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Porter L, Sultan O, Mitchell BG, Jenney A, Kiernan M, Brewster DJ, Russo PL. How long do nosocomial pathogens persist on inanimate surfaces? A scoping review. J Hosp Infect 2024; 147:25-31. [PMID: 38447803 DOI: 10.1016/j.jhin.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Healthcare hygiene plays a crucial role in the prevention of healthcare-associated infections. Patients admitted to a room where the previous occupant had a multi-drug-resistant bacterial infection are at an increased risk of colonization and infection with the same organism. A 2006 systematic review by Kramer et al. found that certain pathogens can survive for months on dry surfaces. The aim of this review is to update Kramer et al.'s previous review and provide contemporary data on the survival of pathogens relevant to the healthcare environment. We systematically searched Ovid MEDLINE, CINAHL and Scopus databases for studies that described the survival time of common nosocomial pathogens in the environment. Pathogens included in the review were bacterial, viral, and fungal. Studies were independently screened against predetermined inclusion/exclusion criteria by two researchers. Conflicts were resolved by one of two senior researchers. A spreadsheet was developed for the data extraction. The search identified 1736 studies. Following removal of duplicates and application of the search criteria, the synthesis of results from 62 included studies were included. 117 organisms were reported. The longest surviving organism reported was Klebsiella pneumoniae which was found to have persisted for 600 days. Common pathogens of concern to infection prevention and control, can survive or persist on inanimate surfaces for months. This data supports the need for a risk-based approach to cleaning and disinfection practices, accompanied by appropriate training, audit and feedback which are proven to be effective when adopted in a 'bundle' approach.
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Affiliation(s)
- L Porter
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - O Sultan
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - B G Mitchell
- School of Nursing, Avondale University, Wahroonga, Australia; School of Nursing and Midwifery, Monash University, Clayton, Australia; School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - A Jenney
- Microbiology Unit, Alfred Health, Prahran, Australia
| | - M Kiernan
- Richard Wells Research Centre, University of West London, London, UK
| | - D J Brewster
- Central Clinical School, Monash University, Clayton, Australia; Intensive Care Unit, Cabrini Health, Malvern, Australia
| | - P L Russo
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia; School of Nursing, Avondale University, Wahroonga, Australia.
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2
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Wang TW, Sofras D, Montelongo-Jauregui D, Paiva TO, Carolus H, Dufrêne YF, Alfaifi AA, McCracken C, Bruno VM, Van Dijck P, Jabra-Rizk MA. Functional Redundancy in Candida auris Cell Surface Adhesins Crucial for Cell-Cell Interaction and Aggregation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.21.586120. [PMID: 38562758 PMCID: PMC10983922 DOI: 10.1101/2024.03.21.586120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Candida auris is an emerging nosocomial fungal pathogen associated with life-threatening invasive disease due to its persistent colonization, high level of transmissibility and multi-drug resistance. Aggregative and non-aggregative growth phenotypes for C. auris strains with different biofilm forming abilities, drug susceptibilities and virulence characteristics have been described. Using comprehensive transcriptional analysis we identified key cell surface adhesins that were highly upregulated in the aggregative phenotype during in vitro and in vivo grown biofilms using a mouse model of catheter infection. Phenotypic and functional evaluations of generated null mutants demonstrated crucial roles for the adhesins Als5 and Scf1 in mediating cell-cell adherence, coaggregation and biofilm formation. While individual mutants were largely non-aggregative, in combination cells were able to co-adhere and aggregate, as directly demonstrated by measuring cell adhesion forces using single-cell atomic force spectroscopy. This co-adherence indicates their role as complementary adhesins, which despite their limited similarity, may function redundantly to promote cell-cell interaction and biofilm formation. Functional diversity of cell wall proteins may be a form of regulation that provides the aggregative phenotype of C. auris with flexibility and rapid adaptation to the environment, potentially impacting persistence and virulence.
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Affiliation(s)
- Tristan W. Wang
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
| | - Dimitrios Sofras
- Laboratory of Molecular Cell Biology, Department of Biology, KU Leuven, Leuven, Belgium
| | - Daniel Montelongo-Jauregui
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
| | - Telmo O. Paiva
- Louvain Institute of Biomolecular Science and Technology, UCLouvain, Croix du Sud, 4-5, L7.07.07, B-1348 Louvain-la-Neuve, Belgium
| | - Hans Carolus
- Laboratory of Molecular Cell Biology, Department of Biology, KU Leuven, Leuven, Belgium
| | - Yves F. Dufrêne
- Louvain Institute of Biomolecular Science and Technology, UCLouvain, Croix du Sud, 4-5, L7.07.07, B-1348 Louvain-la-Neuve, Belgium
| | - Areej A. Alfaifi
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
| | - Carrie McCracken
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Vincent M. Bruno
- Department of Microbiology and Immunology, School of Medicine University of Maryland, Baltimore, MD 21201, USA
| | - Patrick Van Dijck
- Laboratory of Molecular Cell Biology, Department of Biology, KU Leuven, Leuven, Belgium
| | - Mary Ann Jabra-Rizk
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201, USA
- Department of Microbiology and Immunology, School of Medicine University of Maryland, Baltimore, MD 21201, USA
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3
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Santana DJ, Zhao G, O’Meara TR. The many faces of Candida auris: Phenotypic and strain variation in an emerging pathogen. PLoS Pathog 2024; 20:e1012011. [PMID: 38427609 PMCID: PMC10906884 DOI: 10.1371/journal.ppat.1012011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
Candida auris is an emerging fungal pathogen with unusual evolutionary history-there are multiple distinct phylogeographic clades showing a near simultaneous transition from a currently unknown reservoir to nosocomial pathogen. Each of these clades has experienced different selective pressures over time, likely resulting in selection for genotypes with differential fitness or phenotypic consequences when introduced to new environments. We also observe diversification within clades, providing additional opportunities for phenotypic differences. These differences can have large impacts on pathogenic potential, drug resistance profile, evolutionary trajectory, and transmissibility. In recent years, there have been significant advances in our understanding of strain-specific behavior in other microbes, including bacterial and fungal pathogens, and we have an opportunity to take this strain variation into account when describing aspects of C. auris biology. Here, we critically review the literature to gain insight into differences at both the strain and clade levels in C. auris, focusing on phenotypes associated with clinical disease or transmission. Our goal is to integrate clinical and epidemiological perspectives with molecular perspectives in a way that would be valuable for both audiences. Identifying differences between strains and understanding which phenotypes are strain specific will be crucial for understanding this emerging pathogen, and an important caveat when describing the analysis of a singular isolate.
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Affiliation(s)
- Darian J. Santana
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Guolei Zhao
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Teresa R. O’Meara
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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4
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Pelletier C, Shaw S, Alsayegh S, Brown AJP, Lorenz A. Candida auris undergoes adhesin-dependent and -independent cellular aggregation. PLoS Pathog 2024; 20:e1012076. [PMID: 38466738 PMCID: PMC10957086 DOI: 10.1371/journal.ppat.1012076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 03/21/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
Candida auris is a fungal pathogen of humans responsible for nosocomial infections with high mortality rates. High levels of resistance to antifungal drugs and environmental persistence mean these infections are difficult to treat and eradicate from a healthcare setting. Understanding the life cycle and the genetics of this fungus underpinning clinically relevant traits, such as antifungal resistance and virulence, is of the utmost importance to develop novel treatments and therapies. Epidemiological and genomic studies have identified five geographical clades (I-V), which display phenotypic and genomic differences. Aggregation of cells, a phenotype primarily of clade III strains, has been linked to reduced virulence in some infection models. The aggregation phenotype has thus been associated with conferring an advantage for (skin) colonisation rather than for systemic infection. However, strains with different clade affiliations were compared to infer the effects of different morphologies on virulence. This makes it difficult to distinguish morphology-dependent causes from clade-specific or even strain-specific genetic factors. Here, we identify two different types of aggregation: one induced by antifungal treatment which is a result of a cell separation defect; and a second which is controlled by growth conditions and only occurs in strains with the ability to aggregate. The latter aggregation type depends on an ALS-family adhesin which is differentially expressed during aggregation in an aggregative C. auris strain. Finally, we demonstrate that macrophages cannot clear aggregates, suggesting that aggregation might after all provide a benefit during systemic infection and could facilitate long-term persistence in the host.
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Affiliation(s)
- Chloe Pelletier
- Institute of Medical Sciences (IMS), University of Aberdeen, Aberdeen, United Kingdom
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Sophie Shaw
- Centre for Genome-Enabled Biology and Medicine (CGEBM), University of Aberdeen, Aberdeen, United Kingdom
| | - Sakinah Alsayegh
- Institute of Medical Sciences (IMS), University of Aberdeen, Aberdeen, United Kingdom
| | | | - Alexander Lorenz
- Institute of Medical Sciences (IMS), University of Aberdeen, Aberdeen, United Kingdom
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Omardien S, Teska P. Skin and hard surface disinfection against Candida auris - What we know today. Front Med (Lausanne) 2024; 11:1312929. [PMID: 38384416 PMCID: PMC10879571 DOI: 10.3389/fmed.2024.1312929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
Candida auris has emerged as a global healthcare threat, displaying resistance to important healthcare antifungal therapies. Infection prevention and control protocols have become paramount in reducing transmission of C. auris in healthcare, of which cleaning and disinfection plays an important role. Candida albicans is used as a surrogate yeast for yeasticidal claims of disinfection products, but reports have been made that sensitivity to disinfectants by C. auris differs from its surrogate. In this review, we aimed to compile the information reported for products used for skin and hard surface disinfection against C. auris in its planktonic or biofilm form. A comparison was made with other Candida species, and information were gathered from laboratory studies and observations made in healthcare settings.
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Affiliation(s)
| | - Peter Teska
- Diversey Holdings Ltd., Fort Mill, SC, United States
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Malavia-Jones D, Farrer RA, Stappers MH, Edmondson MB, Borman AM, Johnson EM, Lipke PN, Gow NA. Strain and temperature dependent aggregation of Candida auris is attenuated by inhibition of surface amyloid proteins. Cell Surf 2023; 10:100110. [PMID: 37559873 PMCID: PMC10407437 DOI: 10.1016/j.tcsw.2023.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
Candida auris is a multi-drug resistant human fungal pathogen that has become a global threat to human health due to its drug resistant phenotype, persistence in the hospital environment and propensity for patient to patient spread. Isolates display variable aggregation that may affect the relative virulence of strains. Therefore, dissection of this phenotype has gained substantial interest in recent years. We studied eight clinical isolates from four different clades (I-IV); four of which had a strongly aggregating phenotype and four of which did not. Genome analysis identified polymorphisms associated with loss of cell surface proteins were enriched in weakly-aggregating strains. Additionally, we identified down-regulation of chitin synthase genes involved in the synthesis of the chitinous septum. Characterisation of the cells revealed no ultrastructural defects in cytokinesis or cell separation in aggregating isolates. Strongly and weakly aggregating strains did not differ in net surface charge or in cell surface hydrophobicity. The capacity for aggregation and for adhesion to polystyrene microspheres were also not correlated. However, aggregation and extracellular matrix formation were all increased at higher growth temperatures, and treatment with the amyloid protein inhibitor Thioflavin-T markedly attenuated aggregation. Genome analysis further indicated strain specific differences in the genome content of GPI-anchored proteins including those encoding genes with the potential to form amyloid proteins. Collectively our data suggests that aggregation is a complex strain and temperature dependent phenomenon that may be linked in part to the ability to form extracellular matrix and cell surface amyloids.
