title: Candida haemulonii complex: species identification and antifungal susceptibility profiles of clinical isolates from Brazil.
abstract: OBJECTIVE
  The emerging fungal pathogens comprising the Candida haemulonii complex (Candida haemulonii, Candida haemulonii var. vulnera and Candida duobushaemulonii) are notable for their antifungal resistance. Twelve isolates with phenotypic similarity to C. haemulonii were recovered from patients in Brazilian hospitals. Here we aimed to identify these isolates by a molecular approach, using the current classification of this fungal complex, and to evaluate their antifungal susceptibility profiles.
  
  
  METHODS
  The fungal isolates were rechecked to certify their authentication by mycology methodologies and then characterized by ITS1-5.8S-ITS2 gene sequencing. A susceptibility assay was performed using the broth microdilution method published by CLSI (M27-A3/M27-S3).
  
  
  RESULTS
  Based on biochemical tests, all Brazilian isolates were identified as C. haemulonii. After employing ITS sequencing, five isolates were identified as C. haemulonii, four as C. duobushaemulonii and three as C. haemulonii var. vulnera. All 12 clinical isolates were resistant to amphotericin B (MICs ranged from 2 to >16 mg/L) and fluconazole (MICs ≥ 64 mg/L). One isolate of C. haemulonii var. vulnera and two isolates of C. duobushaemulonii were susceptible-dose dependent to itraconazole, while the remaining isolates (75%) were resistant to this antifungal. Eight out of 12 isolates (66.7%) were resistant to voriconazole (MICs ≥ 16 mg/L), while all isolates were susceptible to caspofungin (MICs ≤ 0.5 mg/L).
  
  
  CONCLUSIONS
  Our results reinforce the importance of molecular identification in differentiating species of the C. haemulonii complex. Moreover, the antifungal multiresistant profile of clinical isolates of the C. haemulonii complex represents a challenge to the treatment of such infections.
authors.affiliation: Laboratório de Investigação de Peptidases, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Lívia S
authors.initials: LS
authors.lastname: Ramos
authors.affiliation: Laboratório de Micologia, Instituto Nacional Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Maria Helena G
authors.initials: MH
authors.lastname: Figueiredo-Carvalho
authors.affiliation: Laboratório de Micologia, Instituto Nacional Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Leonardo S
authors.initials: LS
authors.lastname: Barbedo
authors.affiliation: Laboratório de Investigação de Peptidases, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Ziccardi
authors.affiliation: Laboratório de Micologia, Serviço de Patologia Clínica, Instituto Nacional do Câncer, Rio de Janeiro, Brazil.
authors.forename: Alessandra L S
authors.initials: AL
authors.lastname: Chaves
authors.affiliation: Laboratório de Micologia, Instituto Nacional Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Rosely M
authors.initials: RM
authors.lastname: Zancopé-Oliveira
authors.affiliation: Instituto Biomédico, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Pinto
authors.affiliation: Instituto Biomédico, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
authors.forename: Diana B G
authors.initials: DB
authors.lastname: Sgarbi
authors.affiliation: Laboratório de Bacteriologia/Micologia, Instituto de Biologia do Exército, Rio de Janeiro, Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Dornelas-Ribeiro
authors.affiliation: Laboratório de Investigação de Peptidases, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Marta H
authors.initials: MH
authors.lastname: Branquinha
authors.affiliation: Laboratório de Investigação de Peptidases, Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Programa de Pós-Graduação em Bioquímica, Instituto de Química, UFRJ, Rio de Janeiro, Brazil andre@micro.ufrj.br.
authors.forename: André L S
authors.initials: AL
authors.lastname: Santos
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D001938:Brazil; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D002177:Candidiasis / Q000382:microbiology*; D016000:Cluster Analysis; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D016533:Mycological Typing Techniques; D010802:Phylogeny; D017422:Sequence Analysis, DNA
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer
keywords: Brazilian hospitals; Candida haemulonii complex; antifungal susceptibility; resistance