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Candida Glabrata- Pathogenesis and Therapy

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Candida Glabrata- Pathogenesis and Therapy Central Annals of Clinical and Medical Microbiology Mini Review *Corresponding author Ivan Minic, Department of Periodontology and Oral medicine, University of Niš, Serbia, Tel: +381643004883; Candida Glabrata- Email: Submitted: 12 December 2018 Pathogenesis and Therapy Accepted: 31 December 2018 Published: 31 December 2018 Ivan Minic* and Ana Pejcic ISSN: 2578-3629 Copyright Department of Periodontology and Oral medicine, University of Niš, Serbia © 2018 Minic et al. Abstract OPEN ACCESS Candida species has been on the rise in recent years. Species Candida glabrata Keywords is the second most common candidate for candidiasis and is associated with a high • Candida glabrata rate mortality in immunocompromised patients. Candida glabrata is an increasing • Pathogenesis cause of candidemia, especially at cancer and bone marrow transplant centers • Therapy where fluconazole is used for antifungal prophylaxis. This yeast is less susceptible to fluconazole in vitro than is Candida albicans. Pathogenicity infections are most commonly seen in the elderly, immunocompromised, and AIDS patients. It is most importantly known as an agent of urinary tract infections. In fact, 20% of all urinary yeast infections are due to C. glabrata, although they may be asymptomatic and left untreated. Patients with invasive infections such as those of blood, bones, heart, urinary tract and the brain are treated with intravenous amphotericin B or flucanozole for 48 to 72 hours until the infection is under control. This is followed by oral administration of the drugs for 2 to 6 weeks for the complete eradication of C. glabrata from the patient’s body. Recent advances in the C. glabrata molecular tool box should aid research into its virulence mechanisms, host–pathogen relationship and reveal novel putative drug targets. INTRODUCTION Since 1995, Candida species have become the fourth most fluconazole is used for antifungal prophylaxis. This yeast is less common cause of nosocomial bloodstream infection and are susceptiblePATHOGENESIS to fluconazole in vitro than is Candida albicans. associated with a crude mortality rate of 39%, which is the Candida glabrata, once known as Torulopsis glabrata, is highest mortality rate associated with any cause of nosocomial a common nonhyphae forming yeast isolate in the clinical bloodstream infections [1]. laboratory. It is a member, along with over 200 other species, of the Candida genus [6] The fungal cell wall is the predominant Candidiasis is a type of infection caused by fungi of the genus . site of interaction between the fungus and its host. This cell wall Candida, most commonly Candida albicans. This microbial is consists of a complex structure of polysaccharides, proteins, commonly found on the skin, in the digestive and genital tract, and lipids, but its composition is dynamic, responding to the mouth and throat. To infection, i.e. excessive propagation changes in the local environment. Expansion of the fungal wall and spread of the fungus occurs when, for certain reasons, the during growth involves permanent remodeling of the cell wall polysaccharide network, which is comprised of three major types its propagation is disturbed [2]. Then there is the development 7]. Chitin is ofbalance an infection, between which the fungus can affect and the the bacterial skin, nails, flora oral that cavity regulates and full organs. This disease affects as many as 75% of women, essentialof polysaccharide: for biological mannans, functions β-glucans, in fungi, and including chitin [cell division, and in 10% of cases it is a permanent problem [3]. The type of forminga homopolymer the primary of β1, septum 4-N-acetylglucosamine of all septa, hyphal (GlcNAc) growth, and and is Candida albicans is the most common, but not the only candidate virulence. Chitin synthesis in C. glabrata is carried out by chitin for candidiasis whose clinical picture may vary from mild synthases. Deregulation of chitin biosynthesis is a potential surface infections to life-threatening systemic diseases. Number mechanism of virulence and resistance to antifungal treatments Infection caused by non-albicans Candida species has been on the [8-11]. rise in recent years. Species Candida glabrata is the second most Pathogenicity infections are most commonly seen in the common candidate for candidiasis and is associated with a high rate mortality in immunocompromised patients [4, 5] importantly known as an agent of urinary tract infections. In fact, Candida glabrata is an increasing cause of candidemia, 20%elderly, of all immunocompromised, urinary yeast infections and are AIDSdue to patients. C. glabrata, It althoughis most especially at cancer and bone marrow transplant