Relationship between Sap prevalence and biofilm formation among resistant clinical isolates of Candida albicans

Abstract

BackgroundFungal infections represent a serious health problem especially in immunocompromised individuals. Candida albicans is the most common fungi that cause superficial and systemic infections with high mortality rates. Anti-fungal resistance of C. albicans may be attributed to its virulence. Biofilm formation and proteolytic activity are major virulence determents that may influence both pathogenicity and anti-fungal resistance of Candida albicans.ObjectiveThis work studied the relation between biofilm formation, proteolytic activity and prevalence of some Sap genes with reduced susceptibility of C. albicans to different anti-fungal agents.MethodsFifty three C. albicans strains isolated from patients with systemic infections, identified by germ tube, chromogenic agar and confirmed by PCR, were subjected to evaluate their proteolytic activity, the degree of biofilm production and the prevalence of Sap9 and Sap10 genes. The susceptibility of the isolates was determined by disk diffusion method against five antifungal drugs.Results and conclusionFour of the C. albicans isolates were resistant to 3 anti-fungal drugs, strong biofilm producer, have proteolytic activity and contain either Sap9 or Sap10 or both. Conclusively, although anti-fungal resistance among the isolates was rare, a relation between the anti-fungal resistance and some major virulence factors was evidently proved in this study.

<p>Antifungal Activity of ZnO Nanoparticles and Nystatin and Downregulation of SAP1-3 Genes Expression in Fluconazole-Resistant <em>Candida albicans</em> Isolates from Vulvovaginal Candidiasis</p>

“…In some reports from Iran, the incidence of VVC was 5-10%, 12 33.3% 13 and 47.3%. 5 We found that the frequency of VVC in our study is higher than the rates found in Nigerian [14.0%], Indian [20.47%], and Turkish [16%] studies. 1,23,25 In the present study, the species distribution of C. albicans isolates was similar to the study of Shi et al and Yano et al 11,12 There are limited data regarding the antifungal susceptibility of yeast species causing VVC.…”

“…Resistance of candida species against antifungal agents can infect approximately 5% of women at least four times a year. [3][4][5] The causes of the increasing incidence of VVC could be lowdosage azole maintenance regimens and the use of antifungal agents such as Fluconazole without a prescription. [6][7][8] Predisposing factors for VVC include reproductive age, use of contraceptive steroid medications and bacterial antibiotics, and being diabetic, pregnant, or immunocompromised.…”

Pathogenesis and Clinical Relevance of Candida Biofilms in Vulvovaginal Candidiasis

“…The importance of certain virulence factors was found to be closely related to Sap, which is related to biofilm production as described by Kadry et al (2018). Isolates that were found to be resistant to three different anti-fungal drugs were reported as strong biofilm producers and shown to possess proteolytic activity as they contained either Sap9 or Sap10, or both (Černáková et al, 2019).…”

The regulation of hyphae growth in Candida albicans

“…Previous studies revealed a correlation between prevalence of SAP9 and SAP10 genes and the strong biofilm producers by C. albicans isolates, as 66.7% of these isolates have both Sap9 and Sap10. Sap 9 and Sap10 enzymes maintain cell surface integrity of the Candida cell wall and promote biofilm formation [113]. Recent studies have found that patients infected with fluconazole-resistant C. albicans can enhance the Sap production when treated with this drug [110].…”