From the Guidelines
Candida albicans is the most common species, but other notable species include Candida glabrata, Candida krusei, and Candida auris, each with distinct characteristics and antifungal susceptibility patterns 1. When considering the various subspecies of Candida, it's essential to recognize that each species has unique features that influence their ability to cause disease and respond to treatment.
- Candida albicans is the most prevalent species, commonly associated with oral thrush and vaginal yeast infections.
- Candida glabrata and Candida krusei are known for their reduced susceptibility to azole antifungals, making treatment more challenging 1.
- Candida auris has emerged as a significant healthcare-associated pathogen due to its multidrug resistance. The identification of the specific Candida species is crucial for guiding appropriate antifungal therapy, as treatment approaches may vary depending on the species involved and its antifungal susceptibility profile 1. In clinical practice, the most recent and highest quality study recommends that treatment of vulvovaginal candidiasis should be based on the species identified, with Candida albicans being the most common and responsive to fluconazole, while Candida glabrata and Candida krusei may require alternative treatments 1. Key factors to consider when managing Candida infections include the species involved, the severity of the infection, and the patient's underlying health status, as these factors can impact the choice of antifungal therapy and the likelihood of successful treatment 1.
From the FDA Drug Label
The following in vitro data are available, but their clinical significance is unknown. At least 90% of the following fungi exhibit an in vitro MIC less than or equal to the susceptible breakpoint for fluconazole (https://www.fda. gov/STIC) against isolates of similar genus or organism group. However, the effectiveness of fluconazole in treating clinical infections due to these fungi has not been established in adequate and well-controlled clinical trials. Candida dubliniensis Candida guilliermondii Candida kefyr Candida lusitaniae
Antimicrobial Activity Fluconazole has been shown to be active against most isolates of the following microorganisms both in vitro and in clinical infections Candida albicans Candida glabrata (Many isolates are intermediately susceptible) Candida parapsilosis Candida tropicalis
The following data are available, but their clinical significance is unknown At least 90 percent of the following fungi exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for voriconazole against isolates of similar genus or organism group However, the effectiveness of voriconazole in treating clinical infections due to these fungi has not been established in adequate and well-controlled clinical trials: Candida lusitaniae Candida guilliermondii
The sub species of Candida mentioned in the drug labels are:
- Candida albicans
- Candida glabrata
- Candida parapsilosis
- Candida tropicalis
- Candida krusei
- Candida dubliniensis
- Candida guilliermondii
- Candida kefyr
- Candida lusitaniae 2 3
From the Research
Subspecies of Candida
- Candida species are the most common causes of fungal infection, with approximately 90% of infections caused by five species: Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis, and Candida krusei 4
- The Candida glabrata species complex, Candida krusei, Candida parapsilosis species complex, and Candida tropicalis are common non-albicans Candida spp. that cause invasive candidiasis 5
- Candida albicans is the most common cause of candidemia around the world and is categorized as a critical priority pathogen, while Candida glabrata is considered a high-priority pathogen 6
Characteristics of Candida Subspecies
- Candida glabrata sensu stricto isolates have shown reduced susceptibility to azole drugs, with approximately 14.3% of isolates being fluconazole resistant 5
- Candida tropicalis isolates have also shown reduced susceptibility to azoles, with 11.6% and 9.5% of isolates being non-susceptible to fluconazole and voriconazole, respectively 5
- Candida krusei isolates are susceptible to voriconazole, posaconazole, and itraconazole, but may exhibit resistance to other antifungal drugs 5
Epidemiology of Candida Subspecies
- The incidence of Candida-mediated infections has increased in the last decade, mainly due to rising numbers of susceptible individuals 6
- Candida albicans is the most common cause of invasive candidiasis globally, but its proportion is decreasing relative to other Candida species 7
- Candida glabrata has become an increasingly important cause of candidemia in recent years, and is now the second most common causative agent of candidemia in many geographical regions 6