Abstract
Candida albicans remains the most common cause of hospital-acquired fungal infections due to its virulence determinants. Resistance to antifungal therapy has increased dramatically, narrowing the few available therapeutic options due to their potential toxicity. However, the association between C. albicans virulence determinants and resistance profiles needs further investigation. C. albicans (n= 25) isolated from various clinical samples were identified. Antibiogram analysis of the tested isolates against different antifungal agents was performed and their minimum inhibitory concentrations (MICs) were verified. Virulence determinants including extracellular hydrolytic enzymes, biofilm formation, and cell surface hydrophobicity (CSH) were investigated. Correlations between virulence determinants and resistance profiles of the experimented isolates, in addition to their potential association with the source of clinical specimens, were analyzed. All isolates were amphotericin B, nystatin and micafungin sensitive, while 100% were clotrimazole, fluconazole and voriconazole resistant. Extracellular hydrolytic activities were detected in 52, 68 and 100% of the tested isolates for phospholipase, protease, and hemolysin, respectively, while CSH and biofilm production was shown in 24 and 20% of isolates, respectively. CSH had significant (p < 0.05) influence on some resistance and virulence patterns.
Highlights
Candida albicans is part of the normal human microbiome and considered to be a harmless commensal [1]
Typical C. albicans germ tubes were seen under a light microscope after human serum inoculation and incubation for 2-4 h at 37 °C for all the tested isolates (n= 25)
When evaluating the potential relationship between the source of clinical specimens and virulence determinants of the isolates, the results revealed that C. albicans isolates recovered from urine samples had a statistically significant
Summary
Candida albicans is part of the normal human microbiome and considered to be a harmless commensal [1]. In Candida species, extracellular hydrolases are essential for nutrient acquisition, adherence, colonization, host tissue penetration, invasion, dissemination and evasion from host immune responses [4]. Antifungal agents available for candidiasis management include polyenes, azoles, fluoropyrimidines, and the recently developed echinocandins, with the latter being used as an alternative for infections resistant to the previously mentioned antifungal agents [6]. Antifungal drug resistance has emerged as a consequence of the extensive antifungal prescription and the insufficient resources concomitant with the escalating mycotic infections, which occurs through different mechanisms such as upregulation of drug efflux pumps leading to a reduced intracellular antifungal concentration, qualitative or quantitative changes in the drug targets as well as metabolic alterations [7]
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