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Affiliation(s)
- Dhara Malavia-Jones
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - Rhys A. Farrer
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - Mark H.T. Stappers
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - Matt B. Edmondson
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - Andrew M. Borman
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
- UKHSA Mycology Reference Laboratory, National Infection Services, UKHSA South West Laboratory, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK
| | - Elizabeth M. Johnson
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
- UKHSA Mycology Reference Laboratory, National Infection Services, UKHSA South West Laboratory, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK
| | - Peter N. Lipke
- Biology Department, Brooklyn College of City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Neil A.R. Gow
- MRC Centre for Medical Mycology, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
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Rapti V, Iliopoulou K, Poulakou G. The Gordian Knot of C. auris: If You Cannot Cut It, Prevent It. Pathogens 2023; 12:1444. [PMID: 38133327 PMCID: PMC10747958 DOI: 10.3390/pathogens12121444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
Since its first description in 2009, Candida auris has, so far, resulted in large hospital outbreaks worldwide and is considered an emerging global public health threat. Exceptionally for yeast, it is gifted with a profoundly worrying invasive potential and high inter-patient transmissibility. At the same time, it is capable of colonizing and persisting in both patients and hospital settings for prolonged periods of time, thus creating a vicious cycle of acquisition, spreading, and infection. It exhibits various virulence qualities and thermotolerance, osmotolerance, filamentation, biofilm formation and hydrolytic enzyme production, which are mainly implicated in its pathogenesis. Owing to its unfavorable profile of resistance to diverse antifungal agents and the lack of effective treatment options, the implementation of robust infection prevention and control (IPC) practices is crucial for controlling and minimizing intra-hospital transmission of C. auris. Rapid and accurate microbiological identification, adherence to hand hygiene, use of adequate personal protective equipment (PPE), proper handling of catheters and implantable devices, contact isolation, periodical environmental decontamination, targeted screening, implementation of antimicrobial stewardship (AMS) programs and communication between healthcare facilities about residents' C. auris colonization status are recognized as coherent strategies for preventing its spread. Current knowledge on C. auris epidemiology, clinical characteristics, and its mechanisms of pathogenicity are summarized in the present review and a comprehensive overview of IPC practices ensuring yeast prevention is also provided.
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Affiliation(s)
- Vasiliki Rapti
- Third Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria General Hospital, 115 27 Athens, Greece;
| | | | - Garyfallia Poulakou
- Third Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria General Hospital, 115 27 Athens, Greece;
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8
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Hong H, Ximing Y, Jinghan M, Al-danakh A, Shujuan P, Ying L, Yuting Y, Yuehong L, Xingwei Y. Candida auris infection; diagnosis, and resistance mechanism using high-throughput sequencing technology: a case report and literature review. Front Cell Infect Microbiol 2023; 13:1211626. [PMID: 38145050 PMCID: PMC10739385 DOI: 10.3389/fcimb.2023.1211626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/30/2023] [Indexed: 12/26/2023] Open
Abstract
Background Candida auris (C. auris), a recently developing fungal disease with high virulence, easy transmission, and substantial medication resistance in hospitals, poses a growing danger to human health. In 2009, the initial documentation of this disease was made when it was discovered in the ear canal of an elderly Japanese patient. Since its initial isolation, the presence of C. auris across six continents has been a cause for severe concern among medical professionals and scientists. According to recent findings, C. auris is connected with five geographically different lineages and significant rates of antifungal resistance. Furthermore, C. auris infections in healthcare settings lack appropriate treatment options and standardized strategies for prevention and control. This results in many treatment failures and hinders the elimination of C. auris in healthcare institutions. To examine the drug resistance mechanism of C. auris and to aid in clinical therapy, we provide a case of C. auris infection along with a short review of the relevant literature. Clinical presentation An 81-year-old female with cerebral hemorrhage was admitted to the hospital and diagnosed with a urinary catheter-related C. auris. The sample was evaluated and reported in terms of culture, identification, drug sensitivity, and gene sequencing. We also evaluated the relationship between the morphology of the isolated strains and their drug resistance. Whole-genome sequencing yielded the genes ERG11-Y132F, CDR1-E709D, TAC1B-Q503E, and TAC1B-A583S; however, no additional loci included alterations of concern, according to our results. ERG11-Y132F and TAC1B-A583S are drug-resistant gene loci, whereas CDR1-E709D and TAC1B-Q503E are unidentified variants. Conclusion We discover a C. auris case of specific a strain in an old female that has some drug-resistant genes, and some genes may be different from already reported gene sites. Gene locus, mutation, and drug resistance mechanism studies may contribute to the creation of innovative drugs and therapeutic treatments. Clinicians and microbiologists must be aware of this globally spreading yeast, which poses substantial hospital diagnostic, treatment, and infection control challenges. Future multicenter research must be performed to uncover this health threat and provide new, effective treatments.
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Affiliation(s)
- He Hong
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yang Ximing
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Ma Jinghan
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Abdullah Al-danakh
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Pan Shujuan
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Lin Ying
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yang Yuting
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Liu Yuehong
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yao Xingwei
- Department of Clinical Laboratory, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
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Santana DJ, Anku JAE, Zhao G, Zarnowski R, Johnson CJ, Hautau H, Visser ND, Ibrahim AS, Andes D, Nett JE, Singh S, O'Meara TR. A Candida auris-specific adhesin, Scf1 , governs surface association, colonization, and virulence. Science 2023; 381:1461-1467. [PMID: 37769084 DOI: 10.1126/science.adf8972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
Candida auris is an emerging fungal pathogen responsible for health care-associated outbreaks that arise from persistent surface and skin colonization. We characterized the arsenal of adhesins used by C. auris and discovered an uncharacterized adhesin, Surface Colonization Factor (Scf1), and a conserved adhesin, Iff4109, that are essential for the colonization of inert surfaces and mammalian hosts. SCF1 is apparently specific to C. auris, and its expression mediates adhesion to inert and biological surfaces across isolates from all five clades. Unlike canonical fungal adhesins, which function through hydrophobic interactions, Scf1 relies on exposed cationic residues for surface association. SCF1 is required for C. auris biofilm formation, skin colonization, virulence in systemic infection, and colonization of inserted medical devices.
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Affiliation(s)
- Darian J Santana
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Juliet A E Anku
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Guolei Zhao
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Robert Zarnowski
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, WI, USA
| | - Chad J Johnson
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, WI, USA
| | - Haley Hautau
- Division of Infectious Disease, The Lundquist Institute for Biomedical Innovation at Harbor-University of California, Los Angeles Medical Center, Torrance, CA, USA
| | - Noelle D Visser
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Ashraf S Ibrahim
- Division of Infectious Disease, The Lundquist Institute for Biomedical Innovation at Harbor-University of California, Los Angeles Medical Center, Torrance, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - David Andes
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, WI, USA
| | - Jeniel E Nett
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, WI, USA
| | - Shakti Singh
- Division of Infectious Disease, The Lundquist Institute for Biomedical Innovation at Harbor-University of California, Los Angeles Medical Center, Torrance, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Teresa R O'Meara
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
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10
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Caliman Sato M, Izu Nakamura Pietro EC, Marques da Costa Alves L, Kramer A, da Silva Santos PS. Candida auris: a novel emerging nosocomial pathogen - properties, epidemiological situation and infection control. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc18. [PMID: 37693850 PMCID: PMC10486814 DOI: 10.3205/dgkh000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Immunosuppression and critical illnesses in combination with ecological imbalance open the door for novel opportunistic fungal infections, as in case of Candida (C). auris. C. auris has emerged globally as a multidrug-resistant yeast, causing infections and outbreaks in health care facilities. This narrative review discusses the properties of the yeast, the development of the epidemiological situation, the nosocomial spread and causes for nosocomial outbreaks triggered by C. auris in the hospital environment, and summarizes international recommendations for infection control, supplemented by suggestions on diagnostic, screening and antibiotic stewardship.
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Affiliation(s)
- Marcelo Caliman Sato
- Center for Lasers and Applications, Instituto de Pesquisas Energéticas e Nucleares (IPEN-CNEN), São Paulo, Brazil
| | | | | | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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11
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Ramos LS, Parra-Giraldo CM, Branquinha MH, Santos ALS. Cell Aggregation Capability of Clinical Isolates from Candida auris and Candida haemulonii Species Complex. Trop Med Infect Dis 2023; 8:382. [PMID: 37624320 PMCID: PMC10460019 DOI: 10.3390/tropicalmed8080382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
The opportunistic fungal pathogens belonging to the Candida haemulonii complex and the phylogenetically related species Candida auris are well-known for causing infections that are difficult to treat due to their multidrug-resistance profiles. Candida auris is even more worrisome due to its ability to cause outbreaks in healthcare settings. These emerging yeasts produce a wide range of virulence factors that facilitate the development of the infectious process. In recent years, the aggregative phenotype has been receiving attention, as it is mainly associated with defects in cellular division and its possible involvement in helping the fungus to escape from the host immune responses. In the present study, we initially investigated the aggregation ability of 18 clinical isolates belonging to the C. haemulonii species complex (C. haemulonii sensu stricto, C. duobushaemulonii, and C. haemulonii var. vulnera) and C. auris. Subsequently, we evaluated the effects of physicochemical factors on fungal aggregation competence. The results demonstrated that cell-to-cell aggregation was a typically time-dependent event, in which almost all studied fungal isolates of both the C. haemulonii species complex and C. auris exhibited high aggregation after 2 h of incubation at 37 °C. Interestingly, the fungal cells forming the aggregates remained viable. The aggregation of all isolates was not impacted by pH, temperature, β-mercaptoethanol (a protein-denaturing agent), or EDTA (a chelator agent). Conversely, proteinase K, trypsin, and sodium dodecyl sulfate (SDS) significantly diminished the fungal aggregation. Collectively, our results demonstrated that the aggregation ability of these opportunistic yeast pathogens is time-dependent, and surface proteins and hydrophobic interactions seem to mediate cell aggregation since the presence of proteases and anionic detergents affected the aggregation capability. However, further studies are necessary to better elucidate the molecular aspects of this intriguing phenomenon.
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Affiliation(s)
- Lívia S. Ramos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, Brazil; (L.S.R.); (M.H.B.)
| | - Claudia M. Parra-Giraldo
- Unidad de Proteómica y Micosis Humanas, Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
| | - Marta H. Branquinha
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, Brazil; (L.S.R.); (M.H.B.)
- Rede Micologia RJ—Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro 21941-902, Brazil
| | - André L. S. Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, Brazil; (L.S.R.); (M.H.B.)
