What is Candida parapsilosis?

From the Guidelines

Fluconazole is the preferred treatment for Candida parapsilosis, as it has been shown to be effective against this species, with some strains showing reduced susceptibility to echinocandins 1. The treatment of Candida parapsilosis typically involves antifungal medications, with fluconazole being a first-line option. For invasive infections, fluconazole may be preferred, especially for C. parapsilosis, due to its effectiveness and the potential for reduced susceptibility to echinocandins in some strains. The recommended dose of fluconazole is 400-800mg daily, and treatment duration typically ranges from 14 days to several weeks depending on infection severity and clinical response. Some key points to consider in the treatment of C. parapsilosis include:

• The importance of proper hand hygiene and catheter care to prevent the spread of infection
• The potential for C. parapsilosis to form biofilms on medical devices, making infections difficult to eradicate
• The need for careful consideration of treatment options, including the use of echinocandins or other antifungal medications, in patients with specific risk factors or comorbidities
• The recommendation for a dilated ophthalmological examination within the first week after diagnosis to rule out endophthalmitis 1
• The importance of follow-up blood cultures to establish the time point at which candidemia has been cleared 1. Overall, the treatment of C. parapsilosis requires careful consideration of the individual patient's needs and risk factors, as well as the potential benefits and limitations of different treatment options. It is also important to note that the Infectious Diseases Society of America (IDSA) recommends fluconazole as a first-line treatment for C. parapsilosis, with echinocandins being an alternative option 1. In addition, the IDSA recommends that treatment be continued for at least 2 weeks after documented clearance of Candida from the bloodstream and resolution of symptoms attributable to candidemia 1. Central venous catheters should be removed when candidemia is documented, if at all possible, especially in cases of C. parapsilosis, which is often associated with catheter-related infections 1. In terms of specific treatment regimens, the IDSA recommends fluconazole 400-800mg daily, with echinocandins being an alternative option for patients who are not candidates for fluconazole or who have had prior treatment with an echinocandin 1. Overall, the key to successful treatment of C. parapsilosis is careful consideration of the individual patient's needs and risk factors, as well as the potential benefits and limitations of different treatment options.

From the Research

Candida parapsilosis Overview

• Candida parapsilosis is a type of fungus that can cause infections in humans, particularly in those with weakened immune systems or who have undergone medical procedures involving invasive devices 2.
• It is part of the psilosis complex, which also includes Candida orthopsilosis and Candida metapsilosis 3, 2.

Antifungal Susceptibility

• Studies have shown that Candida parapsilosis exhibits varying degrees of susceptibility to different antifungal agents:
  • Amphotericin B has been shown to be effective against C. parapsilosis, with most isolates being killed at concentrations of 1-4 μg/mL 4.
  • Fluconazole has been found to be less effective against C. parapsilosis, with some isolates exhibiting resistance 4, 5.
  • Voriconazole and posaconazole have been shown to be effective against C. parapsilosis, although some isolates may exhibit reduced susceptibility 4, 3.
  • Echinocandins, such as anidulafungin and micafungin, have been found to be effective against C. parapsilosis, with most isolates being susceptible 3.

Clinical Implications

• The susceptibility profile of Candida parapsilosis can have significant clinical implications, particularly in the treatment of bloodstream infections 5, 6.
• Fluconazole resistance has been associated with a higher risk of recurrence, but not with increased mortality 5.
• The use of intravenous itraconazole has been shown to be effective in treating Candida bloodstream infections, including those caused by C. parapsilosis 6.

Virulence and Resistance Mechanisms

• Candida parapsilosis has been found to exhibit enhanced virulence mechanisms, including the ability to form biofilms on medical devices 2.
• The development of antifungal resistance in C. parapsilosis is a significant concern, and further research is needed to understand the underlying mechanisms and to develop effective control strategies 2.