Candida não-albicans (glabrata, krusei, parapsilosis, tropicalis, auris)
Gram-positive yeasts
Identification & Growth
Identification
- Germ tube-negative; identify by CHROMagar, carbohydrate assimilation panel, or MALDI-TOF
- C. glabrata: small yeast, without pseudohyphae
Growth Conditions
- Sabouraud agar, 30–35 °C, 24–72 h; C. auris grows well at 42 °C
Clinical Significance
- Hospital-acquired candidemia, catheter infection, fungal UTI; C. parapsilosis linked to catheters and parenteral nutrition
Intrinsic Resistance
- C. krusei: intrinsically resistant to fluconazole
- C. glabrata: susceptible-dose-dependent response to azoles
- C. parapsilosis: intrinsically higher MICs to echinocandins (FKS polymorphism)
- C. auris: multidrug resistance is frequent
Bench Alerts
- Always identify to species level — the therapeutic choice depends on it
- C. auris requires contact precautions and notification to infection control
Clinical Notes
Clinical presentations
- Causes candidemia and invasive candidiasis with clinical presentation similar to that caused by C. albicans, indistinguishable without culture.
- Candida parapsilosis is strongly associated with catheter-related infections and neonatal candidemia in neonatal intensive care units.
- Candida auris causes severe hospital outbreaks with persistent skin and surface colonization, and high rates of intrahospital spread.
- Candida glabrata and krusei are more common in elderly, oncologic patients, or those with prior azole exposure.
Specimens and collection
- Peripheral and catheter blood cultures are essential for diagnosis and evaluation of candidemia origin.
- Axillary or inguinal swab is used for C. auris colonization screening in at-risk patients or contacts of confirmed cases.
- Species-level laboratory identification is mandatory, given the direct impact on therapeutic choice and infection control.
Epidemiology and at-risk populations
- Candida auris is considered a critical global threat by CDC and WHO due to multidrug resistance and nosocomial transmission capacity.
- Prior exposure to azole and echinocandin antifungals selects for non-albicans species that are intrinsically less susceptible.
- Low-birth-weight premature neonates are at particular risk of catheter-related C. parapsilosis candidemia.
Resistance and therapeutic implications
- Candida krusei is intrinsically resistant to fluconazole, requiring an echinocandin or another antifungal from the outset.
- Candida glabrata shows reduced, dose-dependent susceptibility to azoles, plus emerging echinocandin resistance in some isolates.
- Candida auris frequently shows resistance to multiple antifungal classes, including pan-drug resistance in subsets of isolates.
- Candida parapsilosis has intrinsically reduced echinocandin susceptibility, favoring azole use when susceptible.
Bench and reporting notes
- MALDI-TOF identification may have limitations for C. auris depending on the instrument database, potentially requiring confirmatory sequencing.
- Antifungal susceptibility testing should be performed routinely on every non-albicans species blood isolate.
- Identification of C. auris should immediately trigger contact precautions and notification to public health authorities.
Sources
- CDC — Candida auris
- IDSA — Clinical practice guideline for candidiasis
- EUCAST — Antifungal clinical breakpoints
- WHO — Fungal priority pathogens list
Educational decision-support content. It does not replace laboratory validation, current guidelines or review by the responsible professional.
FAQ: Frequently Asked Questions
How to identify Candida não-albicans (glabrata, krusei, parapsilosis, tropicalis, auris) in the lab?
Candida não-albicans (glabrata, krusei, parapsilosis, tropicalis, auris) is identified through germ tube-negative; identify by chromagar, carbohydrate assimilation panel, or maldi-tof, c. glabrata: small yeast, without pseudohyphae.
What are the intrinsic resistances of Candida não-albicans (glabrata, krusei, parapsilosis, tropicalis, auris)?
This organism is naturally resistant to c. krusei: intrinsically resistant to fluconazole, c. glabrata: susceptible-dose-dependent response to azoles, c. parapsilosis: intrinsically higher mics to echinocandins (fks polymorphism), c. auris: multidrug resistance is frequent. These drugs should not be reported as susceptible.
Where is Candida não-albicans (glabrata, krusei, parapsilosis, tropicalis, auris) commonly found?
It is typically associated with hospital-acquired candidemia, catheter infection, fungal uti; c. parapsilosis linked to catheters and parenteral nutrition.
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