- Unidad de Proteómica y Micosis Humanas, Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
- Programa de Pós-Graduação em Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-909, Brazil
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12
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Brandt P, Mirhakkak MH, Wagner L, Driesch D, Möslinger A, Fänder P, Schäuble S, Panagiotou G, Vylkova S. High-Throughput Profiling of Candida auris Isolates Reveals Clade-Specific Metabolic Differences. Microbiol Spectr 2023; 11:e0049823. [PMID: 37097196 PMCID: PMC10269459 DOI: 10.1128/spectrum.00498-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023] Open
Abstract
Candida auris, a multidrug-resistant human fungal pathogen that causes outbreaks of invasive infections, emerged as four distinct geographical clades. Previous studies identified genomic and proteomic differences in nutrient utilization on comparison to Candida albicans, suggesting that certain metabolic features may contribute to C. auris emergence. Since no high-throughput clade-specific metabolic characterization has been described yet, we performed a phenotypic screening of C. auris strains from all 4 clades on 664 nutrients, 120 chemicals, and 24 stressors. We identified common and clade- or strain-specific responses, including the preferred utilization of various dipeptides as nitrogen source and the inability of the clade II isolate AR 0381 to withstand chemical stress. Further analysis of the metabolic properties of C. auris isolates showed robust growth on intermediates of the tricarboxylic acid cycle, such as citrate and succinic and malic acids. However, there was reduced or no growth on pyruvate, lactic acid, or acetate, likely due to the lack of the monocarboxylic acid transporter Jen1, which is conserved in most pathogenic Candida species. Comparison of C. auris and C. albicans transcriptomes of cells grown on alternative carbon sources and dipeptides as a nitrogen source revealed common as well as species-unique responses. C. auris induced a significant number of genes with no ortholog in C. albicans, e.g., genes similar to the nicotinic acid transporter TNA1 (alternative carbon sources) and to the oligopeptide transporter (OPT) family (dipeptides). Thus, C. auris possesses unique metabolic features which could have contributed to its emergence as a pathogen. IMPORTANCE Four main clades of the emerging, multidrug-resistant human pathogen Candida auris have been identified, and they differ in their susceptibilities to antifungals and disinfectants. Moreover, clade- and strain-specific metabolic differences have been identified, but a comprehensive overview of nutritional characteristics and resistance to various stressors is missing. Here, we performed high-throughput phenotypic characterization of C. auris on various nutrients, stressors, and chemicals and obtained transcriptomes of cells grown on selected nutrients. The generated data sets identified multiple clade- and strain-specific phenotypes and induction of C. auris-specific metabolic genes, showing unique metabolic properties. The presented work provides a large amount of information for further investigations that could explain the role of metabolism in emergence and pathogenicity of this multidrug-resistant fungus.
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Affiliation(s)
- Philipp Brandt
- Septomics Research Center, Friedrich Schiller University, and Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Mohammad H. Mirhakkak
- Systems Biology and Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Lysett Wagner
- Septomics Research Center, Friedrich Schiller University, and Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | | | - Anna Möslinger
- Septomics Research Center, Friedrich Schiller University, and Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
- Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Pauline Fänder
- Septomics Research Center, Friedrich Schiller University, and Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Sascha Schäuble
- Systems Biology and Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Gianni Panagiotou
- Systems Biology and Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Slavena Vylkova
- Septomics Research Center, Friedrich Schiller University, and Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
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13
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Spoladori LFDA, Andriani GM, Castro IMD, Suzukawa HT, Gimenes ACR, Bartolomeu-Gonçalves G, Ishida K, Nakazato G, Pinge-Filho P, Machado RRB, Nakamura CV, Andrade G, Tavares ER, Yamauchi LM, Yamada-Ogatta SF. Synergistic Antifungal Interaction between Pseudomonas aeruginosa LV Strain Metabolites and Biogenic Silver Nanoparticles against Candida auris. Antibiotics (Basel) 2023; 12:antibiotics12050861. [PMID: 37237764 DOI: 10.3390/antibiotics12050861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Candida auris has been found to be a persistent colonizer of human skin and a successful pathogen capable of causing potentially fatal infection, especially in immunocompromised individuals. This fungal species is usually resistant to most antifungal agents and has the ability to form biofilms on different surfaces, representing a significant therapeutic challenge. Herein, the effect of metabolites of Pseudomonas aeruginosa LV strain, alone and combined with biologically synthesized silver nanoparticles (bioAgNP), was evaluated in planktonic and sessile (biofilm) cells of C. auris. First, the minimal inhibitory and fungicidal concentration values of 3.12 and 6.25 μg/mL, respectively, were determined for F4a, a semi-purified bacterial fraction. Fluopsin C and indolin-3-one seem to be the active components of F4a. Like the semi-purified fraction, they showed a time- and dose-dependent fungicidal activity. F4a and bioAgNP caused severe changes in the morphology and ultrastructure of fungal cells. F4a and indolin-3-one combined with bioAgNP exhibited synergistic fungicidal activity against planktonic cells. F4a, alone or combined with bioAgNP, also caused a significant decrease in the number of viable cells within the biofilms. No cytotoxicity to mammalian cells was detected for bacterial metabolites combined with bioAgNP at synergistic concentrations that presented antifungal activity. These results indicate the potential of F4a combined with bioAgNP as a new strategy for controlling C. auris infections.
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Affiliation(s)
| | - Gabriella Maria Andriani
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Isabela Madeira de Castro
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Helena Tiemi Suzukawa
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Ana Carolina Ramos Gimenes
- Laboratório de Biologia Molecular de Microrganismos, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Guilherme Bartolomeu-Gonçalves
- Programa de Pós-Graduação em Fisiopatologia Clínica e Laboratorial, Universidade Estadual de Londrina, Londrina CEP 86038-350, Brazil
| | - Kelly Ishida
- Laboratório de Quimioterapia Antifúngica, Universidade de São Paulo, São Paulo CEP 05508-000, Brazil
| | - Gerson Nakazato
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
- Laboratório de Bacteriologia Básica e Aplicada, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Phileno Pinge-Filho
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
- Laboratório de Imunopatologia Experimental, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Rayanne Regina Beltrame Machado
- Laboratório de Inovação Tecnológica no Desenvolvimento de Fármacos e Cosméticos, Universidade Estadual de Maringá, Maringá CEP 87020-900, Brazil
| | - Celso Vataru Nakamura
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
- Laboratório de Inovação Tecnológica no Desenvolvimento de Fármacos e Cosméticos, Universidade Estadual de Maringá, Maringá CEP 87020-900, Brazil
| | - Galdino Andrade
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
- Laboratório de Ecologia Microbiana, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Eliandro Reis Tavares
- Laboratório de Biologia Molecular de Microrganismos, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Lucy Megumi Yamauchi
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
- Laboratório de Biologia Molecular de Microrganismos, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
| | - Sueli Fumie Yamada-Ogatta
- Programa de Pós-Graduação em Microbiologia, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
- Laboratório de Biologia Molecular de Microrganismos, Universidade Estadual de Londrina, Londrina CEP 86057-970, Brazil
- Programa de Pós-Graduação em Fisiopatologia Clínica e Laboratorial, Universidade Estadual de Londrina, Londrina CEP 86038-350, Brazil
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14
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Oremefetse D, Aijaz A, Sanelisiwe D, Mrudula P. Survival of Candida auris on environmental surface material and low-level resistance to disinfectant. J Hosp Infect 2023:S0195-6701(23)00120-2. [PMID: 37116661 DOI: 10.1016/j.jhin.2023.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/30/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Candida auris persist in the environment despite disinfection. The survival on various environmental surfaces and the effect of sub-lethal concentrations of disinfectants on C. auris has not been studied. AIM This study investigated the survival of C. auris on environmental surfaces and the effect of sub-inhibitory concentrations of disinfectants. METHODS Surface material blocks were fabricated, artificially contaminated with C. auris, and for 3 weeks viable counts were assessed. In addition, C. auris cells were pulsed daily with disinfectants for 15 days and MICs were determined. Ergosterol quantities and efflux pump assays were also performed on disinfectant exposed strains using standard methods. RESULTS C. auris survived on all the surfaces for more than 3 weeks with the lowest count of 2.3 log cfu regardless of wet and dry conditions. Wet wood supported growth of C. auris with a one log increase in contrast to the dry condition which inhibited this organism (both p <0.01). In the biofilm form, C. auris flourished on all the surfaces. Although the MICs increased in sodium dichloroisocyanurate and benzalkonium chloride pulsed C. auris cells, only the benzalkonium chloride exposed cells showed decreased ergosterol content and an activated efflux pump. CONCLUSIONS Although C. auris survived on all the tested surfaces, survival on wet wood was remarkable. Benzalkonium chloride pulsed C. auris developed some degree of tolerance to disinfectant and showed efflux pump activation, suggesting the development of low-level resistance.
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Affiliation(s)
- Dire Oremefetse
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Ahmad Aijaz
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Infection Control, Charlotte Maxeke Johannesburg Academic Hospital National Health Laboratory Service, South Africa
| | - Duze Sanelisiwe
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Patel Mrudula
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Infection Control, Charlotte Maxeke Johannesburg Academic Hospital National Health Laboratory Service, South Africa.
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15
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Rabaan AA, Eljaaly K, Alfouzan WA, Mutair AA, Alhumaid S, Alfaraj AH, Aldawood Y, Alsaleh AA, Albayat H, Azmi RA, AlKaabi N, Alzahrani SJ, AlBahrani S, Sulaiman T, Alshukairi AN, Abuzaid AA, Garout M, Ahmad R, Muhammad J. Psychogenetic, genetic and epigenetic mechanisms in Candida auris: Role in drug resistance. J Infect Public Health 2023; 16:257-263. [PMID: 36608452 DOI: 10.1016/j.jiph.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
In recent years, we are facing the challenge of drug resistance emergence in fungi. The availability of limited antifungals and development of multi-drug resistance in fungal pathogens has become a serious concern in the past years in the health sector. Although several cellular, molecular, and genetic mechanisms have been proposed to explain the drug resistance mechanism in fungi, but a complete understanding of the molecular and genetic mechanisms is still lacking. Besides the genetic mechanism, epigenetic mechanisms are pivotal in the fungal lifecycle and disease biology. However, very little is understood about the role of epigenetic mechanisms in the emergence of multi-drug resistance in fungi, especially in Candida auris (C. auris). The current narrative review summaries the clinical characteristics, genomic organization, and molecular/genetic/epigenetic mechanisms underlying the emergence of drug resistance in C. auris. A very few studies have attempted to evaluate the role of epigenetic mechanisms in C. auris. Furthermore, advanced genetic tools such as the CRISP-Cas9 system can be utilized to elucidate the epigenetic mechanisms and their role in the emergence of multi-drug resistance in C. auris.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan.
| | - Khalid Eljaaly
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; Pharmacy Practice and Science Department, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Wadha A Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat 13110, Kuwait; Microbiology Unit, Department of Laboratories, Farwania Hospital, Farwania 85000, Kuwait
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa 36342, Saudi Arabia; College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia; School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia; Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran 33048, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia
| | - Amal H Alfaraj
- Pediatric Department, Abqaiq General Hospital, First Eastern Health Cluster, Abqaiq 33261, Saudi Arabia
| | - Yahya Aldawood
- Clinical Laboratory Science Department, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Abdulmonem A Alsaleh
- Clinical Laboratory Science Department, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh 7790, Saudi Arabia
| | - Reyouf Al Azmi
- Infection Prevention and Control, Eastern Health Cluster, Dammam 32253, Saudi Arabia
| | - Nawal AlKaabi
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, 51900, United Arab Emirates; College of Medicine and Health Science, Khalifa University, Abu Dhabi, 127788, United Arab Emirates
| | - Samira J Alzahrani
- Molecular Diagnostic Laboratory, King Fahd Military Medical Complex, Dhahran 31932, Saudi Arabia
| | - Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran 31932, Saudi Arabia
| | - Tarek Sulaiman
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abeer N Alshukairi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulmonem A Abuzaid
- Medical Microbiology Department, Security Forces Hospital Programme, Dammam 32314, Saudi Arabia
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Rafiq Ahmad
- Department of Microbiology, The University of Haripur, Haripur 22610, Pakistan
| | - Javed Muhammad
- Department of Microbiology, The University of Haripur, Haripur 22610, Pakistan.
