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Isolation and molecular identification of Candida dubliniensis from non-human immunodeficiency virus-infected patients in Kuwait

Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait

Correspondence Zia U. Khan ziauddin{at}hsc.kuniv.edu.kw

Received May 18, 2003
Accepted March 27, 2004

Candida dubliniensis is an emerging pathogen capable of causing oropharyngeal, vaginal and bloodstream infections. Although C. dubliniensis is similar to Candida albicans in several phenotypic characteristics, it differs from it with respect to epidemiology, certain virulence factors and the ability to develop resistance to fluconazole rapidly. In this study, the first seven isolations of C. dubliniensis from Kuwait are described, all originating from non-human immunodeficiency virus (HIV)-infected patients. The isolates were initially identified by the Vitek 2 yeast identification system, positive germ tube test, production of rough colonies and chlamydospores on Staib agar and by their inability to assimilate xylose, trehalose or methyl -D-glucoside. The species identity of the isolates was subsequently confirmed by specific amplification of rDNA targeting the internally transcribed spacer 2 (ITS2), restriction endonuclease digestion of the amplified DNA and direct DNA sequencing of the ITS2. Using the E-test method, the MICs of C. dubliniensis test isolates were in the range 0.125–0.75 µg ml^–1 for fluconazole, 0.002–0.75 µg ml^–1 for itraconazole, 0.006–0.125 µg ml^–1 for ketoconazole, 0.002–0.5 µg ml^–1 for amphotericin B and 0.002–0.016 µg ml^–1 for voriconazole. Two of the isolates were resistant to 5-flucytosine (>32 µg ml^–1), but none against fluconazole. The study reinforces the current view that C. dubliniensis has a much wider geographical and epidemiological distribution.

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