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Candida parapsilosis complex in the clinical setting

Nature Reviews Microbiology volume 22, pages 46–59 (2024)Cite this article

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Abstract

Representatives of the Candida parapsilosis complex are important yeast species causing human infections, including candidaemia as one of the leading diseases. This complex comprises C. parapsilosis, Candida orthopsilosis and Candida metapsilosis, and causes a wide range of clinical presentations from colonization to superficial and disseminated infections with a high prevalence in preterm-born infants and the potential to cause outbreaks in hospital settings. Compared with other Candida species, the C. parapsilosis complex shows high minimal inhibitory concentrations for echinocandin drugs due to a naturally occurring FKS1 polymorphism. The emergence of clonal outbreaks of strains with resistance to commonly used antifungals, such as fluconazole, is causing concern. In this Review, we present the latest medical data covering epidemiology, diagnosis, resistance and current treatment approaches for the C. parapsilosis complex. We describe its main clinical manifestations in adults and children and highlight new treatment options. We compare the three sister species, examining key elements of microbiology and clinical characteristics, including the population at risk, disease manifestation and colonization status. Finally, we provide a comprehensive resource for clinicians and researchers focusing on Candida species infections and the C. parapsilosis complex, aiming to bridge the emerging translational knowledge and future therapeutic challenges associated with this human pathogen.

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Fig. 1: Candida parapsilosis complex morphology and infectious cycle.
Fig. 2: Comparison of the Candida parapsilosis complex in neonates and adults: risk factors, colonization and infection.
Fig. 3: Candida parapsilosis complex in the clinical setting.

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Acknowledgements

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    Miriam Govrins & Cornelia Lass-Flörl

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M.G. has no competing interests to declare. C.L.-F. reports grant support from Gilead Sciences and Astellas Pharma; has received consulting fees or payment/honoraria for lectures, presentations and educational events from Gilead Sciences, Merck Sharp and Dohme, Pfizer, BioMerieux, F2G and Immy; and has received support for attending meetings and/or travel from Gilead Sciences.

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Glossary

Antifungal susceptibility testing

An in vitro phenotypic method that measures the ability of a particular antifungal drug to inhibit the growth of a fungus over a range of concentrations, with the resulting minimum inhibitory concentration corresponding to the lowest concentration that inhibits fungal growth.

Antimicrobial resistance

Fungal growth above established susceptibility thresholds, as determined by the minimal inhibitory concentration for a given drug.

Clinical breakpoints

Values that categorize fungi as ‘susceptible’, ‘susceptible, increased exposure’ and ‘resistant’ based on minimum inhibitory concentrations, resistance markers, and pharmacokinetic and pharmacodynamic values from animal and human subjects, patient treatment and outcome data derived from controlled clinical trials.

Clonal outbreaks

The occurrence of cases of diseases that are in excess of what would normally be expected and that are caused by genetically identical microbial pathogens.

Epidemiological cut-off values

The highest minimum inhibitory concentrations for isolates devoid of phenotypically detectable resistance mechanisms.

Heterozygous

An organism that has different copies of an allele for a particular marker.

Homozygous

An organism that has the same two copies of an allele for a genomic marker.

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Govrins, M., Lass-Flörl, C. Candida parapsilosis complex in the clinical setting. Nat Rev Microbiol 22, 46–59 (2024). https://doi.org/10.1038/s41579-023-00961-8

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