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临床环境中的近平滑念珠菌复合体

Candida parapsilosis complex in the clinical setting.

作者信息

Govrins Miriam, Lass-Flörl Cornelia

机构信息

Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.

出版信息

Nat Rev Microbiol. 2024 Jan;22(1):46-59. doi: 10.1038/s41579-023-00961-8. Epub 2023 Sep 6.

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.

摘要

近平滑念珠菌复合体的代表菌株是引起人类感染的重要酵母菌种,包括念珠菌血症这一主要疾病。该复合体包括近平滑念珠菌、正平滑念珠菌和副平滑念珠菌,可导致从定植到浅表及播散性感染的广泛临床表现,在早产儿中患病率很高,且有可能在医院环境中引发暴发。与其他念珠菌属相比,由于天然存在的FKS1多态性,近平滑念珠菌复合体对棘白菌素类药物表现出较高的最低抑菌浓度。对常用抗真菌药物(如氟康唑)耐药的菌株出现克隆暴发,令人担忧。在本综述中,我们介绍了有关近平滑念珠菌复合体的流行病学、诊断、耐药性及当前治疗方法的最新医学数据。我们描述了其在成人和儿童中的主要临床表现,并强调了新的治疗选择。我们比较了这三个姊妹菌种,研究了微生物学和临床特征的关键要素,包括高危人群、疾病表现和定植状态。最后,我们为专注于念珠菌属感染和近平滑念珠菌复合体的临床医生和研究人员提供了一个全面的资源,旨在弥合与这种人类病原体相关的新兴转化知识与未来治疗挑战之间的差距。

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