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Invasive candidiasis
Peter G Pappas1, Michail S Lionakis2, Maiken Cavling Arendrup3,4,5
1Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
Abstract:
Invasive candidiasis is an important health-care-associated fungal infection that can be caused by several Candida spp.; the most common species is Candida albicans, but the prevalence of these organisms varies considerably depending on geographical location. The spectrum of disease of invasive candidiasis ranges from minimally symptomatic candidaemia to fulminant sepsis with an associated mortality exceeding 70%. Candida spp. are common commensal organisms in the skin and gut microbiota, and disruptions in the cutaneous and gastrointestinal barriers (for example, owing to gastrointestinal perforation) promote invasive disease. A deeper understanding of specific Candida spp. virulence factors, host immune response and host susceptibility at the genetic level has led to key insights into the development of early intervention strategies and vaccine candidates. The early diagnosis of invasive candidiasis is challenging but key to the effective management, and the development of rapid molecular diagnostics could improve the ability to intervene rapidly and potentially reduce mortality. First-line drugs, including echinocandins and azoles, are effective, but the emergence of antifungal resistance, especially among Candida glabrata, is a matter of concern and underscores the need to administer antifungal medications in a judicious manner, avoiding overuse when possible. A newly described pathogen, Candida auris, is an emerging multidrug-resistant organism that poses a global threat.
Insights
Invasive candidiasis, a serious fungal infection, presents diverse clinical forms and mortality risks. Understanding Candida species, host immunity, and diagnostics is crucial for effective management and combating antifungal resistance.
Area of Science:
- Mycology
- Infectious Diseases
- Public Health
Background:
- Invasive candidiasis is a significant healthcare-associated fungal infection caused by Candida species, with Candida albicans being most common.
- Disease spectrum ranges from mild candidemia to severe sepsis with high mortality.
- Candida species are commensals, but barrier disruptions can lead to invasive disease.
Purpose of the Study:
- To explore virulence factors, host immune responses, and genetic susceptibility in invasive candidiasis.
- To highlight the importance of early diagnosis and rapid molecular diagnostics.
- To address the challenge of antifungal resistance and the emergence of multidrug-resistant Candida auris.
Main Methods:
- Review of current understanding of Candida species, pathogenesis, and host-pathogen interactions.
- Analysis of diagnostic challenges and advancements in molecular diagnostics.
- Assessment of antifungal treatment strategies and the growing issue of resistance.
Main Results:
- Insights into Candida virulence factors and host genetic susceptibility are advancing intervention and vaccine development.
- Rapid molecular diagnostics show potential for improving early detection and intervention.
- Antifungal resistance, particularly in Candida glabrata, and the emergence of multidrug-resistant Candida auris are significant concerns.
Conclusions:
- Effective management of invasive candidiasis requires a comprehensive understanding of the pathogen, host, and diagnostic capabilities.
- Judicious use of antifungals is essential to mitigate resistance.
- Emerging threats like Candida auris necessitate global vigilance and adaptive strategies.
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