Virulence factors attributed to pathogenicity of non albicans Candida species isolated from Human Immunodeficiency virus infected patients with oropharyngeal candidiasis.

  • Sachin Chandrakant Deorukhkar Rural Medical college
  • Santosh Saini Rural Medical College
Keywords: Candid albicans, extracellular hydrolytic enzymes, haemolysin, Non albicans Candida, Virulence factors.


Background: Oropharyngeal candidiasis (OPC) is the most common opportunistic mycoses among HIV infected patients. Although Candida albicans is the most common aetiological agent of OPC, in recent years non albicans Candida (NAC) species have become increasingly prominent pathogens. As compared to C. albicans, NAC spp. often demonstrates low susceptibility to commonly used antifungal drugs.Aim: The present study was conducted with an aim to determine the expression of virulence factors of NAC spp. isolated from HIV infected patients with OPC.Methods: A total of 123 NAC spp. isolated from HIV infected patients with OPC were included in the study. The virulence factors studied were adherence to buccal epithelial cell, exoenzymatic activity and haemolytic activities.Results: C. glabrata and C. tropicalis were predominant isolates from NAC spp. ABEC was more in C. dubliniensis isolates. As compared to other NAC spp. C. glabrata demonstrated low ABEC. High phospholipase activity was noted in C. tropicalis followed by C. kefyr. Proteinase activity was high in C. dubliniensis followed by C. tropicalis. Haemolysin production was high in C. tropicalis followed by C. kefyr isolates.Conclusion: NAC spp. once overlooked as mere contaminants or non pathogenic commensals have emerged as potent pathogens. These isolates are capable of producing virulence factors once attributed only to C. albicans. Knowledge of these virulence factors is important for understanding the pathogenesis of candidiasis and will help to explore new antimycotic drug targets for improved therapeutic regimens.


1. Junqueria JC, Fuchs BB, Muhammed M, Coleman JJ, Suleiman JMAH, Vilela SFG et al. Oral Candida albicans isolates from HIV-positive individuals have similar in vitro biofilm-forming ability and pathogenicity as invasive Candida isolates. BMC Microbiology 2011; 11: 247-55.

2. Jeddy N, Ranganathan K, Devi U, Joshua E. A study of antifungal drug sensitivity of Candida isolated from human immunodeficiency virus infected patients in Chennai. South India. J Oral Maxillofac Pathol 2011; 15:182-6.

3. Cannon RD, Chaffin WL. Oral colonization by Candida albicans. Crit Rev Oral Biol Med 1999; 10:359-83.

4. Sardi JCO, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJS. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol 2013; 62:10-24.

5. Kimura LH, Pearsall NN. Adherence of Candida albicans to human buccal epithelial cells. Infect Immun 1978; 21: 64-8.

6. Samaranayake LP, Raeside JM, MacFarlane TW. Factors affecting the phospholipase activity of Candida species in vitro. Sabouraudia1984; 22:201–07.

7. Aoki S, Ito Kuwa S, Nakamura Y. Comparative pathogenicity of wild type strains and respiratory mutants of Candida albicans in mice. Zentralbl Bakteriol 1990; 273: 332-43.

8. Luo G, Samaranayake LP, Yau JY. Candida species exhibit differential in vitro haemolytic activities. J Clin Microbiol 2001; 39: 2971-74.

9. Mane A, Panchvalli S, Bembalkar S, Risbud A. Species distribution & antifungal susceptibility of oral Candida colonising or infecting HIV infected individuals. Indian J Med Res 2010; 131: 836–38.

10. Johnson EM, Warnock DW, Luker J, Porter SR, Scully C. Emergence of azole drug azole drug resistance in Candida species from HIV-infected patients receiving prolonged fluconazole therapy for oral candidosis. J Antimicrob Chemother 1995; 35: 103-14.

11. Deorukhkar S, Saini S. Virulence markers and antifungal susceptibility profile of Candida glabrata: an emerging pathogen. British Microbiology Research Journal 2014; 4: 35-45.

12. Samaranayake LP, Fidel PL, Naglik JR, Sweet SP, Teanpaisan R, Coogan MM, et al. Fungal infections associated with HIV infection. Oral Dis 2002; 8 (suppl. 2): 151-60.

13. Gilfillan GD, Sullivan DJ, Haynes K, Parkison T, Coleman DC, Coleman NA. Candida dubliniensis: phylogeny and putative virulence factors. Microbiology 1998; 144: 829-38.

14. Li L, Redding S, Dongari-bagtzoglou A. Candida glabrata, an emerging oral opportunistic pathogen. J Dent Res 2007; 86:204-15.

15. Deorukhkar SC, Saini S, Mathew S. Virulence factors contributing to pathogenicity of Candida tropicalis and its antifungal susceptibility profile. Int J Microbiol 2014, Article ID 456878, 6 pages, doi: 10.1155/2014/456878.

16. Thangam M, Smitha S, Deivanayagam CN. Phospholipase activity of Candida isolates from patients with chronic lung disease. Lung India 1989; 49:125-26.

17. Borst A, Fluit AC. High levels of hydrolytic enzymes secreted by Candida albicans isolates involved in respiratory infections. J Med Microbiol 2003; 52:971-74.
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