Abstract
In recent years, opportunistic and nosocomial fungal pathogens have been dominated by yeasts of the genus Candida. Most of the research has focused on Candida albicans since it is the most prominent etiological agent. There are numerous publications that describe the biology, virulence factors, morphology, immunity, genomics, diseases, and laboratory aspects of Candida albicans. In this chapter we offer a historic perspective of C. albicans and focus on other non-albicans candida (NAC) that cause serious disease. We review the current knowledge of emerging NAC pathogens with useful graphics and current references. This chapter is laid out as an overview and is geared for students seeking basic information and may be superficial for an infectious diseases clinician.
Keywords
- C. albicans
- C. tropicalis
- C. glabrata
- C. parapsilosis
- C. guilliermondii
- C. auris and C. krusei
- non-albicans candida (NAC)
- fungal pathogen
1. Introduction
By the end of the twentieth century, hospital-acquired fungal infections were on the rise. Infections by yeasts of the genus Candida have become one of the most common causes of bloodstream infections [1]. The increase in fungal infections is typically attributed to the longer survival of immuno-compromised individuals as well as the increase in the number of people in long term health care facilities undergoing, immunosuppressive therapy, long-term catheterization, broad-spectrum antibiotic use among others. This alarming increase in nosocomial fungal infections has alerted clinicians and scientist that yeasts, previously thought innocuous and relegated to plant pathology or industrial use were capable of causing serious illness.
While infections caused by Candida species are typically superficial and restricted to the urogenital or mucosal oral cavities, they are also capable of entering the bloodstream leading to deep-tissue infections [2].
The predominant yeasts in bloodstream infection remain restricted to the genus Candida [3] most of which, belong to the CTG clade, where the CTG codon is translated as Serine rather than Leucine [4]. Although the recent rise in the number of these infections [5] is mainly associated to
The definition of a new or “emerging” pathogen is subjective at best. For example, how many independent isolations are required before an emerging pathogen is established as an infectious agent? Indications of emerging infections typically consist of case reports. The incidence of yeast infections is likely under-reported because it is dependent on clinical diagnosis and their desire to investigate, then confirm the novelty of the etiological agent, write a compelling report, and to withstand the critique and rigor of publishing the report. A close partnership between a research scientist and a clinical physician is critical for the most rigorous reports.
Furthermore, a single report describing several cases of infection by a novel microbe does not necessarily indicate that a new infection has emerged. Since these temporally separated clinical samples must be confirmed as being independent and not affected by laboratory practices, personnel and/or environmental factors [8]. For example, recent retrospective studies of blood stream infection caused by the genus
For the purposes of this chapter we limit the definition of emerging pathogens to those that have recently appeared within a population or those whose incidence or geographic range is rapidly increasing or threatens to increase in the near future or those caused by previously undetected or unknown infectious agents.
2. Established pathogens of the Candida species
2.1. Candida albicans
The first description of a yeast infection was of thrush, by Hippocrates in the fifth century B.C. [9]. Since its first microscopic detection in thrush swabs by Langenbeck, subsequently Berg and Gruby [9] in 1839,
Post-transcriptional mechanisms underlying this transition include mRNA stability, alternative transcript localization, and translation and influence
At the transcriptional level,
When interacting with macrophages, the SPS system is stimulated in the nutrient poor host environment and is critical for resistance of
Detection and identification of various yeasts has been a challenge. These yeasts can be distinguished morphologically on CHROMagar or spider media (Figure 4). However, genome sequencing is the most reliable method for species identification. In addition, detection of microsatellites also represents a reliable method for molecular typing and genetic analysis of
2.2. Candida glabrata
In contrast to most
Both
3. Emerging pathogens of the Candida species
3.1. Candida auris
Fluconazole-resistant
Phylogenetically,
Risk factors for
The genomes of several isolates have been sequenced and they appear to parse into four distinct clades by geographic region [35]. Clades were separated by thousands of single-nucleotide polymorphisms, but within each clade isolates were typically clonal. Various mutations in
Again, while whole genome sequencing is the most reliable method for species identification, PCR and real-time PCR assays have shown excellent accuracy and have been effective for diagnosis, to rapidly identify
3.2. Candida krusei
In contrast to most other ovoid shaped Candida spp.,
Like
The susceptibility to lysozyme, an antimicrobial enzyme produced in phagosomes has been used as a method to assess the microbial virulence. Such tests indicate that the susceptibility to lysozyme of
3.3. Candida kefyr
These emerging pathogens of the Candida species themselves are typically not more virulent than
4. Other Candida species
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