Candida Virulence Properties and Adverse Clinical Outcomes in Neonatal Candidiasis

The Journal of Pediatrics, 05/08/2012

Bliss JM et al. – Individual isolates of Candida species vary in their virulence properties. Strains with higher virulence are associated with certain clinical outcomes.


  • Clinical isolates were studied from 2 populations of premature infants, those colonized with Candida spp (commensal; n = 27) and those with invasive candidiasis (n = 81).
  • Individual isolates of C albicans and C parapsilosis were tested for virulence in 3 assays: phenotypic switching, adhesion, and cytotoxicity.
  • Invasive isolates were considered to have enhanced virulence if detected at a level >1 SD above the mean for the commensal isolates in at least one assay.
  • Outcomes of patients with invasive isolates with enhanced virulence were compared with those with invasive isolates lacking enhanced virulence characteristics.


  • Enhanced virulence was detected in 61% of invasive isolates of C albicans and 42% of invasive isolates of C parapsilosis.
  • All C albicans cerebrospinal fluid isolates (n = 6) and 90% of urine isolates (n = 10) had enhanced virulence, compared with 48% of blood isolates (n = 40).
  • Infants with more virulent isolates were younger at the time of positive culture and had higher serum creatinine levels.

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