Candidemia by Candida parapsilosis in a neonatal intensive care unit: human and environmental reservoirs, virulence factors, and antifungal susceptibility

Abstract

The Candida parapsilosis complex has emerged as one of the main causes of candidemia worldwide. This study aims to evaluate possible C. parapsilosis sensu stricto reservoirs in a NICU, the expression of virulence factors, and antifungal susceptibility, and to analyze their genetic and phenotypic similarity. The study included 17 isolates of C. parapsilosis: seven environmental, one from a newborn’s mother, and nine samples from six newborns. We used molecular and phenotypic tests to characterize the isolates and to trace possible routes of infection. The genetic similarity was determined by random amplified polymorphic DNA. The hemolytic and DNAse activity was determined using sheep’s blood and DNAse agar, biofilm production by XTT method, and the susceptibility to antifungals through microdilution methodology. Two environmental strains isolated in the same month had high similarity. The 17 isolates expressed at least one of the three virulence factors studied, and one environmental isolate was resistant to fluconazole. This study shows that environmental contamination can be an important reservoir of potentially pathogenic microorganisms, since isolates of C. parapsilosis sensu stricto collected from the hospital environment were able to express virulence factors. Therefore, we emphasized the importance of determining the transmission routes in NICU in order to detect pathogen sources and reservoirs, as well as to establish prevention measures, such as adequate disinfection of the environment.

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Acknowledgments

We would like to thank the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for the Scientific Scholarship Initiation, Curso Técnico em Análises Clínicas (ESTES-UFU) for providing the necessary equipment to carry out all the tests, Professor Regina Helena Pires of the Franca University for assigning the ATCC strains of the C. parapsilosis complex required to carry out the molecular differentiation of these isolates through the RFLP, and finally, Rodrigo Augusto Machado de Moraes for help in translating and correcting the article into English.

Funding

This study received financial support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Financing Code 001.

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Correspondence to Ralciane de Paula Menezes.

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The Committee of Ethics in Research approved the research with human participants at the Federal University of Uberlandia (Approval number 989.139/2015).

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de Paula Menezes, R., de Oliveira Melo, S.G., Bessa, M.A.S. et al. Candidemia by Candida parapsilosis in a neonatal intensive care unit: human and environmental reservoirs, virulence factors, and antifungal susceptibility. Braz J Microbiol 51, 851–860 (2020). https://doi.org/10.1007/s42770-020-00232-1

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Keywords

  • Antifungals
  • Candida parapsilosis
  • Neonates
  • NICU
  • Virulence
  • RAPD-PCR