Outbreak of Candida parapsilosis in a neonatal intensive care unit: a health care workers source

Hernández‐Castro, Rigoberto; Arroyo‐Escalante, Sara; Carrillo-Casas, Erika M.; Moncada-Barrón, David; Álvarez-Verona, Elizabeth; Hernández-Delgado, Lorena; Torres-Narváez, Patricia; Lavalle-Villalobos, Antonio

doi:10.1007/s00431-009-1109-7

Cited by 74 publications

(56 citation statements)

References 20 publications

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“…Indeed, there is some evidence for this: C. parapsilosis is more commonly isolated from skin than C. albicans, with one study identifying it as the most commonly isolated yeast species on hands (55-57; see also reference 58). A few studies have linked cases in neonatal intensive care units to transmission from health care workers (59)(60)(61), including the type strain CDC317 (47). The prevalence of C. parapsilosis fungemia in neonates suggests that this population is particularly susceptible to this species (3,61,62) and that the risk factors for these patients may not be modeled effectively in vitro or in mouse models.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Virulence-Related Phenotypes in Candida Species of the CUG Clade

Priest

Lorenz

2015

Eukaryot Cell

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bCandida species cause a variety of mucosal and invasive infections and are, collectively, the most important human fungal pathogens in the developed world. The majority of these infections result from a few related species within the "CUG clade," so named because they use a nonstandard translation for that codon. Some members of the CUG clade, such as Candida albicans, present significant clinical problems, whereas others, such as Candida (Meyerozyma) guilliermondii, are uncommon in patients. The differences in incidence rates are imperfectly correlated with virulence in animal models of infection, but comparative analyses that might provide an explanation for why some species are effective pathogens and others are not have been rare or incomplete. To better understand the phenotypic basis for these differences, we characterized eight CUG clade species-C. albicans, C. dubliniensis, C. tropicalis, C. parapsilosis, Clavispora lusitaniae, M. guilliermondii, Debaryomyces hansenii, and Lodderomyces elongisporus-for host-relevant phenotypes, including nutrient utilization, stress tolerance, morphogenesis, interactions with phagocytes, and biofilm formation. Two species deviated from expectations based on animal studies and human incidence. C. dubliniensis was quite robust, grouping in nearly all assays with the most virulent species, C. albicans and C. tropicalis, whereas C. parapsilosis was substantially less fit than might be expected from its clinical importance. These findings confirm the utility of in vitro measures of virulence and provide insight into the evolution of virulence in the CUG clade. Candida species are the most important fungal pathogens of humans and are collectively responsible for a vast number of infections. These range from superficial mucosal infections such as vulvovaginal candidiasis, and oropharyngeal thrush, to lifethreatening infections such as disseminated hematogenous and invasive candidiasis. These latter infections have steadily increased in incidence in the last 30 years and are associated with a stubbornly high mortality rate as a result of the underlying immunodeficiency of the patients and inadequate diagnostics and treatments (1).Of the approximately 150 species in the genus, 95% of infections are caused by just four species: C. albicans, C. tropicalis, C. parapsilosis, and C. glabrata (2-4). C. albicans is the dominant species, representing about half of disseminated disease and an even greater percentage of mucosal infections. Other clinically relevant species include Clavispora lusitaniae (anamorph: Candida lusitaniae), M. guilliermondii (anamorph: Candida guilliermondii), C. krusei, and C. dubliniensis, while D. hansenii (synonym: Candida famata) and Lodderomyces elongisporus are subjects of rare clinical reports. Because the genus Candida is polyphyletic, a better sense of evolutionary relationships comes in the "CUG clade," a grouping of species that use an alternative genetic code in which that codon specifies serine rather than leucine (5, 6). The CUG clade encompasses ...

