The Second Candida auris Isolate from Aural Discharge in Japan

SaijoCandida is one of the most common causative agents of mycoses identified in autopsy cases in Japan (1).Candidosis is known as a hospital-acquired infection which is sometimes refractory.Candida auris is a rapidly emerging, life-threatening, fungal pathogen that is difficult to identify and shows multi-antifungal drug resistance (MDR).C. auris was first identified in 2009 from the external ear canal discharge of a patient admitted to a hospital in Japan (2).However, for reasons that remain unclear, it has not since been isolated in Japan.Meanwhile, C. auris has been identified and reported in other countries, including South Korea, India, Venezuela, the USA, Colombia, the UK, South Africa, Kuwait, Pakistan, Kenya, and Israel (3).We have identified the second isolate of the C. auris strain (TWCC 58191) from the tympanic cavity discharge of an outpatient who presented with a history of chronic otitis media and type 1 diabetes mellitus and no history of antifungal agent usage.The cultured strain appeared slightly light pink on the CHROMagar Candida medium (Becton Dickinson, Baltimore, MD, USA) after 2 days of culturing at 35 C and was initially erroneously identified as either Candida haemulonii (99%, excellent identification) using VITEK 2 Yeast (bioMérieux, Marcy l'Etoile, France) or Saccharomyces kluyveri (45.1%, T = 0.69) using API ID 32C (bioMérieux).This strain was later determined to be a C. auris strain, using a matrix-assisted laser desorption/ionization time-offlight mass spectrometry (MALDI-TOF MS, Microflex LT with Biotyper ver 3.0; Bruker Daltonics, Bremen, Germany) with a species level score value of 2.07.Species identification was confirmed using an internal transcribed spacer (ITS) and D1/D2 region of 26S rDNA sequences (DDBJ accession no.LC318417).The phylogenetic analysis of ITS sequences with neighborjoining analysis, using Geneious R9 (Biomatters, Auckland, New Zealand), is shown in Fig. 1.The strain identified in the present study was most closely related