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16
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Proactive infection control measures to prevent nosocomial transmission of Candida auris in Hong Kong. J Hosp Infect 2023; 134:166-168. [PMID: 36646138 DOI: 10.1016/j.jhin.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
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17
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Thatchanamoorthy N, Rukumani Devi V, Chandramathi S, Tay ST. Candida auris: A Mini Review on Epidemiology in Healthcare Facilities in Asia. J Fungi (Basel) 2022; 8:1126. [PMID: 36354893 PMCID: PMC9696804 DOI: 10.3390/jof8111126] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 07/28/2023] Open
Abstract
Candida auris, a newly emerging healthcare-associated yeast pathogen from the Metschnikowiaceae family, was first described in the ear canal of an elderly Japanese patient in 2009. The yeast is one of the causative agents of candidemia, which has been linked with nosocomial outbreaks and high mortality rates in healthcare facilities worldwide. Since its first isolation, the occurrence of C. auris in six continents has becomes a grave concern for the healthcare professionals and scientific community. Recent reports showed the identification of five geographically distinct clades and high rates of antifungal resistance associated with C. auris. Till date, there are no effective treatment options, and standardized measures for prevention and control of C. auris infection in healthcare facilities. This leads to frequent therapeutic failures and complicates the eradication of C. auris infection in healthcare facilities. Thus, this review focuses on the recent understanding of the epidemiology, risk factors, diagnosis, transmission and prevention and control strategies of C. auris infection in healthcare facilities in Asia.
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Affiliation(s)
- Nishanthinie Thatchanamoorthy
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
| | - Velayuthan Rukumani Devi
- Department of Medical Microbiology, University Malaya Medical Centre, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 59100, Wilayah Persekutuan, Malaysia
| | - Samudi Chandramathi
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Wilayah Persekutuan, Malaysia
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18
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Brown JL, Short B, Ware A, Sherry L, Kean R, Ramage G. Cell Viability Assays for Candida auris. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2022; 2517:129-153. [PMID: 35674950 DOI: 10.1007/978-1-0716-2417-3_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cell viability assays are useful for assessing the efficacy of antifungal therapeutics and disinfection strategies in vitro. In recent years these assays have been fundamental for the testing of conventional and novel therapies against the nosocomial fungal pathogen Candida auris. Here we provide detailed descriptions of methods for assessing cellular viability of Candida auris in vitro, such as metabolic assays (XTT and resazurin), colony-forming unit counting, live/dead quantitative PCR, and fluorescent staining for microscopic analyses.
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Affiliation(s)
- Jason L Brown
- Oral Sciences Research Group, College of Medical, Veterinary and Life Sciences, Glasgow University, Glasgow, UK. .,Glasgow Biofilm Research Network, Glasgow, UK.
| | - Bryn Short
- Oral Sciences Research Group, College of Medical, Veterinary and Life Sciences, Glasgow University, Glasgow, UK.,Glasgow Biofilm Research Network, Glasgow, UK
| | - Alicia Ware
- Glasgow Biofilm Research Network, Glasgow, UK.,Department of Biological and Biomedical, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Leighann Sherry
- Oral Sciences Research Group, College of Medical, Veterinary and Life Sciences, Glasgow University, Glasgow, UK.,Glasgow Biofilm Research Network, Glasgow, UK
| | - Ryan Kean
- Glasgow Biofilm Research Network, Glasgow, UK.,Department of Biological and Biomedical, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Gordon Ramage
- Oral Sciences Research Group, College of Medical, Veterinary and Life Sciences, Glasgow University, Glasgow, UK. .,Glasgow Biofilm Research Network, Glasgow, UK.
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19
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Man A, Mare AD, Mares M, Ruta F, Pribac M, Maier AC, Cighir A, Ciurea CN. Antifungal and anti-virulence activity of six essential oils against important Candida species - a preliminary study. Future Microbiol 2022; 17:737-753. [PMID: 35531749 DOI: 10.2217/fmb-2021-0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Opportunistic infections with Candida species are becoming more problematic, considering their increasing virulence and resistance to antifungal drugs. AIM To assess the antifungal and anti-virulence activity of basil, cinnamon, clove, melaleuca, oregano and thyme essential oils (EOs) on five Candida species (C. albicans, C. auris, C. krusei C. parapsilosis and C. guillermondii). METHODS The MIC, growth rate, antibiofilm activity, regulation of gene expression (ALS3, SAP2, HSP70) and germ-tube formation were evaluated by specific methods. RESULTS Most EOs inhibited Candida species growth and reduced the expression of some virulence factors. Cinnamon and clove EO showed the most significant inhibitory effects. CONCLUSIONS The tested EOs are promising agents for facilitating the management of some Candida infections.
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Affiliation(s)
- Adrian Man
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, 540142, Romania
| | - Anca-Delia Mare
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, 540142, Romania
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University of Life Sciences of Iași, Iași, 700490, Romania
| | - Florina Ruta
- Department of Community Nutrition & Food Safety, George Emil Palade University of Medicine, Pharmacy, Science, & Technology of Târgu Mureș, Târgu Mureș, 540142, Romania
| | - Mirela Pribac
- Nutrition & Holistic Health, Holomed, Târgu Mureș, 540272, Romania
| | - Adrian-Cornel Maier
- Department of Urology, "Dunarea de Jos" University of Galați, Galați, 800008, Romania
| | - Anca Cighir
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, 540142, Romania.,Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, & Technology of Târgu Mureș, Târgu Mureș, 540142, Romania
| | - Cristina-Nicoleta Ciurea
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, 540142, Romania.,Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, & Technology of Târgu Mureș, Târgu Mureș, 540142, Romania
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20
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Bugli F, Massaro F, Buonocore F, Saraceni PR, Borocci S, Ceccacci F, Bombelli C, Di Vito M, Marchitiello R, Mariotti M, Torelli R, Sanguinetti M, Porcelli F. Design and Characterization of Myristoylated and Non-Myristoylated Peptides Effective against Candida spp. Clinical Isolates. Int J Mol Sci 2022; 23:ijms23042164. [PMID: 35216297 PMCID: PMC8875392 DOI: 10.3390/ijms23042164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 01/08/2023] Open
Abstract
The increasing resistance of fungi to antibiotics is a severe challenge in public health, and newly effective drugs are required. Promising potential medications are lipopeptides, linear antimicrobial peptides (AMPs) conjugated to a lipid tail, usually at the N-terminus. In this paper, we investigated the in vitro and in vivo antifungal activity of three short myristoylated and non-myristoylated peptides derived from a mutant of the AMP Chionodracine. We determined their interaction with anionic and zwitterionic membrane-mimicking vesicles and their structure during this interaction. We then investigated their cytotoxic and hemolytic activity against mammalian cells. Lipidated peptides showed a broad spectrum of activity against a relevant panel of pathogen fungi belonging to Candida spp., including the multidrug-resistant C. auris. The antifungal activity was also observed vs. biofilms of C. albicans, C. tropicalis, and C. auris. Finally, a pilot efficacy study was conducted on the in vivo model consisting of Galleria mellonella larvae. Treatment with the most-promising myristoylated peptide was effective in counteracting the infection from C. auris and C. albicans and the death of the larvae. Therefore, this myristoylated peptide is a potential candidate to develop antifungal agents against human fungal pathogens.
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Affiliation(s)
- Francesca Bugli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (M.D.V.); (R.M.); (M.M.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
| | - Federica Massaro
- Department for Innovation in Biological, Agrofood and Forest Systems, University of Tuscia, 01100 Viterbo, Italy; (F.M.); (F.B.); (P.R.S.); (S.B.)
| | - Francesco Buonocore
- Department for Innovation in Biological, Agrofood and Forest Systems, University of Tuscia, 01100 Viterbo, Italy; (F.M.); (F.B.); (P.R.S.); (S.B.)
| | - Paolo Roberto Saraceni
- Department for Innovation in Biological, Agrofood and Forest Systems, University of Tuscia, 01100 Viterbo, Italy; (F.M.); (F.B.); (P.R.S.); (S.B.)
| | - Stefano Borocci
- Department for Innovation in Biological, Agrofood and Forest Systems, University of Tuscia, 01100 Viterbo, Italy; (F.M.); (F.B.); (P.R.S.); (S.B.)
- CNR—Institute for Biological Systems, Area Della Ricerca di Roma 1, SP35d 9, 00010 Montelibretti, Italy
| | - Francesca Ceccacci
- CNR—Institute For Biological Systems, Sede Secondaria di Roma-Meccanismi di Reazione, c/o Università La Sapienza, 00185 Rome, Italy; (F.C.); (C.B.)
| | - Cecilia Bombelli
- CNR—Institute For Biological Systems, Sede Secondaria di Roma-Meccanismi di Reazione, c/o Università La Sapienza, 00185 Rome, Italy; (F.C.); (C.B.)
| | - Maura Di Vito
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (M.D.V.); (R.M.); (M.M.)
| | - Rosalba Marchitiello
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (M.D.V.); (R.M.); (M.M.)
| | - Melinda Mariotti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (M.D.V.); (R.M.); (M.M.)
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.B.); (M.D.V.); (R.M.); (M.M.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence: (M.S.); (F.P.); Tel.: +39-063-015-4218 (M.S.); +39-076-135-7041 (F.P.)
| | - Fernando Porcelli
- Department for Innovation in Biological, Agrofood and Forest Systems, University of Tuscia, 01100 Viterbo, Italy; (F.M.); (F.B.); (P.R.S.); (S.B.)
- Correspondence: (M.S.); (F.P.); Tel.: +39-063-015-4218 (M.S.); +39-076-135-7041 (F.P.)
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21
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Corzo-León DE, Mark C, MacCallum DM, Munro CA. A Human Ex Vivo Skin Model to Study Candida auris Biofilms. Methods Mol Biol 2022; 2517:259-267. [PMID: 35674961 DOI: 10.1007/978-1-0716-2417-3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Candida auris can persist for long periods on hospital surfaces and on the skin. C. auris has the ability to form drug-resistant biofilms, which can substantially impact on patient outcome. In comparison to Candida albicans, C. auris has a lower capacity to form biofilms in in vitro models and a higher capacity when tested on animal skin models. Intraspecies variation is shown to exist, with some clinical isolates having greater biofilm capabilities than others. There is a need for models that closely mimic the real niches where infection occurs on human patients. This protocol describes, in detail, a human skin model to study C. auris biofilm formation using catheterized and non-catheterized skin.
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Affiliation(s)
- Dora E Corzo-León
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK.
- Unidad de Epidemiología Hospitalaria e Infectologia, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
| | - Catherine Mark
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Donna M MacCallum
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Carol A Munro
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, UK
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22
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Activity of Free and Liposome-Encapsulated Essential Oil from Lavandula angustifolia against Persister-Derived Biofilm of Candida auris. Antibiotics (Basel) 2021; 11:antibiotics11010026. [PMID: 35052903 PMCID: PMC8772840 DOI: 10.3390/antibiotics11010026] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
The high virulence of Candida auris, a pathogen fungus considered as a global threat for public health, is due to its peculiar traits such as its intrinsic resistance to conventional antifungals. Its biofilm lifestyle certainly promotes the prolonged survival of C. auris after disinfection or antifungal treatments. In this work, for the first time, we detected persister cells in a biofilm of C. auris in a microwell plate model, following caspofungin treatment. Furthermore, we showed how persisters can progressively develop a new biofilm in situ, mimicking the re-colonization of a surface which may be responsible for recalcitrant infections. Plant-derived compounds, such as essential oils, may represent a valid alternative to combat fungal infections. Here, Lavandula angustifolia essential oil, as free or encapsulated in liposomes, was used to eradicate primary and persister-derived biofilms of C. auris, confirming the great potential of alternative compounds against emergent fungal pathogens. As in other Candida species, the action of essential oils against C. auris involves ROS production and affects the expression of some biofilm-related genes.
