Emergence and Genomic Characterization of Multidrug resistant Candida auris in West Africa.

Candida auris is an emerging multidrug-resistant fungal pathogen that has become a worldwide public health threat due to limitations of treatment options, difficulty in diagnosis, and its potential for clonal transmission. Antifungal suceptibility tests and next generation sequencing were carried out on cultured isolates. Bioinformatics analysis was done using variant calling methods and genome-wide short nucleotide polymorphism (SNP) based phylogeny. Here, we report the first four cases of C. auris infection and colonization reported in West Africa. A total of four isolates from four reported cases of candidemia were analyzed. Three patients had fungaemia, which led to fatal invasive infection and the last patient was a likely case of colonization. Of the four patients, two had mutations which conferred resistance to the antifungal azole group and other non-synonymous mutations in hotspot genes such as ERG2, ERG11 and FKS1. Isolates from these patients clustered to clades I and IV, which indicates more than one introduction of C.auris into Nigeria. The first report of C. auris in Nigeria and West Africa is of public health importance as this report will aid identification, surveillance and intervention of resistant drug resistant candidiasis in the region.