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Species distribution and antifungal susceptibility profiles of yeasts isolated from onychomycosis: a cross-sectional study with insights into emerging species

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Abstract

Candida onychomycosis is a common fungal infection affecting the nails, primarily caused by Candida (C.) species. Regarding the increasing trend of Candida onychomycosis and the antifungal resistant phenomenon in recent years, this study aims to evaluate the epidemiological characteristics of Candida onychomycosis, the distribution of emerging species, and the antifungal susceptibility profiles of isolates. Onychomycosis caused by yeast species was confirmed through direct examination and culture of nail scra** among all individuals suspected to have onychomycosis and referred to a medical mycology laboratory between June 2019 and March 2022. Species of yeast isolates were identified using the multiplex PCR and PCR-RFLP methods. The antifungal susceptibility of isolates to common antifungal agents and imidazole drugs was evaluated according to the M-27-A3 CLSI protocol. Among 101 yeast strains isolated from onychomycosis, Candida parapsilosis complex (50.49%) was the most common species, followed by C. albicans (20.79%) and C. tropicalis (10.89%). Rare species of yeasts such as C. guilliermondii and Saccharomyces cerevisiae were also identified by molecular methods. Results obtained from antifungal susceptibility testing showed significant differences in MIC values of isoconazole, fenticonazole, and sertaconazole among different species. Overall, a fluconazole-resistant rate of 3% was found among Candida species. Moreover, there was a statistically significant difference in MICs of fenticonazole and clotrimazole between the two most prevalent causative species, C. parapsilosis complex and C. albicans. Correct identification of the causative agents of onychomycosis and performing susceptibility testing could be helpful in choosing the most appropriate antifungal therapy.

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Data availability

The datasets generated and analyzed during the current study are available. Requests for access to these data should be made to Marjan Motamedi at marjanmotamedi64@yahoo.com.

Abbreviations

C.:

Candida

SDA:

Sabouraud's dextrose agar

RFLP:

Restriction fragment length polymorphism

TBE:

Tris/Borate/EDTA

CLSI:

Clinical and Laboratory Standards Institute

MOPS:

Morpholinopropanesulfonic acid

MIC:

Minimal inhibitory concentration

GM:

Geometric mean

bp:

Base pair

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Funding

This study was funded by Shiraz University of Medical Sciences, Shiraz, Iran, under Projects Numbers 26967, 25869, and 25626.

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Authors and Affiliations

  1. Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Somayeh Yazdanpanah, Ahmad Jabrodini, Marjan Motamedi, Kamiar Zomorodian, Mahboobeh Kharazi, Shafigheh Shabanzadeh, Farnia Ghasemi, Sahar Shariat & Maryam Rezaei Arab

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  1. Somayeh Yazdanpanah
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  2. Ahmad Jabrodini
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  3. Marjan Motamedi
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  4. Kamiar Zomorodian
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  5. Mahboobeh Kharazi
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  6. Shafigheh Shabanzadeh
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  7. Farnia Ghasemi
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  9. Maryam Rezaei Arab
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Contributions

SY: methodology and writing—original draft preparation. AJ: methodology, reviewing, and editing. MM: project administration, conceptualization, reviewing, editing, and validation. KZ and MKH: investigation and data curation. SS: writing—original draft preparation. FG, SS and MRA: investigation.

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Correspondence to Marjan Motamedi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This project was found to be in accordance with the ethical principles and the national norms and standards for conducting medical research in Iran and has been approved by the Ethics Committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR.SUMS.MED.REC.1401.422, 1401.174, 1401.068).

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Yazdanpanah, S., Jabrodini, A., Motamedi, M. et al. Species distribution and antifungal susceptibility profiles of yeasts isolated from onychomycosis: a cross-sectional study with insights into emerging species. Antonie van Leeuwenhoek 117, 6 (2024). https://doi.org/10.1007/s10482-023-01914-0

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