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23
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Forward and reverse genetic dissection of morphogenesis identifies filament-competent Candida auris strains. Nat Commun 2021; 12:7197. [PMID: 34893621 PMCID: PMC8664941 DOI: 10.1038/s41467-021-27545-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022] Open
Abstract
Candida auris is an emerging healthcare-associated pathogen of global concern. Recent reports have identified C. auris isolates that grow in cellular aggregates or filaments, often without a clear genetic explanation. To investigate the regulation of C. auris morphogenesis, we applied an Agrobacterium-mediated transformation system to all four C. auris clades. We identified aggregating mutants associated with disruption of chitin regulation, while disruption of ELM1 produced a polarized, filamentous growth morphology. We developed a transiently expressed Cas9 and sgRNA system for C. auris that significantly increased targeted transformation efficiency across the four C. auris clades. Using this system, we confirmed the roles of C. auris morphogenesis regulators. Morphogenic mutants showed dysregulated chitinase expression, attenuated virulence, and altered antifungal susceptibility. Our findings provide insights into the genetic regulation of aggregating and filamentous morphogenesis in C. auris. Furthermore, the genetic tools described here will allow for efficient manipulation of the C. auris genome. Some isolates of the emerging fungal pathogen Candida auris can form cellular aggregates or filaments. Here, Santana and O’Meara use Agrobacterium-mediated transformation and a CRISPR-Cas9 system to identify several genes that regulate C. auris morphogenesis.
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24
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Antifungal loaded calcium sulfate beads as a potential therapeutic in combating Candida auris. Antimicrob Agents Chemother 2021; 66:e0171321. [PMID: 34694875 PMCID: PMC8765289 DOI: 10.1128/aac.01713-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida auris provides a substantial global nosocomial threat clinically. With the recent emergence that the organism can readily colonize skin niches, it will likely continue to pose a risk in health care units, particularly to patients undergoing surgery. The purpose of this study was to investigate the efficacy of antifungal-loaded calcium sulfate (CS) beads in combatting C. auris infection. We demonstrate that the CS-packed beads have the potential to interfere with planktonic and sessile C. auris.
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25
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Di Mambro T, Vanzolini T, Bruscolini P, Perez-Gaviro S, Marra E, Roscilli G, Bianchi M, Fraternale A, Schiavano GF, Canonico B, Magnani M. A new humanized antibody is effective against pathogenic fungi in vitro. Sci Rep 2021; 11:19500. [PMID: 34593880 PMCID: PMC8484667 DOI: 10.1038/s41598-021-98659-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
Invasive fungal infections mainly affect patients undergoing transplantation, surgery, neoplastic disease, immunocompromised subjects and premature infants, and cause over 1.5 million deaths every year. The most common fungi isolated in invasive diseases are Candida spp., Cryptococcus spp., and Aspergillus spp. and even if four classes of antifungals are available (Azoles, Echinocandins, Polyenes and Pyrimidine analogues), the side effects of drugs and fungal acquired and innate resistance represent the major hurdles to be overcome. Monoclonal antibodies are powerful tools currently used as diagnostic and therapeutic agents in different clinical contexts but not yet developed for the treatment of invasive fungal infections. In this paper we report the development of the first humanized monoclonal antibody specific for β-1,3 glucans, a vital component of several pathogenic fungi. H5K1 has been tested on C. auris, one of the most urgent threats and resulted efficient both alone and in combination with Caspofungin and Amphotericin B showing an enhancement effect. Our results support further preclinical and clinical developments for the use of H5K1 in the treatment of patients in need.
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Affiliation(s)
- Tomas Di Mambro
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61029 Urbino, Italy ,Diatheva S.R.L, Via Sant’Anna 131/135, 61030 Cartoceto, Italy
| | - Tania Vanzolini
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61029 Urbino, Italy
| | - Pierpaolo Bruscolini
- grid.11205.370000 0001 2152 8769Instituto de Biocomputación y Física de Sistemas Complejos (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Departamento de Física Teórica, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Sergio Perez-Gaviro
- grid.11205.370000 0001 2152 8769Instituto de Biocomputación y Física de Sistemas Complejos (BIFI), Universidad de Zaragoza, 50018 Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Departamento de Física Teórica, Universidad de Zaragoza, 50009 Zaragoza, Spain ,grid.467120.6Centro Universitario de la Defensa, 50090 Zaragoza, Spain
| | - Emanuele Marra
- Takis S.R.L, Via di Castel Romano 100, 00128 Rome, Italy
| | | | - Marzia Bianchi
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61029 Urbino, Italy
| | - Alessandra Fraternale
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61029 Urbino, Italy
| | - Giuditta Fiorella Schiavano
- grid.12711.340000 0001 2369 7670Department of Humanities, University of Urbino “Carlo Bo”, 61029 Urbino, Italy
| | - Barbara Canonico
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61029 Urbino, Italy
| | - Mauro Magnani
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61029 Urbino, Italy ,Diatheva S.R.L, Via Sant’Anna 131/135, 61030 Cartoceto, Italy
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26
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Carolus H, Jacobs S, Lobo Romero C, Deparis Q, Cuomo CA, Meis JF, Van Dijck P. Diagnostic Allele-Specific PCR for the Identification of Candida auris Clades. J Fungi (Basel) 2021; 7:754. [PMID: 34575792 PMCID: PMC8471779 DOI: 10.3390/jof7090754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022] Open
Abstract
Candida auris is an opportunistic pathogenic yeast that emerged worldwide during the past decade. This fungal pathogen poses a significant public health threat due to common multidrug resistance (MDR), alarming hospital outbreaks, and frequent misidentification. Genomic analyses have identified five distinct clades that are linked to five geographic areas of origin and characterized by differences in several phenotypic traits such as virulence and drug resistance. Typing of C. auris strains and the identification of clades can be a powerful tool in molecular epidemiology and might be of clinical importance by estimating outbreak and MDR potential. As C. auris has caused global outbreaks, including in low-income countries, typing C. auris strains quickly and inexpensively is highly valuable. We report five allele-specific polymerase chain reaction (AS-PCR) assays for the identification of C. auris and each of the five described clades of C. auris based on conserved mutations in the internal transcribed spacer (ITS) rDNA region and a clade-specific gene cluster. This PCR method provides a fast, cheap, sequencing-free diagnostic tool for the identification of C. auris, C. auris clades, and potentially, the discovery of new clades.
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Affiliation(s)
- Hans Carolus
- Laboratory of Molecular Cell Biology, Department of Biology, Institute of Botany and Microbiology, KU Leuven, 3001 Leuven, Belgium; (H.C.); (S.J.); (C.L.R.)
- VIB-KU Leuven Center for Microbiology, 3001 Leuven, Belgium;
| | - Stef Jacobs
- Laboratory of Molecular Cell Biology, Department of Biology, Institute of Botany and Microbiology, KU Leuven, 3001 Leuven, Belgium; (H.C.); (S.J.); (C.L.R.)
| | - Celia Lobo Romero
- Laboratory of Molecular Cell Biology, Department of Biology, Institute of Botany and Microbiology, KU Leuven, 3001 Leuven, Belgium; (H.C.); (S.J.); (C.L.R.)
- VIB-KU Leuven Center for Microbiology, 3001 Leuven, Belgium;
| | - Quinten Deparis
- VIB-KU Leuven Center for Microbiology, 3001 Leuven, Belgium;
- Laboratory for Genetics and Genomics, Centre for Microbial and Plant Genetics, KU Leuven, 3001 Leuven, Belgium
| | | | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 Nijmegen, The Netherlands;
- Centre of Expertise in Mycology Radboudumc/CWZ, 6532 Nijmegen, The Netherlands
| | - Patrick Van Dijck
- Laboratory of Molecular Cell Biology, Department of Biology, Institute of Botany and Microbiology, KU Leuven, 3001 Leuven, Belgium; (H.C.); (S.J.); (C.L.R.)
- VIB-KU Leuven Center for Microbiology, 3001 Leuven, Belgium;
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27
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Zatorska B, Moser D, Diab-Elschahawi M, Ebner J, Lusignani LS, Presterl E. The effectiveness of surface disinfectants and a micellic H 2O 2 based water disinfectant on Candida auris. J Mycol Med 2021; 31:101178. [PMID: 34388399 DOI: 10.1016/j.mycmed.2021.101178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND As infection control faces new challenges from emerging, multidrug resistant strains of the yeast Candida auris, this study was conducted in order to examine the efficacy of hospital surface disinfectants and a new water disinfectant against C. auris biofilm forms. METHODS We tested four reference strains of C. auris (NCPF8971, NCPF8977, NCPF8984, DSM21092) and one C. albicans strain (ATCC10231) against disinfectants based on ethanol (ETH), quaternary ammonium (QAC), a combination of glutaraldehyde, quaternary ammonium and surfactant (ALD) and potassium peroxymonosulfate (PP) as well as 3.4% H2O2 and 4.25% H2O2 alone. In addition, a micellic-based formulation containing 17% v/v hydrogene peroxide disinfectant (mH2O2) was tested. The efficacy of the disinfectants was measured in a 96-well plate using tetrazolium salt reduction (XTT) and the log10 reduction assay. RESULTS ETH and QAC displayed in clinically recommended concentrations more than 5log10 reduction and more than 80% XTT activity reduction for all of the Candida biofilms and planktonic cells. Only biofilms of C. auris NCPF8984 were additionally sensitive to all remaining disinfectants. All tested C. auris biofilms were sensitive to PP disinfectant and showed more than 5log10 reduction. However, the XTT assay showed a reduction of less than 80% for the PP disinfectant, indicating the presence of active but non-culturable cells. The 25% mH2O2 (corresponding to 4.25% H2O2) killed Candida biofilms after 1 minute.
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Affiliation(s)
- Beata Zatorska
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Doris Moser
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Magda Diab-Elschahawi
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Julia Ebner
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Luigi Segagni Lusignani
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Elisabeth Presterl
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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28
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Giacobbe DR, Magnasco L, Sepulcri C, Mikulska M, Koehler P, Cornely OA, Bassetti M. Recent advances and future perspectives in the pharmacological treatment of Candida auris infections. Expert Rev Clin Pharmacol 2021; 14:1205-1220. [PMID: 34176393 DOI: 10.1080/17512433.2021.1949285] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Candida auris is responsible for hospital outbreaks worldwide. Some C. auris isolates may show concomitant resistance to azoles, echinocandins, and polyenes, thereby possibly leaving clinicians with few therapeutic options. AREAS COVERED Antifungal agents both in early and in late phases of clinical development showing anti-C. auris activity. EXPERT OPINION The research on antifungal agents active against C. auris has made important steps forward in recent years: (i) the development of drugs with novel mechanisms of action, such as ibrexafungerp and fosmanogepix, could provide a valid option against C. auris strains resistant to one or more older antifungals, including pan-resistant strains; (ii) rezafungin could allow once weekly administration of an active drug in the case of echinocandin-susceptible isolates, providing an effective outpatient treatment, while at the same time relieving selective pressure on novel classes; (iii) the development of oral formulations could allow step-down therapy and/or early discharge, or even to avoid hospitalization in mild or noninvasive diseases; (iv) according to available data, these novel agents show a good safety profile and a low potential for drug-drug interactions.
