Chapter 4. Candida Auris, an Emerging Pathogen: Virulence, Current Diagnostic Approaches, and Therapeutic Options

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Thayná Ellen de Sousa Alves Ferreira1, Andréa Cristina Barbosa da Silva2, Janaína de Cássia Orlandi Sardi1, Tahyna Duda Deps3, Paula Ribeiro Garcia3Sindy Magri Roque4, Priscila Guimarães Silva Vasconcelos5, Edja Maria Melo de Brito Costa5 and Diego Romario-Silva1,3,*
1Graduate Program in Integrated Dental Sciences, School of Dentistry of the University of Cuiabá, Cuiabá, Brazil
2Department of Pharmacy, State University of Paraiba (UEPB), Campina Grande, PB, Brazil
3Faipe College, Cuiabá, Mato Grosso, Brazil
4School of Pharmaceutical Sciences, State University of Campinas, Campinas, SP, Brazil
5Department of Dentistry, State University of Paraíba, Campina Grande, Paraíba, Brazil

Part of the book: The Book of Fungal Pathogens

Abstract

Fungal infections have been progressively considered a global threat to human health, added to the limited number of drug classes currently available to treat them. In recent years, atypical pathogens such as Candida auris are being increasingly recovered from human infections. This species is part of the Candida/Clavispora clade and has been claimed to be a “superbug” for its high virulence and resistance to standard antifungals. C. auris was first isolated in 2009, in Japan, from an external ear canal discharge of a female patient and is now a frequent cause of nosocomial outbreaks. The main challenges to control invasive C. auris infections are: difficulties in strain identification, multidrug resistance, virulence factors, and high mortality rates. C. auris strains have a long-term survival on environmental surfaces and are much more resistant than other Candida species. While C. auris has virulence factors as well as Candida albicans (e.g., adhesion, biofilm formation, and production of phospholipases and proteinases), they further developed multidrug resistance to antifungals and a peculiar growth pattern, that is, instead of releasing new cells after budding, they form cell aggregates with high physical resistance. This explains the great adaptability of C. auris cells to host tissues and the environment, including hospital devices such as catheters. Recent research identified several biofilm-related proteins that may be potential therapeutic targets, including enzymes, transcription factors, ribosomal proteins, and transporters. In addition, transporters of the major facilitator superfamily (MFS) and ATP binding cassettes (ABC), which act as efflux pumps, were also reported. These targets are likely related to the intrinsic resistance of C. auris cells to antifungal drugs. To date, an easy method for strain detection, appropriate drug of choice, and therapeutic protocols for treating C. auris infections remain unclear. Thus, in this chapter, we discuss the epidemiology of C. auris, strain detection methods, virulence factors, potential therapeutic targets for the development of new antifungals, as well as the therapeutic options currently available.

Keywords: Candida auris, invasive infection, fungemia


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