Candida dubliniensis – levedura emergente associada à candidose oral
Candida dubliniensis – emergent yeast associated with oral candidosis
Nonaka, C.F.W.; Nascimento, G.J.F.; Goulart Filho, J.A.V.; Lima, K.C.; Milan, E.P.
Rev. odontol. UNESP, vol.37, n2, p.125-132, 2008
Resumo
Dentre os microrganismos capazes de determinar o desenvolvimento de processos patológicos em humanos, encontram-se as espécies de leveduras pertencentes ao gênero Candida. A presença destas leveduras em pacientes que apresentam condições predisponentes como terapias com múltiplos antimicrobianos, imunossupressores e imunodeficiências, é capaz de determinar numerosos processos patológicos, sejam estes de ordem local ou sistêmica. Apesar da Candida albicans ser implicada como principal patógeno relacionado ao desenvolvimento de candidose oral, o isolamento de uma espécie intimamente relacionada, denominada Candida dubliniensis, tem sido reportado de forma crescente. Diversos fatores de virulência são descritos para esta nova levedura, assumindo destaque a hidrofobicidade de superfície celular, as aspartil proteinases secretadas (Saps) e compostos enzimáticos extracelulares, como fosfatase ácida, leucinaarilamidase, estearases e α-mannosidase. Além disso, isolados de C. dubliniensis apresentam bombas de efluxo de drogas, codificadas pelos genes CdCR1 e CdMDR1, um dos mecanismos propostos para explicar o desenvolvimento de resistência a quimioterápicos como o fluconazol e, em certos casos, ao cetoconazol e itraconazol. Em decorrência do emergente número de relatos e pesquisas enfatizando o papel da C. dubliniensis no desenvolvimento de doença local e sistêmica, o presente trabalho realiza uma revisão da literatura acerca dos aspectos epidemiológicos, métodos de identificação, fatores de virulência e mecanismos de resistência a antifúngicos inerentes a esta levedura.
Palavras-chave
Candida dubliniensis, candidose oral, virulência, resistência.
Abstract
Amongst the microorganisms that can cause pathologic processes in humans are yeasts species belonging to the genus Candida. The presence of these yeasts in patients with a number of predisposing conditions such as multiple therapies with antibiotics and immunossupressors and immunodeficiencies is capable of causing a variety of local and systemic diseases. Although Candida albicans remains the most common cause of oral candidosis, the identification of a close related species, named Candida dubliniensis, has been increasing steadily. Numerous virulence factors are described for this new yeast, mainly represented by cell surface hydrophobicity, secretory aspartyl proteinases (Saps) and extracellular enzymatic compounds as acid phosphatase, leucine-arylamidase, esterases and α-mannosidase. Besides, C. dubliniensis presents drug efflux pumps, encoded by CdCR1 and CdMDR1 genes, one of the proposed mechanisms to explain the development of antifungal drug resistance against fluconazole, and occasionally, ketoconazole and itraconazole. In view of the emergent number of case reports and studies emphasizing the importance of C. dubliniensis on the development of local and systemic diseases, the present paper performs a review of the literature about the epidemiology, identification methods, factors of virulence and mechanisms of antifungal resistance inherent to this yeast.
Keywords
Candida dubliniensis, oral candidosis, virulence, resistance
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