Candidiasis Pathogenesis and Antifungal Resistance
Summary
Candidiasis arises when normally commensal Candida species, most notably Candida albicans, exploit host vulnerabilities to transition from benign colonisers to invasive pathogens. Key virulence attributes include the ability to adhere to epithelial and endothelial surfaces, switch between yeast and filamentous forms (morphogenesis), and assemble protective biofilms composed of extracellular matrix. Within biofilms, yeast cells evade immune surveillance and display reduced susceptibility to antifungal agents. Host factors such as immunosuppression, barrier disruption and microbiome imbalance further tip the balance towards infection, resulting in mucosal, cutaneous or systemic disease. Antifungal therapy relies primarily on azoles, echinocandins and polyenes, each targeting distinct fungal components. Resistance mechanisms have emerged through overexpression of efflux pumps, mutations in drug‐target enzymes, alterations in membrane sterol composition and enhanced biofilm formation. The global rise in antifungal resistance threatens treatment efficacy, emphasising the need for novel diagnostics, stewardship and alternative therapeutics to safeguard public health.
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Candidiasis Pathogenesis and Antifungal Resistance publication trend
The graph below shows the total number of articles in candidiasis pathogenesis and antifungal resistance across all publications each year (not limited to Nature Index journals).
Technical terms
Biofilm: A structured community of fungal cells encased in extracellular matrix that confers protection against host defences and antifungal agents.
Efflux pump: A membrane protein that actively exports antifungal drugs from the cell, reducing intracellular drug concentration and efficacy.
Minimum inhibitory concentration (MIC): The lowest concentration of an antifungal agent required to prevent visible fungal growth in vitro.
Azole: A class of antifungal drugs that inhibit ergosterol synthesis by targeting the lanosterol 14α‐demethylase enzyme.
Genotype: The genetic constitution of a Candida strain, which can influence virulence traits and susceptibility to antifungal drugs.
References
- Phenotypic and genotypic characterization of Candida species from the oral cavity of healthy individuals in Lublin province, Poland. Journal of Oral Microbiology (2024).
- Distribution of clinical isolates of Candida spp. and antifungal susceptibility of high biofilm-forming Candida isolates. Revista da Sociedade Brasileira de Medicina Tropical (2018).
- Fungal diversity and drug susceptibility of the oral mycobiome of domestic dogs. Frontiers in Veterinary Science (2023).
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