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      On the Origin of Candida auris: Ancestor, Environmental Stresses, and Antiseptics

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          Abstract

          Candida auris has emerged as a serious threat to the health care settings. Advancements in molecular biology have provided several insights into the evolution of C. auris since it was first described in 2009.

          ABSTRACT

          Candida auris has emerged as a serious threat to the health care settings. Advancements in molecular biology have provided several insights into the evolution of C. auris since it was first described in 2009. However, the simultaneous emergence of four different clades of the fungus at distinct geographical locations remains a mystery. The hypotheses already proposed by researchers fall short of explaining how and why C. auris emerged. In this article, we theorize that C. auris emerged from a common ancestor, subsequently migrated to specific geographical locations, and diversified genetically. This hypothesis is supported by genomic insights, historical events, and indirect scientific facts. C. auris adapted to humans at locations and times coinciding with the divergence from the most recent common ancestor, emerging almost simultaneously as an opportunist pathogen due to antiseptic practices. Future research will support or refute this hypothesis.

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          Most cited references35

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          Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses.

          Candida auris, a multidrug-resistant yeast that causes invasive infections, was first described in 2009 in Japan and has since been reported from several countries.
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            Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital.

            A single strain of a novel ascomycetous yeast species belonging to the genus Candida was isolated from the external ear canal of an inpatient in a Japanese hospital. Analyses of the 26S rDNA D1/D2 domain, nuclear ribosomal DNA ITS region sequences, and chemotaxonomic studies indicated that this strain represents a new species with a close phylogenetic relationship to Candida ruelliae and Candida haemulonii in the Metschnikowiaceae clade. This strain grew well at 40 degrees C, but showed slow and weak growth at 42 degrees C. The taxonomic description of Candida auris sp. nov. is proposed (type strain JCM15448T= CBS10913T= DSM21092T).
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              Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997–2016

              Abstract Background The emergence of antifungal resistance threatens effective treatment of invasive fungal infection (IFI). Invasive candidiasis is the most common health care–associated IFI. We evaluated the activity of fluconazole (FLU) against 20 788 invasive isolates of Candida (37 species) collected from 135 medical centers in 39 countries (1997–2016). The activity of anidulafungin, caspofungin, and micafungin (MCF) was evaluated against 15 308 isolates worldwide (2006–2016). Methods Species identification was accomplished using phenotypic (1997–2001), genotypic, and proteomic methods (2006–2016). All isolates were tested using reference methods and clinical breakpoints published in the Clinical and Laboratory Standards Institute documents. Results A decrease in the isolation of Candida albicans and an increase in the isolation of Candida glabrata and Candida parapsilosis were observed over time. Candida glabrata was the most common non–C. albicans species detected in all geographic regions except for Latin America, where C. parapsilosis and Candida tropicalis were more common. Six Candida auris isolates were detected: 1 each in 2009, 2013, 2014, and 2015 and 2 in 2016; all were from nosocomial bloodstream infections and were FLU-resistant (R). The highest rates of FLU-R isolates were seen in C. glabrata from North America (NA; 10.6%) and in C. tropicalis from the Asia-Pacific region (9.2%). A steady increase in isolation of C. glabrata and resistance to FLU was detected over 20 years in the United States. Echinocandin-R (EC-R) ranged from 3.5% for C. glabrata to 0.1% for C. albicans and C. parapsilosis. Resistance to MCF was highest among C. glabrata (2.8%) and C. tropicalis (1.3%) from NA. Mutations on FKS hot spot (HS) regions were detected among 70 EC-R isolates (51/70 were C. glabrata). Most isolates harboring FKS HS mutations were resistant to 2 or more ECs. Conclusions EC-R and FLU-R remain uncommon among contemporary Candida isolates; however, a slow and steady emergence of resistance to both antifungal classes was observed in C. glabrata and C. tropicalis isolates.
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                Author and article information

                Contributors
                Role: Editor
                Role: Editor
                Journal
                mBio
                mBio
                mbio
                mbio
                mBio
                mBio
                American Society for Microbiology (1752 N St., N.W., Washington, DC )
                2150-7511
                15 December 2020
                Nov-Dec 2020
                : 11
                : 6
                : e02102-20
                Affiliations
                [a ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                Westerdijk Fungal Biodiversity Institute
                Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute Jena (HKI)
                Author notes
                Address correspondence to Arunaloke Chakrabarti, arunaloke@ 123456hotmail.com .
                Author information
                https://orcid.org/0000-0002-6740-0493
                https://orcid.org/0000-0003-1555-3807
                Article
                mBio02102-20
                10.1128/mBio.02102-20
                7773985
                33323512
                aae29538-fdc9-4123-b6a3-ccd01c56c77c
                Copyright © 2020 Sharma and Chakrabarti.

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

                History
                Page count
                supplementary-material: 0, Figures: 1, Tables: 0, Equations: 0, References: 39, Pages: 7, Words: 4672
                Funding
                Funded by: Indian Council of Medical Research (ICMR), https://doi.org/10.13039/501100001411;
                Award ID: AMR/160/2018
                Award Recipient :
                Categories
                Opinion/Hypothesis
                Clinical Science and Epidemiology
                Custom metadata
                November/December 2020

                Life sciences
                candida auris,emerging infection,epidemiology,evolution
                Life sciences
                candida auris, emerging infection, epidemiology, evolution

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