
authors.initials: S
authors.lastname: Sulaiman
authors.forename: Shiang Ling
authors.initials: SL
authors.lastname: Na
authors.forename: Kee Peng
authors.initials: KP
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D002177:Candidiasis / Q000382:microbiology*; D016000:Cluster Analysis; D003470:Culture Media / Q000737:chemistry; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D006784:Hospitals, Teaching; D006801:Humans; D008296:Malaysia; D008826:Microbial Sensitivity Tests; D008828:Microbiological Techniques / Q000379:methods; D008969:Molecular Sequence Data; D016533:Mycological Typing Techniques; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA
chemical_list: D000935:Antifungal Agents; D003470:Culture Media; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer