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Published on: December 28, 2017
Emergence and Genomic Characterization of Multidrug Resistant Candida auris in Nigeria, West Africa
Rita Oladele1, Jessica N Uwanibe2,3, Idowu B Olawoye2,3
1College of Medicine, University of Lagos, Lagos 102212, Nigeria.
Abstract:
Candida auris is an emerging multidrug-resistant fungal pathogen that has become a worldwide public health threat due to the limitations of treatment options, difficulty in diagnosis, and its potential for clonal transmission. Four ICU patients from three different healthcare facilities in Southern Nigeria presented features suggestive of severe sepsis and the blood cultures yielded the growth of Candida spp., which was identified using VITEK 2 as C. auris. Further confirmation was performed using whole genome sequencing (WGS). From the genomic analysis, two had mutations that conferred resistance to the antifungal azole group and other non-synonymous mutations in hotspot genes, such as ERG2, ERG11, and FKS1. From the phylogenetic analysis, cases 2 and 4 had a confirmed mutation (ERG11:Y132F) that conferred drug resistance to azoles clustered with clade 1, whilst cases 1 and 3 clustered with clade 4. Three of the patients died, and the fourth was most likely a case of colonization since he received no antifungals and was discharged home. These first cases of C. auris reported from Nigeria were most likely introduced from different sources. It is of public health importance as it highlights diagnostic gaps in our setting and the need for active disease surveillance in the region.
Insights
The first reported cases of the multidrug-resistant fungus Candida auris in Nigeria highlight diagnostic challenges and the need for surveillance. Genomic analysis revealed azole resistance mutations, with patients clustering into different clades.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Genomics
Background:
- Candida auris is a growing global threat due to multidrug resistance, diagnostic difficulties, and transmission.
- Limited treatment options exacerbate the public health risk posed by this fungal pathogen.
Purpose of the Study:
- To report the first cases of Candida auris in Nigeria.
- To characterize the genetic and resistance profiles of these isolates.
- To assess the implications for public health and surveillance.
Main Methods:
- Identification of Candida species using VITEK 2 system.
- Confirmation of Candida auris through whole genome sequencing (WGS).
- Phylogenetic analysis to determine clade and identify resistance mutations.
Main Results:
- Four intensive care unit patients in Southern Nigeria presented with severe sepsis, with blood cultures positive for Candida auris.
- Genomic analysis identified azole resistance mutations (e.g., ERG11:Y132F) in two patients.
- Phylogenetic analysis placed isolates into different clades (clade 1 and clade 4), suggesting multiple introductions.
- Three patients died; one likely represented colonization.
Conclusions:
- These findings represent the first documented cases of Candida auris in Nigeria.
- The study underscores diagnostic limitations and the urgent need for enhanced disease surveillance in the region.
- Multiple introductions of Candida auris are suggested, emphasizing the importance of infection control.
