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An Autochthonous Susceptible Candida auris Clade I Otomycosis Case in Iran
Bahram Ahmadi1, Behrouz Naeimi1, Mohammad Javad Ahmadipour2
1Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr 75187-59577, Iran.
Abstract:
Candida auris is a newly emerging multidrug-resistant fungal pathogen considered to be a serious global health threat. Due to diagnostic challenges, there is no precise estimate for the prevalence rate of this pathogen in Iran. Since 2019, only six culture-proven C. auris cases have been reported from Iran, of which, five belonged to clade V and one to clade I. Herein, we report a case of otomycosis due to C. auris from 2017 in a 78-year-old man with diabetes mellitus type II without an epidemiological link to other cases or travel history. Short tandem repeat genotyping and whole genome sequencing (WGS) analysis revealed that this isolate belonged to clade I of C. auris (South Asian Clade). The WGS single nucleotide polymorphism calling demonstrated that the C. auris isolate from 2017 is not related to a previously reported clade I isolate from Iran. The presence of this retrospectively recognized clade I isolate also suggests an early introduction from other regions or an autochthonous presence. Although the majority of reported C. auris isolates worldwide are resistant to fluconazole and, to a lesser extent, to echinocandins and amphotericin B, the reported clade I isolate from Iran was susceptible to all antifungal drugs.
Insights
A 2017 case of Candida auris otomycosis in Iran, caused by a clade I strain, was identified retrospectively. This multidrug-resistant fungus isolate was susceptible to all tested antifungal drugs.
Area of Science:
- Mycology
- Infectious Diseases
- Genomics
Background:
- Candida auris is an emerging multidrug-resistant fungal pathogen posing a global health threat.
- Limited data exists on C. auris prevalence in Iran, with only six cases reported since 2019, primarily clade V and one clade I.
- Diagnostic challenges hinder accurate prevalence estimation in Iran.
Purpose of the Study:
- To report a case of otomycosis caused by Candida auris in Iran.
- To characterize the C. auris isolate using molecular methods.
- To investigate the genetic relationship and antifungal susceptibility of the identified isolate.
Main Methods:
- Case report of otomycosis in a diabetic patient.
- Short tandem repeat (STR) genotyping.
- Whole genome sequencing (WGS) for single nucleotide polymorphism (SNP) calling.
Main Results:
- A Candida auris otomycosis case from 2017 was identified retrospectively in a 78-year-old male with diabetes mellitus type II.
- Molecular analysis confirmed the isolate belonged to clade I (South Asian Clade).
- WGS revealed the 2017 clade I isolate is distinct from a previously reported Iranian clade I isolate and showed susceptibility to all antifungal drugs tested.
Conclusions:
- The retrospective identification of a clade I C. auris isolate in 2017 suggests earlier introduction or autochthonous presence in Iran.
- This case highlights the importance of considering C. auris even in the absence of typical risk factors like travel history.
- The susceptibility of this clade I isolate to all antifungals contrasts with the typical multidrug resistance patterns observed globally.