centers where they may be asymptomatic and left untreated [12]. Cite this article: Minic I, Pejcic A (2018) Candida Glabrata- Pathogenesis and Therapy. Ann Clin Med Microbiol 3(2): 1021. Minic et al. (2018) Email: [email protected] Central C. glabrata, relative to other pathogenic yeast species like C. albicans are C. albicans cannot survive beyond four months [20]. Rodrigues poorlyAt present,understood. the virulenceWhen compared factors associatedwith C. albicans, with C. glabrata etand al. can [21] survive, note that on thisinanimate adaptation surfaces has mostfor five likely months, arisen whilefrom can sometimes be considered to be “less virulent”. C. glabrata’s response to stresses like oxidative stress, nutrient limitation, competition with other microorganisms and the Furthermore, its inability to secrete proteases led it to lack of sporulation. Fidel et al. [22], Note that C. glabrata is not originally being called Torulopsis glabrata the species was only as sensitive to environmental conditions as C. albicans despite both species having comparable cell surface hydrophobicity is agreement that the two major functional differences between properties. However, in a more recent study it was found that C. C.reclassified albicans and to Candida C. glabrata because are the of its inability human of Pathogenicity. C. glabrata to There form glabrata has a notably higher relative cell-surface hydrophobicity true hyphae and to secrete certain proteases. than other Candida species [23]. More serious infections would include rare cases of Pathogenicity Infections are most commonly seen in the endocarditis, meningitis, and disseminated infections importantly known as an agent of urinary tract infections. elderly, immunocompromised, and AIDS patients. It is most (fungaemias). It has the ability to form sticky “biofilms” that In fact, 20% of all urinary yeast infections are due to C. Recentlyadhere to a livingshift has and been non-living noted from surfaces fungal (such disease as causedcatheters) by glabrata, although they may be asymptomatic and left untreated. C.thus albicans forming to microbialthat of non-albicans mats, making species treatment of Candida, more difficult.such as More serious infections would include rare cases of endocarditis, glabrata, especially in ICU patients [13,14]. This phenomenon is copied by selection less sensitive meningitis, and disseminated infections (fungaemias). It has the strains of C. glabrata ability to form sticky “biofilms” that adhere to living and non- prophylactic and therapeutics. One of the most important yeast fromliving fungal surfaces disease (such caused as catheters) by C. albicans thus forming to that microbialof non-albicans mats, virulence factors for C.yeast glabrata by the is the wide ability use toof adherefluconazole to tissues as a speciesmaking treatmentof Candida, more such difficult. as glabrata, Recently especially a shift inhas ICU been patients noted [24]. 15]. ahost serious and a clinicalbiotic surface, problem and because the establishment they increase of aresistance colonization to THERAPY process and the formation of a biofilm [ Biofilms represent the immune response of the host [16]. Resistance to antifungal treatment by C. glabrata was almost antifungal therapy and protects the cells within the biofilm from unheard of prior to HIV infection. However, with growing The pathogenesis of yeast C. glabrata is mediated by numerous numbers of patients being unable to rid invasive candidiasis due virulence factors, of which the most important adhesion ability to compromised immune systems and/or increased widespread to the tissue of the host and medical devices, the formation of antifungal usage, the drug resistance phenomenon is of immense resistance in clinical isolates across several countries has been biofilm and secretion of hydrolytic enzymes. Initial adherence to shownconcern to toincrease the medical in the period community. from 2001 The to proportion 2007. In C. glabrata,of azole candida is conditioned by non-specific factors (hydrophobic and electrostatic forces) and is supported. by specific adhesives on increased P-450-dependent ergosterol synthesis and an energy- the surface of fungal cells that recognize ligands such as proteins, several mechanisms of azole resistance have been identified: fibrinogen,The amount and fibronectin of fungal [17]adhesion may also depend on the resistance-type transporter [25]. Moreover, a study by Pfaller et surface properties of the microorganism and a biotic surfaces, dependent efflux pump of fluconazole, possibly via a multidrug Surface roughness is in a positive correlation with the rate of C. glabrata isolates was shown to have increased from no cases such as hydrophobicity, zeta potentials and surface roughness. betweenal. showed 2001 resistances and 2004 to toechinocandins
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