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Affiliation(s)
- Daniele R Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
| | - Laura Magnasco
- Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
| | - Chiara Sepulcri
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, San Martino Policlinico Hospital - IRCCS, Genoa, Italy
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29
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Bonadonna L, Briancesco R, Coccia AM, Meloni P, Rosa GL, Moscato U. Microbial Air Quality in Healthcare Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6226. [PMID: 34207509 PMCID: PMC8296088 DOI: 10.3390/ijerph18126226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022]
Abstract
There is increasing evidence that indoor air quality and contaminated surfaces provide an important potential source for transmission of pathogens in hospitals. Airborne hospital microorganisms are apparently harmless to healthy people. Nevertheless, healthcare settings are characterized by different environmental critical conditions and high infective risk, mainly due to the compromised immunologic conditions of the patients that make them more vulnerable to infections. Thus, spread, survival and persistence of microbial communities are important factors in hospital environments affecting health of inpatients as well as of medical and nursing staff. In this paper, airborne and aerosolized microorganisms and their presence in hospital environments are taken into consideration, and the factors that collectively contribute to defining the infection risk in these facilities are illustrated.
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Affiliation(s)
- Lucia Bonadonna
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Rossella Briancesco
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Anna Maria Coccia
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Pierluigi Meloni
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Giuseppina La Rosa
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Umberto Moscato
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Section of Occupational Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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30
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Abstract
Invasive fungal diseases continue to cause substantial mortality in the enlarging immunocompromised population. It is fortunate that the field has moved past amphotericin B deoxycholate as the only available antifungal drug but despite new classes of antifungal agents both primary and secondary drug resistance in molds and yeasts abound. From the rise of multiple-drug-resistant Candida auris to the agrochemical selection of environmental azole-resistant Aspergillus fumigatus, it is and will be critical to understand antifungal drug resistance and both prevent and treat it with new strategies and agents.
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31
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Hernando-Ortiz A, Mateo E, Perez-Rodriguez A, de Groot PWJ, Quindós G, Eraso E. Virulence of Candida auris from different clinical origins in Caenorhabditis elegans and Galleria mellonella host models. Virulence 2021; 12:1063-1075. [PMID: 33843456 PMCID: PMC8043173 DOI: 10.1080/21505594.2021.1908765] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Candida auris is an emerging multidrug-resistant fungal pathogen responsible for nosocomial outbreaks of invasive candidiasis. Although several studies on the pathogenicity of this species have been reported, the knowledge on C. auris virulence is still limited. This study aims to analyze the pathogenicity of C. auris, using one aggregating isolate and eleven non-aggregating isolates from different clinical origins (blood, urine and oropharyngeal specimens) in two alternative host models of candidiasis: Caenorhabditis elegans and Galleria mellonella. Furthermore, possible associations between virulence, aggregation, biofilm-forming capacity, and clinical origin were assessed. The aggregating phenotype isolate was less virulent in both in vivo invertebrate infection models than non-aggregating isolates but showed higher capacity to form biofilms. Blood isolates were significantly more virulent than those isolated from urine and respiratory specimens in the G. mellonella model of candidiasis. We conclude that both models of candidiasis present pros and cons but prove useful to evaluate the virulence of C. auris in vivo. Both models also evidence the heterogeneity in virulence that this species can develop, which may be influenced by the aggregative phenotype and clinical origin.
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Affiliation(s)
- Ainara Hernando-Ortiz
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Estibaliz Mateo
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Aitzol Perez-Rodriguez
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Piet W J de Groot
- Regional Center for Biomedical Research, Castilla-La Mancha Science & Technology Park, University of Castilla-La Mancha, Albacete, Spain
| | - Guillermo Quindós
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Elena Eraso
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
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Ahmad S, Alfouzan W. Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities. Microorganisms 2021; 9:microorganisms9040807. [PMID: 33920482 PMCID: PMC8069182 DOI: 10.3390/microorganisms9040807] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/21/2022] Open
Abstract
Candida auris, a recently recognized, often multidrug-resistant yeast, has become a significant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently resulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of 'dry' biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new infections in healthcare facilities, including the screening of susceptible patients for colonization; the cleaning and decontamination of the environment, equipment, and colonized patients; and successful approaches to identify and treat infected patients, particularly during outbreaks.
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Chakrabarti A, Sood P. On the emergence, spread and resistance of Candida auris: host, pathogen and environmental tipping points. J Med Microbiol 2021; 70. [PMID: 33599604 PMCID: PMC8346726 DOI: 10.1099/jmm.0.001318] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Over a decade ago, a multidrug-resistant nosocomial fungus Candida auris emerged worldwide and has since become a significant challenge for clinicians and microbiologists across the globe. A resilient pathogen, C. auris survives harsh disinfectants, desiccation and high-saline environments. It readily colonizes the inanimate environment, susceptible patients and causes invasive infections that exact a high toll. Prone to misidentification by conventional microbiology techniques, C. auris rapidly acquires multiple genetic determinants that confer multidrug resistance. Whole-genome sequencing has identified four distinct clades of C. auris, and possibly a fifth one, in circulation. Even as our understanding of this formidable pathogen grows, the nearly simultaneous emergence of its distinct clades in different parts of the world, followed by their rapid global spread, remains largely unexplained. We contend that certain host–pathogen–environmental factors have been evolving along adverse trajectories for the last few decades, especially in regions where C. auris originally appeared, until these factors possibly reached a tipping point to compel the evolution, emergence and spread of C. auris. Comparative genomics has helped identify several resistance mechanisms in C. auris that are analogous to those seen in other Candida species, but they fail to fully explain how high-level resistance rapidly develops in this yeast. A better understanding of these unresolved aspects is essential not only for the effective management of C. auris patients, hospital outbreaks and its global spread but also for forecasting and tackling novel resistant pathogens that might emerge in the future. In this review, we discuss the emergence, spread and resistance of C. auris, and propose future investigations to tackle this resilient pathogen.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Arunaloke Chakrabarti,
| | - Prashant Sood
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Persistence of Pathogens on Inanimate Surfaces: A Narrative Review. Microorganisms 2021; 9:microorganisms9020343. [PMID: 33572303 PMCID: PMC7916105 DOI: 10.3390/microorganisms9020343] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
For the prevention of infectious diseases, knowledge about transmission routes is essential. In addition to respiratory, fecal-oral, and sexual transmission, the transfer of pathogens via surfaces plays a vital role for human pathogenic infections-especially nosocomial pathogens. Therefore, information about the survival of pathogens on surfaces can have direct implications on clinical measures, including hygiene guidelines and disinfection strategies. In this review, we reviewed the existing literature regarding viral, bacterial, and fungal persistence on inanimate surfaces. In particular, the current knowledge of the survival time and conditions of clinically relevant pathogens is summarized. While many pathogens persist only for hours, common nosocomial pathogens can survive for days to weeks under laboratory conditions and thereby potentially form a continuous source of transmission if no adequate inactivation procedures are performed.
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Griffith N, Danziger L. Candida auris Urinary Tract Infections and Possible Treatment. Antibiotics (Basel) 2020; 9:antibiotics9120898. [PMID: 33322761 PMCID: PMC7764735 DOI: 10.3390/antibiotics9120898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022] Open
Abstract
Candida auris is a globally emerging pathogen that has been identified in urinary tract infections (UTIs) worldwide. The novel pathogen is characterized by common misidentification, difficult eradication, and multidrug resistance. To date, there is a paucity of data to guide the optimal management of C. auris UTIs. This review provides an overview of C. auris as an etiologic agent of UTIs, a comprehensive review of published data on C. auris UTIs, and a proposed treatment algorithm based on patient clinical status, the presence or absence of clinical infection, comorbidities, infection, and therapy history. Echinocandin and liposomal amphotericin B are recommended as first-line agents for most patients with C. auris isolated in the urine, with a focus on infection control measures and appropriate follow-up criteria. A variety of combination therapies, flucytosine, and amphotericin B bladder irrigations are offered as potential alternatives in the event of infection persistence or recurrence. The treatment approach centers on the aggressive treatment of C. auris in most patients, with the goal of preventing subsequent invasive spread, multi-drug resistance, and ultimate mortality. Published literature on C. auris urinary isolation and treatment is imperative for the future evolution of evidence-based treatment recommendations for this unique pathogen of concern.
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Affiliation(s)
- Nicole Griffith
- Department of Pharmacy Practice (m/c 833), University of Illinois at Chicago College of Pharmacy, Chicago, IL 60612, USA;
| | - Larry Danziger
- Department of Pharmacy Practice (m/c 833), University of Illinois at Chicago College of Pharmacy, Chicago, IL 60612, USA;
- Department of Medicine, Division of Infectious Disease, University of Illinois at Chicago College of Medicine, UIC College of Pharmacy, Suite 164 833 S. Wood Street, Chicago, IL 60612, USA
- Correspondence:
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Agnew-Francis KA, Tang Y, Lin X, Low YS, Wun SJ, Kuo A, Elias SMASI, Lonhienne T, Condon ND, Pimentel BNAS, Vergani CE, Smith MT, Fraser JA, Williams CM, Guddat LW. Herbicides That Target Acetohydroxyacid Synthase Are Potent Inhibitors of the Growth of Drug-Resistant Candida auris. ACS Infect Dis 2020; 6:2901-2912. [PMID: 32986949 DOI: 10.1021/acsinfecdis.0c00229] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acetohydroxyacid synthase (AHAS, EC 2.2.1.6), the first enzyme in the branched chain amino acid biosynthesis pathway, is the target for more than 50 commercially available herbicides, and is a promising target for antimicrobial drug discovery. Herein, we have expressed and purified AHAS from Candida auris, a newly identified human invasive fungal pathogen. Thirteen AHAS inhibiting herbicides have Ki values of <2 μM for this enzyme, with the most potent having Ki values of <32 nM. Six of these compounds exhibited MIC50 values of <1 μM against C. auris (CBS10913 strain) grown in culture, with bensulfuron methyl (BSM) being fungicidal and the most potent (MIC50 of 0.090 μM) in defined minimal media. The MIC50 value increases to 0.90 μM in media enriched by the addition of branched-chain amino acids at the expected concentration in the blood serum. The sessile MIC50 for BSM is 0.6 μM. Thus, it is also an excellent inhibitor of the growth of C. auris biofilms. BSM is nontoxic in HEK-293 cells at concentrations >100 μM and thus possesses a therapeutic index of >100. These data suggest that targeting AHAS is a viable strategy for treating C. auris infections.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bruna N. A. S. Pimentel
- School of Dentistry, São Paulo State University (UNESP), Araraquara, Rua Humaita, 1680, 14801-903 Araraquara, SP Brazil
| | - Carlos E. Vergani
- School of Dentistry, São Paulo State University (UNESP), Araraquara, Rua Humaita, 1680, 14801-903 Araraquara, SP Brazil
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Kim HR, Eom YB. Antifungal and anti-biofilm effects of 6-shogaol against Candida auris. J Appl Microbiol 2020; 130:1142-1153. [PMID: 32981148 DOI: 10.1111/jam.14870] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/18/2022]
Abstract
AIMS This study aimed to assess the antifungal and anti-biofilm effects of 6-shogaol against Candida auris using in vitro phenotypic and genotypic analyses. METHODS AND RESULTS Our results showed that 6-shogaol exhibited antifungal as well as anti-biofilm activity by inhibiting biofilm formation and eradicating the preformed biofilms of C. auris. The rate and extent of antifungal activity were further confirmed by a time-kill assay. The XTT reduction assay confirmed that 6-shogaol decreased cellular metabolic activity in the biofilm. The effect of 6-shogaol on established C. auris biofilms was visualized by confocal laser scanning microscopy. Also, this study demonstrated that 6-shogaol reduced the levels of aspartyl proteinases and downregulated the expression of the efflux pump-related CDR1 gene in C. auris. CONCLUSIONS The data indicated that 6-shogaol extracted from ginger had antifungal and anti-biofilm effects on C. auris. SIGNIFICANCE AND IMPACT OF THE STUDY This study demonstrated the value of the plant-derived 6-shogaol as a promising and potent bioactive compound. The mode of action of this compound against C. auris biofilm was also proposed.
