Fatemeh Nikoomanesh^1,2, Maryam Roudbary³ and Farhad Saeif^4
1Department of Medical Microbiology, School of Medicine, Birjand University of Medical Sciences,
Birjand, Iran
²Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
³Deapartment of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
⁴Department of Immunology and Allergy, Academic Center for Education, Culture, and Research (ACECR), Tehran, Iran

Part of the book: The Book of Fungal Pathogens

Abstract

Candidiasis is an opportunistic fungal infection resulting from an imbalance between the host immune system and crucial virulence factors of Candida species. The Candida spp., are one of the major constituents of the human mycobiome as well as the main cause of invasive fungal infections, particularly in immunocompromised patients. They affect the cases who consume a wide-spectrum antibiotic/steroid and those who have prolonged ICU stays and central venous catheters, transplant patients, chemotherapy/ radiotherapy, patients under invasive or noninvasive ventilation, and diabetic individuals with high-rate mortality. In recent decades, Candida species are considered the fourth cause of bloodstream infections; however, the epidemiology of candidemia has been linked to different geographical areas. On the other hand, the emergence of multidrug-resistant Candida spp. named Candia auris, as a global challenge in different countries over recent years in the world, leads to lethal as well as invasive infections with a high rate of spread among patients. At the beginning of the novel coronavirus disease 2019 (COVID-19) pandemic with causative agent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), invasive yeast infections (IYFs), especially Candidiasis, are dramatically increasing in those individuals as the major groups under immunosuppressed condition. Although echinocandins and azoles are the most common antifungals used for the treatment of IYFs, the increased therapeutic failures exerted by multidrug-resistant Candida spp. such as C. auris and C. glabrata, calling for the discovery of novel antifungal agents with therapeutic approaches seems necessary. Here, we attempt to focus on the acquisition of knowledge associated with pathogenicity of Candida spp., particularly the indispensable role of virulence factors (germination, adherence, biofilm formation, phospholipase and proteinase production), genes that contribute to drug resistance and the related mechanisms, new therapeutic strategies for the treatment of Candidiasis includes combination therapies, application of biomaterials for drug delivery, antibodies, and vaccination, photodynamic therapy, probiotics, and new antifungal products to overcome Candida infections.

Keywords: Candida spp., virulence factors, multidrug-resistance, new therapeutic strategies

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