Loop-mediated isothermal amplification for Candida species surveillance in under-resourced setting: a review of evidence

ABSTRACT

Introduction

Non-albicans Candida species (NACS) have emerged as a major public health burden, although they are still underappreciated. Some NACS have intrinsic antifungal resistance, requiring constant surveillance to improve patient care and thwart outbreaks of recalcitrant candida infections. However, effective Candida species surveillance has relied on PCR-based or other high-end techniques that are largely unaffordable in under-resourced countries. Loop-mediated isothermal amplification (LAMP) has emerged as a potentially effective and affordable technique for infectious disease surveillance, especially in under-resourced settings.

Areas covered

We critically reviewed current literature on the application of LAMP for Candida species identification in pure fungal isolates, and in clinical and non-clinical samples.

Expert opinion

LAMP has been studied for Candida species identification, including the NACS. Besides a short turnaround time, LAMP has analytical sensitivity and specificity that are not only higher than culture method but also comparable with conventional and quantitative PCR techniques. However, extensive evaluation of LAMP for Candida species detection using various types of clinical and environmental samples is required before deploying the technique for Candida species surveillance.

KEYWORDS:

• Analytical performance
• Candida albicans
• Loop-mediated isothermal amplification
• Non-albicansCandida species

Article highlights

• The emergence of clinically relevant non-albicans Candida species with intrinsic antifungal resistance calls for sustainable Candida species surveillance.

• Traditional methods such as culture and biochemical tests are affordable; however, they have limited specificity for effective Candida species surveillance.

• High-end techniques such as PCR, sequencing, and matrix-assisted laser–desorption ionization time of flight are more specific than phenotypic methods, but they are too expensive for routine use in resource–constrained settings.

• LAMP is an isothermal technique that does not require expensive instruments such as the thermal cycler used in PCR, hence, it is more affordable for continuous surveillance of NACS in developing countries.

• LAMP has a short turnaround time and is highly sensitive and specific for Candida species identification.

• Further studies are required to assess the performance of LAMP to warrant deploying the technique for Candida species surveillance from clinical or environmental samples.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contributions

OO, COO, and EJT conceived the study; OO and COO performed literature search; OO COO and EJT prepared the first draft of the manuscript; BOA and EUD critically reviewed the draft; all the authors approved the final version of the manuscript.

Additional information

Funding

This paper was not funded.