First Isolation of Candida dubliniensis from Oral Cavities of Dermatological Patients in Nanjing, China

Candida dubliniensis is an emerging pathogen capable of causing both superficial and systemic infections. Although C. dubliniensis and C. albicans are phenotypically similar, the two species differ in terms of epidemiology and the ability to rapidly develop resistance to fluconazole. C. dubliniensis is primarily associated with oral candidiasis of human immunodeficiency virus (HIV)-infected individuals. In this study, we describe the first recovery of C. dubliniensis from oral cavities of non-HIV-infected patients with dermatological diseases in Nanjing, China. The isolates were phenotypically characterized as C. dubliniensis by their production of brown rough colonies and chlamydospores on tobacco agar and their inability to grow on hypertonic Sabouraud dextrose agar or to assimilate xylose or a-methyl-D-glycoside. The species identification was subsequently confirmed by amplification and sequencing of the internal transcribed spacer region (ITS). Three C. dubliniensis isolates out of 128 (2.3%) presumptive C. albicans/C. dubliniensis ones were finally identified. Further sequence analysis separated the three isolates into two of the four reported ITS genotypes. Antifungal susceptibility testing showed that they were susceptible to fluconazole, itraconazole, voriconazole, micafungin, and amphotericin B. This study adds to the accumulating evidence that C. dubliniensis is widely distributed in non-HIV-infected populations worldwide.