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Affiliation(s)
- H-R Kim
- Department of Medical Sciences, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Y-B Eom
- Department of Medical Sciences, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea.,Department of Biomedical Laboratory Science, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
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What do we know about the biology of the emerging fungal pathogen of humans Candida auris? Microbiol Res 2020; 242:126621. [PMID: 33096325 DOI: 10.1016/j.micres.2020.126621] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
Abstract
Candida auris is a worrisome fungal pathogen of humans which emerged merely about a decade ago. Ever since then the scientific community worked hard to understand clinically relevant traits, such as virulence factors, antifungal resistance mechanisms, and its ability to adhere to human skin and medical devices. Whole-genome sequencing of clinical isolates and epidemiological studies outlining the path of nosocomial outbreaks have been the focus of research into this pathogenic and multidrug-resistant yeast since its first description in 2009. More recently, work was started by several laboratories to explore the biology of C. auris. Here, we review the insights of studies characterizing the mechanisms underpinning antifungal drug resistance, biofilm formation, morphogenetic switching, cell aggregation, virulence, and pathogenicity of C. auris. We conclude that, although some progress has been made, there is still a long journey ahead of us, before we fully understand this novel pathogen. Critically important is the development of molecular tools for C. auris to make this fungus genetically tractable and traceable. This will allow an in-depth molecular dissection of the life cycle of C. auris, of its characteristics while interacting with the human host, and the mechanisms it employs to avoid being killed by antifungals and the immune system.
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First Report of Candidemia Clonal Outbreak Caused by Emerging Fluconazole-Resistant Candida parapsilosis Isolates Harboring Y132F and/or Y132F+K143R in Turkey. Antimicrob Agents Chemother 2020; 64:AAC.01001-20. [PMID: 32690638 DOI: 10.1128/aac.01001-20] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022] Open
Abstract
Clonal outbreaks of fluconazole-resistant (FLZR) Candida parapsilosis isolates have been reported in several countries. Despite its being the second leading cause of candidemia, the azole resistance mechanisms and the clonal expansion of FLZR C. parapsilosis blood isolates have not been reported in Turkey. In this study, we consecutively collected C. parapsilosis blood isolates (n = 225) from the fifth largest hospital in Turkey (2007 to 2019), assessed their azole susceptibility pattern using CLSI M27-A3/S4, and sequenced ERG11 for all and MRR1, TAC1, and UPC2 for a selected number of C. parapsilosis isolates. The typing resolution of two widely used techniques, amplified fragment length polymorphism typing (AFLP) and microsatellite typing (MST), and the biofilm production of FLZR isolates with and without Y132F were compared. Approximately 27% of isolates were FLZR (60/225), among which 90% (54/60) harbored known mutations in Erg11, including Y132F (24/60) and Y132F+K143R (19/60). Several mutations specific to FLZR isolates were found in MRR1, TAC1, and UPC2 AFLP grouped isolates into two clusters, while MST revealed several clusters. The majority of Y132F/Y132F+K143R isolates grouped in clonal clusters, which significantly expanded throughout 2007 to 2019 in neonatal wards. Candida parapsilosis isolates carrying Y132F were associated with significantly higher mortality and less biofilm production than other FLZR isolates. Collectively, we documented the first outbreak of FLZR C. parapsilosis blood isolates in Turkey. The MRR1, TAC1, and UPC2 mutations exclusively found in FLZR isolates establishes a basis for future studies, which will potentially broaden our knowledge of FLZR mechanisms in C. parapsilosis MST should be a preferred method for clonal analysis of C. parapsilosis isolates in outbreak scenarios.
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Management of Candida auris outbreak in a tertiary-care setting in Saudi Arabia. Infect Control Hosp Epidemiol 2020; 42:149-155. [PMID: 32880247 DOI: 10.1017/ice.2020.414] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe local experience in managing an outbreak of Candida auris in a tertiary-care setting. METHODS In response to emerging Candida auris, an outbreak investigation was conducted at our hospital between March 2018 and June 2019. Once a patient was confirmed to have Candida auris, screening of exposed patients and healthcare workers (HCWs) was conducted. Postexposure screening included those who had had direct contact with or shared the same unit or ward with a laboratory-confirmed case. In response to the increasing number of cases, new infection control measures were implemented. RESULTS In total, 23 primary patients were detected over 15 months. Postexposure screening identified 11 more cases, and all were patients. Furthermore, ~28.6% of patients probably caught infection in another hospital or in the community. Infection control measures were strictly implemented including hand hygiene, personal protective equipment, patient hygiene, environmental cleaning, cohorting of patients and HCWs, and avoiding the sharing of equipment. The wave reached a peak in April 2019, followed by a sharp decrease in May 2019 and complete clearance in June 2019. The case patients were equally distributed between intensive care units (51.4%) and wards (48.6%). More infections (62.9%) occurred than colonizations (37.1%). Urinary tract infection (42.9%) and candidemia (17.1%) were the main infections. In total, 7 patients (20.0%) died during hospitalization; among them, 6 (17.1%) died within 30 days of diagnosis. CONCLUSIONS Active screening of exposed patients followed by strict infection control measures, including environmental cleaning, was successful in ending the outbreak. Preventing future outbreaks is challenging due to outside sources of infection and environmental resistance.
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Arias LS, Butcher MC, Short B, McKloud E, Delaney C, Kean R, Monteiro DR, Williams C, Ramage G, Brown JL. Chitosan Ameliorates Candida auris Virulence in a Galleria mellonella Infection Model. Antimicrob Agents Chemother 2020; 64:e00476-20. [PMID: 32482674 PMCID: PMC7526850 DOI: 10.1128/aac.00476-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023] Open
Abstract
Candida auris has emerged as a multidrug-resistant nosocomial pathogen over the last decade. Outbreaks of the organism in health care facilities have resulted in life-threatening invasive candidiasis in over 40 countries worldwide. Resistance by C. auris to conventional antifungal drugs such as fluconazole and amphotericin B means that alternative therapeutics must be explored. As such, this study served to investigate the efficacy of a naturally derived polysaccharide called chitosan against aggregative (Agg) and nonaggregative (non-Agg) isolates of C. aurisin vitro and in vivo. In vitro results indicated that chitosan was effective against planktonic and sessile forms of Agg and non-Agg C. auris In a Galleria mellonella model to assess C. auris virulence, chitosan treatment was shown to ameliorate killing effects of both C. auris phenotypes (NCPF 8973 and NCPF 8978, respectively) in vivo Specifically, chitosan reduced the fungal load and increased survival rates of infected Galleria, while treatment alone was nontoxic to the larvae. Finally, chitosan treatment appeared to induce a stress-like gene expression response in NCPF 8973 in the larvae likely arising from a protective response by the organism to resist antifungal activity of the compound. Taken together, results from this study demonstrate that naturally derived compounds such as chitosan may be useful alternatives to conventional antifungals against C. auris.
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Affiliation(s)
- Laís Salomão Arias
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- São Paulo State University (Unesp), School of Dentistry, Department of Preventive and Restorative Dentistry, São Paulo, Brazil
| | - Mark C Butcher
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
| | - Bryn Short
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
| | - Emily McKloud
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
| | - Chris Delaney
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
| | - Ryan Kean
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
| | - Douglas Roberto Monteiro
- São Paulo State University (Unesp), School of Dentistry, Department of Preventive and Restorative Dentistry, São Paulo, Brazil
- Graduate Program in Dentistry, University of Western São Paulo (UNOESTE), Prudente/São Paulo, Brazil
| | - Craig Williams
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
| | - Gordon Ramage
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
| | - Jason L Brown
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Biofilm Research Network, Glasgow Dental School, Glasgow, United Kingdom
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Mataraci-Kara E, Ataman M, Yilmaz G, Ozbek-Celik B. Evaluation of antifungal and disinfectant-resistant Candida species isolated from hospital wastewater. Arch Microbiol 2020; 202:2543-2550. [DOI: 10.1007/s00203-020-01975-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
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Abstract
Candida auris is an enigmatic yeast that provides substantial global risk in health care facilities and intensive care units. A unique phenotype exhibited by certain isolates of C. auris is their ability to form small clusters of cells known as aggregates, which have been to a limited extent described in the context of pathogenic traits. In this study, we screened several nonaggregative and aggregative C. auris isolates for biofilm formation, where we observed a level of heterogeneity among the different phenotypes. Next, we utilized an RNA sequencing approach to investigate the transcriptional responses during biofilm formation of a nonaggregative and aggregative isolate of the initial pool. Observations from these analyses indicate unique transcriptional profiles in the two isolates, with several genes identified relating to proteins involved in adhesion and invasion of the host in other fungal species. From these findings, we investigated for the first time the fungal recognition and inflammatory responses of a three-dimensional skin epithelial model to these isolates. In these models, a wound was induced to mimic a portal of entry for C. auris We show that both phenotypes elicited minimal response in the model minus induction of the wound, yet in the wounded tissue, both phenotypes induced a greater response, with the aggregative isolate more proinflammatory. This capacity of aggregative C. auris biofilms to generate such responses in the wounded skin highlights how this opportunistic yeast is a high risk within the intensive care environment where susceptible patients have multiple indwelling lines.IMPORTANCE Candida auris has recently emerged as an important cause of concern within health care environments due to its ability to persist and tolerate commonly used antiseptics and disinfectants, particularly when attached to a surface (biofilms). This yeast is able to colonize and subsequently infect patients, particularly those that are critically ill or immunosuppressed, which may result in death. We have undertaken analysis on two different phenotypic types of this yeast, using molecular and immunological tools to determine whether either of these has a greater ability to cause serious infections. We describe that both isolates exhibit largely different transcriptional profiles during biofilm development. Finally, we show that the inability to form small aggregates (or clusters) of cells has an adverse effect on the organism's immunostimulatory properties, suggesting that the nonaggregative phenotype may exhibit a certain level of immune evasion.
