Abstract
Representatives of the Candida parapsilosis complex are important yeast species causing human infections, including candidaemia as one of the leading diseases. This complex comprises C. parapsilosis, Candida orthopsilosis and Candida metapsilosis, and causes a wide range of clinical presentations from colonization to superficial and disseminated infections with a high prevalence in preterm-born infants and the potential to cause outbreaks in hospital settings. Compared with other Candida species, the C. parapsilosis complex shows high minimal inhibitory concentrations for echinocandin drugs due to a naturally occurring FKS1 polymorphism. The emergence of clonal outbreaks of strains with resistance to commonly used antifungals, such as fluconazole, is causing concern. In this Review, we present the latest medical data covering epidemiology, diagnosis, resistance and current treatment approaches for the C. parapsilosis complex. We describe its main clinical manifestations in adults and children and highlight new treatment options. We compare the three sister species, examining key elements of microbiology and clinical characteristics, including the population at risk, disease manifestation and colonization status. Finally, we provide a comprehensive resource for clinicians and researchers focusing on Candida species infections and the C. parapsilosis complex, aiming to bridge the emerging translational knowledge and future therapeutic challenges associated with this human pathogen.
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Glossary
- Antifungal susceptibility testing
-
An in vitro phenotypic method that measures the ability of a particular antifungal drug to inhibit the growth of a fungus over a range of concentrations, with the resulting minimum inhibitory concentration corresponding to the lowest concentration that inhibits fungal growth.
- Antimicrobial resistance
-
Fungal growth above established susceptibility thresholds, as determined by the minimal inhibitory concentration for a given drug.
- Clinical breakpoints
-
Values that categorize fungi as ‘susceptible’, ‘susceptible, increased exposure’ and ‘resistant’ based on minimum inhibitory concentrations, resistance markers, and pharmacokinetic and pharmacodynamic values from animal and human subjects, patient treatment and outcome data derived from controlled clinical trials.
- Clonal outbreaks
-
The occurrence of cases of diseases that are in excess of what would normally be expected and that are caused by genetically identical microbial pathogens.
- Epidemiological cut-off values
-
The highest minimum inhibitory concentrations for isolates devoid of phenotypically detectable resistance mechanisms.
- Heterozygous
-
An organism that has different copies of an allele for a particular marker.
- Homozygous
-
An organism that has the same two copies of an allele for a genomic marker.
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Cite this article
Govrins, M., Lass-Flörl, C. Candida parapsilosis complex in the clinical setting.
Nat Rev Microbiol (2023). https://doi.org/10.1038/s41579-023-00961-8
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Accepted: 03 August 2023
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Published: 06 September 2023
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DOI: https://doi.org/10.1038/s41579-023-00961-8