The Contribution of Growth Rate to the Pathogenicity of Candida spp.

Fungal infections are becoming more common and the range of susceptible individuals has expanded. While Candida albicans remains the most common infective species, other Candida spp. are becoming increasingly significant. In a range of large-scale studies of candidaemia between 1999 and 2006, about 52% of 9717 cases involved C. albicans, about 30% involved either C. glabrata or C. parapsilosis and less than 15% involved C. tropicalis, C. krusei or C. guilliermondii. However, the probability of mortality within 30 days of infection with a particular species was at least 40% for C. tropicalis, C. albicans, C. glabrata and C. krusei and only 22% for C. parapsilopsis. Clinical isolates of Candida spp. grew at rates ranging from 1.65 h-1 to 4.9 h-1. Three species (C. krusei, C. albicans and C. glabrata) had relatively high growth rates (μm > 4 h-1), C. tropicalis and C. dubliniensis grew moderately quickly (Ôëê 3 h-1) and C. parapsilosis and C. guilliermondii grew slowly (< 2 h-1). Based on these data, the log of the odds of mortality within 30 days of diagnosis was linearly related to μm. From this the underlying probability of mortality is 0.13 (95% CI: 0.10-0.17) and it increases by about 0.09 ± 0.02 for each unit increase in μm. Given that the overall crude mortality is about 0.36, the growth of Candida spp. approximately doubles the rate, consistent with the results of larger case-matched studies of candidaemia.

Authors:

• Shu-Ying Marissa Pang
• Stephen Tristram
• Simon Brown

Keywords:

• Candida spp.
• candidiasis
• growth
• pathogenicity.

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