The emerging threat antifungal-resistant Candida tropicalis in humans, animals, and environment

Abstract

Antifungal resistance in humans, animals, and the environment is an emerging problem. Among the different fungal species that can develop resistance, Candida tropicalis is ubiquitous and causes infections in animals and humans. In Asia and some Latin American countries, C. tropicalis is among the most common species related to candidemia, and mortality rates are usually above 40%. Fluconazole resistance is especially reported in Asian countries and clonal spread in humans and the environment has been investigated in some studies. In Brazil, high rates of azole resistance have been found in animals and the environment. Multidrug resistance is still rare, but recent reports of clinical multidrug-resistant isolates are worrisome. The molecular apparatus of antifungal resistance has been majorly investigated in clinical C. tropicalis isolates, revealing that this species can develop resistance through the conjunction of different adaptative mechanisms. In this review article, we summarize the main findings regarding antifungal resistance and Candida tropicalis through an “One Health” approach.

Water Quality, Heavy Metals, and Antifungal Susceptibility to Fluconazole of Yeasts from Water Systems

“…Similarly, antifungal resistance to FCZ has been reported in Candida species from tropical freshwater environments in Brazil and China [ 9 , 53 , 54 , 55 ]. The presence of environmental yeasts with high resistance to FCZ is probably due to the fact that this azole is the most widely used antifungal in humans and animals, and it is among the most reported drugs in hospital and home wastewater [ 56 , 57 ]. In addition, there are fungicides routinely used in agriculture that share the action mechanism of azoles, which can generate cross-resistance in yeasts found in these aquatic environments [ 56 , 57 , 58 ].…”

“…The presence of environmental yeasts with high resistance to FCZ is probably due to the fact that this azole is the most widely used antifungal in humans and animals, and it is among the most reported drugs in hospital and home wastewater [ 56 , 57 ]. In addition, there are fungicides routinely used in agriculture that share the action mechanism of azoles, which can generate cross-resistance in yeasts found in these aquatic environments [ 56 , 57 , 58 ]. In Asia, some studies reported a significant increase in resistant C. tropicalis isolated from poultry, and this has been associated with the extensive use of azoles in agriculture [ 56 , 59 , 60 ].…”

“…In addition, there are fungicides routinely used in agriculture that share the action mechanism of azoles, which can generate cross-resistance in yeasts found in these aquatic environments [ 56 , 57 , 58 ]. In Asia, some studies reported a significant increase in resistant C. tropicalis isolated from poultry, and this has been associated with the extensive use of azoles in agriculture [ 56 , 59 , 60 ]. Brilhante et al suggested that azole resistance in the Candida strains recovered from aquatic environments would be influenced by the activity of efflux pumps [ 53 ].…”

Antifungal activity of selected sea cucumber species from Tukuran, Zamboanga del Sur, Mindanao, Philippines using modified SPOTi assay

“…Noteworthy, Aspergillus and Candida species were used as test organisms because the resistance of Aspergillus and Candida species to commercially available drugs have been increasingly reported due to susceptibility test standards and with increasing use of antifungal agents (Arendrup 2014). Candida tropicalis is predominant and causes infections in animals and humans (Lima et al 2022). Candidiasis is a broad term that refers to mucosal, cutaneous, and deep-rooted organ infections caused by fungi of the Candida genus.…”

“…In Asia and some parts of Latin America, C. tropicalis is among the most common species related to candidemia, and mortality rates are usually 40%. A recent study suggests an increasing ubiquity of fluconazole and multidrug resistance of C. tropicalis retrieved from humans (Lima et al 2022). On the other hand, aspergillosis is a severe clinical problem that is caused by Aspergillus species, especially in immunocompromised patients, thus Aspergilli has become an opportunistic fungal pathogen (Shishodia et al 2019).…”