Racial distribution of Candida dubliniensis colonization among South Africans

Candida dubliniensis is a yeast species that has only recently been differentiated from Candida albicans. C. dubliniensis colonization was initially associated with human immunodeficiency virus (HIV)-positive individuals. Because of the large proportion of AIDS patients in South Africa, we tested the generality of this association by assessing the prevalence of C. dubliniensis colonization among 253 black HIV-positive individuals, 66 healthy black individuals, 22 white HIV-positive individuals, and 55 healthy white individuals in South Africa carrying germ tube-positive yeasts in their oral cavities. Molecular fingerprinting with Ca3, a complex DNA fingerprinting probe specific for C. albicans, and Cd25, a complex DNA fingerprinting probe specific for C. dubliniensis, provides the first conclusive evidence of the existence of C. dubliniensis among South African clinical yeast isolates and reveals a higher relative prevalence of this species among white healthy individuals (16%) than among HIV-positive white individuals (9%), black healthy individuals (0%), and black HIV-positive individuals (1.5%). A cluster analysis separated South African C. dubliniensis isolates into two previously described groups, groups I and II, with the majority of isolates clustering in group I. Isolates from white healthy individuals exhibited a higher level of relatedness. A comparison of the C. dubliniensis isolates from South Africa with a general collection of C. dubliniensis isolates collected worldwide revealed no South Africa-specific clade, as has been demonstrated for C. albicans. These results suggest that in South Africa, C. dubliniensis carriage is influenced more by race than by HIV infection status.