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Candida krusei: biology, epidemiology, pathogenicity and clinical manifestations of an emerging pathogen
Y H Samaranayake1, L P Samaranayake
1Department of Pathology (Oral), Faculty of Medicine, University of Hong Kong.
Abstract:
Early reports of Candida krusei in man describe the organism as a transient, infrequent isolate of minor clinical significance inhabiting the mucosal surfaces. More recently it has emerged as a notable pathogen with a spectrum of clinical manifestations such as fungaemia, endophthalmitis, arthritis and endocarditis, most of which usually occur in compromised patient groups in a nosocomial setting. The advent of human immunodeficiency virus infection and the widespread use of the newer triazole fluconazole to suppress fungal infections in these patients have contributed to a significant increase in C. krusei infection, particularly because of the high incidence of resistance of the yeast to this drug. Experimental studies have generally shown C. krusei to be less virulent than C. albicans in terms of its adherence to both epithelial and prosthetic surfaces, proteolytic potential and production of phospholipases. Furthermore, it would seem that C. krusei is significantly different from other medically important Candida spp. in its structural and metabolic features, and exhibits different behaviour patterns towards host defences, adding credence to the belief that it should be re-assigned taxonomically. An increased awareness of the pathogenic potential of this yeast coupled with the newer molecular biological approaches to its study may facilitate the continued exploration of the epidemiology and pathogenesis of C. krusei infections.
Insights
Candida krusei is an emerging pathogen causing serious infections, especially in immunocompromised individuals. Its increasing resistance to fluconazole and unique characteristics warrant further investigation into its epidemiology and pathogenesis.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Candida krusei was initially considered a minor pathogen with limited clinical significance.
- It has recently emerged as a significant opportunistic pathogen causing severe infections like fungemia, endophthalmitis, arthritis, and endocarditis.
- The rise in Candida krusei infections is linked to human immunodeficiency virus (HIV) and the extensive use of fluconazole, to which C. krusei exhibits high resistance.
Purpose of the Study:
- To review the evolving clinical significance of Candida krusei.
- To highlight the challenges posed by fluconazole resistance in C. krusei infections.
- To discuss the distinct biological characteristics of C. krusei compared to other Candida species and its implications for taxonomy and host interactions.
Main Methods:
- Review of early and recent clinical reports on Candida krusei.
- Analysis of experimental studies comparing virulence factors of C. krusei and Candida albicans.
- Discussion of the impact of HIV infection and antifungal drug usage on C. krusei prevalence.
- Consideration of molecular biological approaches for studying C. krusei.
Main Results:
- Candida krusei is now recognized as a notable pathogen, particularly in nosocomial settings among compromised patients.
- Experimental studies suggest C. krusei possesses lower virulence than Candida albicans regarding adherence, proteolysis, and phospholipase production.
- C. krusei displays unique structural, metabolic, and host-defense interaction patterns, suggesting a need for taxonomic re-evaluation.
Conclusions:
- Candida krusei represents a growing threat due to its increasing prevalence and antifungal resistance.
- Its distinct biological profile necessitates further research into its epidemiology and pathogenesis.
- Understanding these aspects may lead to revised taxonomic classification and improved clinical management strategies.