Molecular Analysis of Candida species with Emphasis on Predisposing Factors in Cutaneous Candidiasis Patients

Background: Candida species are known as the most common fungal pathogens isolated from clinical specimens that can develop complications ranging from cutaneous to systemic diseases. Objectives: The present study was conducted to evaluate the diversity and distribution of Candida species in various kinds of cutaneous candidiasis in Tehran, Iran. In addition, the critical effects of several predisposing factors on the induction and progression of the disease were considered. Methods: A total of 3000 samples were taken from March 2014 to 2015. The samples were examined using direct microscopy and culturing method. The polymorphism analysis was performed by using polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) technique. The internal spacer region (ITS) of the fungal rRNA genes was recruited for PCR amplification of target sequences and Msp1 enzyme was employed to digest PCR amplicons. Results: Out of 3000 samples, yeast was recovered in 290 (9.67%) cases. Onychomycosis was observed predominantly in 164 nail samples (56.5%). The majority of patients were within the age range of 51 - 60 years (22.14%). Women working at home (housewives) showed the highest percentage of people at risk (n = 135, 46.5%). Among patients with underlying diseases, diabetic patients with 46 cases (14.2 %) had the highest susceptibility to candidiasis. Genotypic identification showed that Candida albicans is the most common species (n = 132, 45.5 %) recovered from clinical samples, followed by C. parapsilosis (n = 77, 26.5%), C. glabrata (n = 22, 7.5 %), C. krusei (n = 16, 5.5 %), C. tropicalis (n = 37, 12.7 %), and C. guilliermondii (n = 6, 2%). Conclusions: The results of the present study, compared to the previous studies, showed a significantly lower prevalence of cutaneous candidiasis. Among Candida species, C. albicans was still the most common infectious agent isolated from clinical samples. Shifting toward non-albicans Candida species was not confirmed in this study. In addition, our study revealed that there is a direct correlation between some predisposing factors including age of patients, and existence of some non-infectious diseases (e.g. metabolic disorder) and occurrence of Candida infection.