title: Genetic and phenotypic characterization of Candida albicans strains isolated from infectious disease patients in Shanghai.
abstract: Candida albicans, as an opportunistic pathogen, can cause superficial and life-threatening candidiasis in immunocompromised individuals. The formation of surface-associated biofilms and the appearance of drug resistance pose a significant challenge for clinical intervention. In this study, a total of 104 hospital-acquired C. alibcans clinical isolates were collected from sterile sites and mucosal lesions of 92 infectious disease patients in the Shanghai Public Health Clinical Center and analysed. The resistance rates to fluconazole, itraconazole and voriconazole were 12.5 %, 15.4 % and 11.5 % respectively. Multilocus sequence typing (MLST) analysis identified 63 diploid sequence types (DSTs) with a decentralized phylogeny, of which 37 DSTs (58.7 %) had not been reported in the online MLST database. Loss of heterozygosity was observed in ACC1 and ADP1 sequences obtained from six sequential isolates from a patient receiving antifungal treatment, which exemplified the effect of microevolution on C. albicans genetic alterations. Biofilm formation capability, an important virulence trait of C. albicans, was variable among strains isolated from different anatomical sites (P = 0.0302) and affected by genotypes (P = 0.0185). The mRNA levels of the azole antifungal target ERG11 gene and efflux pump genes (CDR1, CDR2 and MDR1) were detected in 9-18.1 % of azole-resistant and susceptible-dose dependent (S-DD) isolates. Twelve mutations encoding distinct amino acid substitutions in ERG11 were found in azole-resistant and S-DD isolates. Among them, A114S, Y132H and Y257H substitution in the ERG11 gene may be primarily related to azole resistance. Taken together, we observed a high level of diversity within C. albicans isolates. Multiple inter-related underlying mechanisms, including genetic and environmental factors, may account for high surface adhesion or azole resistance in clinical C. albicans infections.
authors.affiliation: Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Cao Lang Rd, Shanghai, PR China.|Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai, PR China.
authors.forename: Lvyin
authors.initials: L
authors.lastname: Hu
authors.affiliation: Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai, PR China.
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.affiliation: Department of Laboratory Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
authors.forename: Tianming
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai, PR China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Cao Lang Rd, Shanghai, PR China.
authors.forename: Shubei
authors.initials: S
authors.lastname: Zai
authors.affiliation: Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Cao Lang Rd, Shanghai, PR China.
authors.forename: Xiangnan
authors.initials: X
authors.lastname: Hu
authors.affiliation: Research Unit, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Cao Lang Rd, Shanghai, PR China.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.|Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai, PR China.
authors.forename: Min
authors.initials: M
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D018441:Biofilms / Q000254:growth & development; D002176:Candida albicans / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology*; D002681:China / Q000453:epidemiology; D025141:Drug Resistance, Fungal; D005260:Female; D020869:Gene Expression Profiling; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016533:Mycological Typing Techniques; D055815:Young Adult
chemical_list: D000935:Antifungal Agents