Intra-clade Heterogeneity in Candida auris: Risk of Management.

Abstract

Candida aurishas emerged as a significant nosocomial fungal pathogen with a high risk of pathogenicity. Since the initial detection ofC. aurisin 2009, it gained lots of attention with a recent alert by theCenters for Disease Control and Prevention(CDC) due to its high infectivity and drug resistance. Several studies showed the capability ofC. auristo secrete lytic enzymes, germinate, and form a biofilm that eventually results in interactions with the host cells, leading to serious infections. Other studies demonstrated a decrease in susceptibility ofC. aurisstrains to available antifungals, which may be caused by mutations within the target genes, or the drug efflux pumps. However, the contribution ofC. aurisheterogeneity in pathogenicity and drug resistance is not well studied. Here, we shed light on the factors contributing to the development of heterogeneity inC. auris.These include phenotypic changes, biofilm formation, mechanisms of drug resistance, host invasion, mode of transmission, and expression of virulence factors.C. aurisexhibits different phenotypes, particularly aggregative, and non-aggregative forms that play an important role in fungal heterogeneity, which significantly affects drug resistance and pathogenicity. Collectively, heterogeneity in C. auris significantly contributes to ineffective treatment, which in turn affects the fungal pathogenicity and drug resistance. Therefore, understanding the underlying reasons forC. aurisheterogeneity and applying effective antifungal stewardship could play a major role in controlling this pathogen.