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Schwartz RA, Kapila R. Cutaneous manifestations of a 21st century worldwide fungal epidemic possibly complicating the COVID-19 pandemic to jointly menace mankind. Dermatol Ther 2020; 33:e13481. [PMID: 32369240 DOI: 10.1111/dth.13481] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022]
Abstract
In view of the new viral COVID-19 pandemic, the fungal Candida auris epidemic still in progress worldwide highlights non-Candida albicans candidal infections. We describe an immunocompetent woman with a cutaneous manifestation of Candida parasilopsis fungemia, a prominent eschar, which proved to be the nidus for the candidemia. We stress the value of selectively removing eschars. C. parasilopsis and C. auris are increasingly important causes of sepsis and wound infections. We emphasize that commercially available biochemical-based tests may misidentify C. auris as C. parapsilosis, and stress the added danger of C. auris to critically ill-hospitalized COVID-19 patients. Any health care facility with evidence of infection or colonization with C. auris requires very close monitoring, since this fungus is a nosocomial threat comparable to SARS-CoV-2 in its mortality and fomite adhesiveness! Both organisms have the potential to be transmitted as nosocomial pathogens; health care workers need to follow strict CDC guidelines. During this COVID-19 pandemic, every health care facility should closely monitor for the possible deadly combination of the SARS-CoV-2 and C. auris. The identification of C. auris necessitates use of sophisticated technology not readily available to make this essential diagnosis since C. auris is multi-drug resistant and isolation precautions would become paramount.
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Affiliation(s)
- Robert A Schwartz
- Dermatology, Medicine, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rajendra Kapila
- Dermatology, Medicine, and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Lara HH, Ixtepan-Turrent L, Yacaman MJ, Lopez-Ribot J. Inhibition of Candida auris Biofilm Formation on Medical and Environmental Surfaces by Silver Nanoparticles. ACS APPLIED MATERIALS & INTERFACES 2020; 12:21183-21191. [PMID: 31944650 PMCID: PMC8243355 DOI: 10.1021/acsami.9b20708] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Candida auris is an emerging pathogenic fungus implicated in healthcare-associated outbreaks and causes bloodstream infections associated with high mortality rates. Biofilm formation represents one of the major pathogenetic traits associated with this microorganism. Unlike most other Candida species, C. auris has the ability to survive for weeks on different surfaces. Therefore, there is an urgent need to develop new effective control strategies to combat the threat of C. auris. Advances in nanotechnologies have emerged that carry significant potential impact against Candida biofilms. We obtained pure round silver nanoparticles (AgNPs) (1 to 3 nm in diameter) using a microwave-assisted synthetic approach. When tested against C. auris, our results indicated a potent inhibitory activity both on biofilm formation (half maximal inhibitory concentration (IC50) of 0.06 ppm) and against preformed biofilms (IC50 of 0.48 ppm). Scanning electron microscopy images of AgNP-treated biofilms showed cell wall damage mostly by disruption and distortion of the outer surface of the fungal cell wall. In subsequent experiments AgNPs were used to functionalize medical and environmental surfaces. Silicone elastomers functionalized with AgNPs demonstrated biofilm inhibition (>50%) at relatively low concentrations (2.3 to 0.28 ppm). Bandage dressings loaded with AgNPs inhibited growth of C. auris biofilms by more than 80% (2.3 to 0.017 ppm). Also, to demonstrate long-lasting protection, dressings loaded with AgNPs (0.036 ppm) were washed thoroughly with phosphate-buffered saline, maintaining protection against the C. auris growth from cycles 1 to 3 (>80% inhibition) and from cycles 4 to 6 (>50% inhibition). Our results demonstrate the dose-dependent activity of AgNPs against biofilms formed by C. auris on both medical (silicone elastomer) and environmental (bandage fibers) surfaces. The AgNPs-functionalized fibers retain the fungicidal effect even after repeated thorough washes. Overall these results point to the utility of silver nanoparticles to prevent and control infections caused by this emerging pathogenic fungus.
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Affiliation(s)
- Humberto H. Lara
- Department of Biology and South Texas Center for Emerging Infectious Diseases
| | - Liliana Ixtepan-Turrent
- Departamento de Ciencias Basicas, Division de Ciencia de la Salud, Universidad de Monterrey, San Pedro Garza García, Nuevo León 66238, México
| | - Miguel Jose Yacaman
- Department of Applied Physics and Materials Science, Northern Arizona University, 700 South Osborne Drive, Flagstaff, Arizona 86011, United States
| | - Jose Lopez-Ribot
- Department of Biology and South Texas Center for Emerging Infectious Diseases
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ElBaradei A. A decade after the emergence of Candida auris: what do we know? Eur J Clin Microbiol Infect Dis 2020; 39:1617-1627. [PMID: 32297040 DOI: 10.1007/s10096-020-03886-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022]
Abstract
Candida auris is a remarkable emerging pathogen. It has emerged separately, yet simultaneously in different parts of the world, establishing four phylogenetic and geographic distinct clades with a potential fifth clade that was recently reported. C. auris is often perceived as a pathogen in disguise, due to its frequent misidentification and its immune evasion. On the other hand, many of the recovered isolates are multidrug-resistant. In fact, some of these isolates are resistant to the three main antifungal classes: echinocandins, azoles, and polyenes. Moreover, C. auris has the ability to persist and survive on different objects for a long time, aided by different adhering mechanisms including aggregation and biofilm formation, thereby causing outbreaks of invasive infections in hospital settings. However, C. auris ability to maintain its pathogenicity at high temperatures remains among its most unique properties. This is why C. auris represents a challenging threat, and more studies are needed to meet this challenge. This review highlights different characteristics of this emerging yeast with emphasis on its antifungal resistance, its ability to persistent on different surfaces, and its immune evasion capability.
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Affiliation(s)
- Amira ElBaradei
- Department of Microbiology and Immunology, Faculty of Pharmacy and Drug Manufacturing, Pharos University in Alexandria, Alexandria, Egypt. .,Alexandria University Hospital, Alexandria University, Alexandria, Egypt.
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Kean R, Brown J, Gulmez D, Ware A, Ramage G. Candida auris: A Decade of Understanding of an Enigmatic Pathogenic Yeast. J Fungi (Basel) 2020; 6:jof6010030. [PMID: 32110970 PMCID: PMC7150997 DOI: 10.3390/jof6010030] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 12/17/2022] Open
Abstract
Candida auris is an enigmatic yeast that continues to stimulate interest within the mycology community due its rapid and simultaneous emergence of distinct clades. In the last decade, almost 400 manuscripts have contributed to our understanding of this pathogenic yeast. With dynamic epidemiology, elevated resistance levels and an indication of conserved and unique pathogenic traits, it is unsurprising that it continues to cause clinical concern. This mini-review aims to summarise some of the key attributes of his remarkable pathogenic yeast.
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Affiliation(s)
- Ryan Kean
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Jason Brown
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G2 3JZ, UK
| | - Dolunay Gulmez
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G2 3JZ, UK
- Medical Microbiology Department, Faculty of Medicine, Hacettepe University, Ankara 06230, Turkey
| | - Alicia Ware
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Gordon Ramage
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow G2 3JZ, UK
- Correspondence: ; Tel.: +44(0)141 211 9752
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Buil JB, van der Lee HAL, Curfs-Breuker I, Verweij PE, Meis JF. External Quality Assessment Evaluating the Ability of Dutch Clinical Microbiological Laboratories to Identify Candida auris. J Fungi (Basel) 2019; 5:jof5040094. [PMID: 31591307 PMCID: PMC6958413 DOI: 10.3390/jof5040094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Candida auris is a yeast that is causing nosocomial outbreaks in healthcare facilities around the world. There is a risk of the misidentification of C. auris with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)—when libraries are used that lack C. auris spectra, or when conventional biochemical methods are used. Methods: We conducted an external quality assessment to evaluate the ability of Dutch clinical microbiological laboratories to identify C. auris, and to raise awareness about the risk of misidentification. Results: 35/47 participating laboratories were able to identify C. auris correctly. Only 2/14 labs that potentially misidentified C. auris with their primary identification methods specified that they would perform additional tests to exclude C. auris when appropriate. 45/47 labs used MALDI-TOF MS systems to identify Candida species. Conclusions: There was a lack of awareness about the potential misidentification of C. auris in many labs that used MALDI-TOF MS with libraries that lacked C. auris spectra, and labs that used Vitek 2. However, as the currently available MALDI-TOF MS libraries in The Netherlands contain several C. auris spectra, we expect that currently almost all participating laboratories are able to identify C. auris correctly, as 45/47 participating laboratories use MALDI-TOF MS as their primary yeast identification method.
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Affiliation(s)
- Jochem B Buil
- Department of Medical Microbiology, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands.
- Center of Expertise in Mycology Radboudumc/CWZ, 6525GA Nijmegen, The Netherlands.
| | - Henrich A L van der Lee
- Department of Medical Microbiology, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands.
- Center of Expertise in Mycology Radboudumc/CWZ, 6525GA Nijmegen, The Netherlands.
| | - Ilse Curfs-Breuker
- Department of Medical Microbiology, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands.
- Center of Expertise in Mycology Radboudumc/CWZ, 6525GA Nijmegen, The Netherlands.
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), 6532SZ Nijmegen, The Netherlands.
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands.
- Center of Expertise in Mycology Radboudumc/CWZ, 6525GA Nijmegen, The Netherlands.
| | - Jacques F Meis
- Department of Medical Microbiology, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands.
- Center of Expertise in Mycology Radboudumc/CWZ, 6525GA Nijmegen, The Netherlands.
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), 6532SZ Nijmegen, The Netherlands.
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Wall G, Herrera N, Lopez-Ribot JL. Repositionable Compounds with Antifungal Activity against Multidrug Resistant Candida auris Identified in the Medicines for Malaria Venture's Pathogen Box. J Fungi (Basel) 2019; 5:jof5040092. [PMID: 31581540 PMCID: PMC6958377 DOI: 10.3390/jof5040092] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background. Candida auris has spread rapidly around the world as a causative agent of invasive candidiasis in health care facilities and there is an urgent need to find new options for treating this emerging, often multidrug-resistant pathogen. Methods. We screened the Pathogen Box® chemical library for inhibitors of C. auris strain 0390, both under planktonic and biofilm growing conditions. Results. The primary screen identified 12 compounds that inhibited at least 60% of biofilm formation or planktonic growth. After confirmatory dose-response assays, iodoquinol and miltefosine were selected as the two main leading repositionable compounds. Iodoquinol displayed potent in vitro inhibitory activity against planktonic C. auris but showed negligible inhibitory activity against biofilms; whereas miltefosine was able to inhibit the growth of C. auris under both planktonic and biofilm-growing conditions. Subsequent experiments confirmed their activity against nine other strains C. auris clinical isolates, irrespective of their susceptibility profiles against conventional antifungals. We extended our studies further to seven different species of Candida, also with similar findings. Conclusion. Both drugs possess broad spectrum of activity against Candida spp., including multiple strains of the emergent C. auris, and may constitute promising repositionable options for the development of novel therapeutics for the treatment of candidiasis.
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Affiliation(s)
- Gina Wall
- Department of Biology and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA.
| | - Natalia Herrera
- Department of Biology and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA.
| | - José L Lopez-Ribot
- Department of Biology and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA.
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Abstract
The enigmatic yeast Candida auris has emerged over the last decade and rapidly penetrated our consciousness. The global threat from this multidrug-resistant yeast has generated a call to arms from within the medical mycology community. Over the past decade, our understanding of how this yeast has spread globally, its clinical importance, and how it tolerates and resists antifungal agents has expanded. This review highlights the clinical importance of antifungal resistance in C. auris and explores our current understanding of the mechanisms associated with azole, polyene, and echinocandin resistance. We also discuss the impact of phenotypic tolerance, with particular emphasis on biofilm-mediated resistance, and present new pipelines of antifungal drugs that promise new hope in the management of C. auris infection.
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