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Section: Discussionmentioning

confidence: 99%

Characterization of Virulence-Related Phenotypes in Candida Species of the CUG Clade

Priest

Lorenz

2015

Eukaryot Cell

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“…In some regions in Latin America and Spain, C. parapsilosis occurs at the same or even a higher frequency than does Candida albicans, particularly in bloodstream infections in young children and premature neonates (1)(2)(3)(4)(5)(6). C. parapsilosis is considered a normal or transient inhabitant of the skin and is found on the hands of health care workers who install central venous catheters and other medical devices, thus suggesting a nosocomial route of transmission (7)(8)(9)(10).…”

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confidence: 99%

Analysis of Inteins in the Candida parapsilosis Complex for Simple and Accurate Species Identification

et al. 2013

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cInteins are coding sequences that are transcribed and translated with flanking sequences and then are excised by an autocatalytic process. There are two types of inteins in fungi, mini-inteins and full-length inteins, both of which present a splicing domain containing well-conserved amino acid sequences. Full-length inteins also present a homing endonuclease domain that makes the intein a mobile genetic element. These parasitic genetic elements are located in highly conserved genes and may allow for the differentiation of closely related species of the Candida parapsilosis (psilosis) complex. The correct identification of the three psilosis complex species C. parapsilosis, Candida metapsilosis, and Candida orthopsilosis is very important in the clinical setting for improving antifungal therapy and patient care. In this work, we analyzed inteins that are present in the vacuolar ATPase gene VMA and in the threonyl-tRNA synthetase gene ThrRS in 85 strains of the Candida psilosis complex (46 C. parapsilosis, 17 C. metapsilosis, and 22 C. orthopsilosis). Here, we describe an accessible and accurate technique based on a single PCR that is able to differentiate the psilosis complex based on the VMA intein. Although the ThrRS intein does not distinguish the three species of the psilosis complex by PCR product size, it can differentiate them by sequencing and phylogenetic analysis. Furthermore, this intein is unusually present as both mini-and full-length forms in C. orthopsilosis. Additional population studies should be performed to address whether this represents a common intraspecific variability or the presence of subspecies within C. orthopsilosis.

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“…Candida parapsilosis nosocomial outbreaks have been reported to occur not only through direct and indirect contact via the hands of health care workers but also through contaminated patient care equipment (5,12,13,21). The close genetic relatedness of C. parapsilosis strains in clinical settings emphasizes the need for reliable identification methods to clarify potential transmission routes.…”

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confidence: 99%

Microsatellite Genotyping Clarified Conspicuous Accumulation of Candida parapsilosis at a Cardiothoracic Surgery Intensive Care Unit

et al. 2012

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Candida parapsilosis has become a significant cause of invasive fungal infections in seriously ill patients. Nosocomial outbreaks through direct and indirect contact have been described. The aim of this study was the molecular characterization of what appeared to be an ongoing C. parapsilosis outbreak at the cardiothoracic intensive care unit of the University Hospital of Vienna between January 2007 and December 2008. Using two different molecular typing methods-automated repetitive sequencebased PCR (DiversiLab; bioMérieux) and microsatellite genotyping-we investigated the genetic relationship of 99 C. parapsilosis isolates. Eighty-three isolates originated from the cardiothoracic intensive care unit, while 16 isolates were random control isolates from other intensive care units and a different Austrian hospital. The 99 C. parapsilosis isolates analyzed by repetitiveelement PCR all showed identical genotypes, suggesting an ongoing outbreak. In contrast, microsatellite genotyping showed a total of 56 different genotypes. Two major genotypes were observed in 10 and 15 isolates, respectively, whereas another 13 genotypes were observed in 2 to 4 isolates each. Forty-one genotypes were observed only once. Closely related genotypes that differed in only a single microsatellite marker were grouped into clonal complexes. When it comes to C. parapsilosis, microsatellite genotyping is a more discriminative method than repetitive-element PCR genotyping to investigate outbreaks.

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Outbreak of Candida parapsilosis in a neonatal intensive care unit: a health care workers source

Cited by 74 publications

References 20 publications

Characterization of Virulence-Related Phenotypes in Candida Species of the CUG Clade

Characterization of Virulence-Related Phenotypes in Candida Species of the CUG Clade

Analysis of Inteins in the Candida parapsilosis Complex for Simple and Accurate Species Identification

Microsatellite Genotyping Clarified Conspicuous Accumulation of Candida parapsilosis at a Cardiothoracic Surgery Intensive Care Unit

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