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Candida albicans—The Virulence Factors and Clinical Manifestations of Infection
Open accessAbstract
Candida albicans is a common commensal fungus that colonizes the oropharyngeal cavity, gastrointestinal and vaginal tract, and healthy individuals’ skin. In 50% of the population, C. albicans is part of the normal flora of the microbiota. The various clinical manifestations of Candida species range from localized, superficial mucocutaneous disorders to invasive diseases that involve multiple organ systems and are life-threatening. From systemic and local to hereditary and environmental, diverse factors lead to disturbances in Candida’s normal homeostasis, resulting in a transition from normal flora to pathogenic and opportunistic infections. The transition in the pathophysiology of the onset and progression of infection is also influenced by Candida’s virulence traits that lead to the development of candidiasis. Oral candidiasis has a wide range of clinical manifestations, divided into primary and secondary candidiasis. The main supply of C. albicans in the body is located in the gastrointestinal tract, and the development of infections occurs due to dysbiosis of the residential microbiota, immune dysfunction, and damage to the muco-intestinal barrier. The presence of C. albicans in the blood is associated with candidemia–invasive Candida infections. The commensal relationship exists as long as there is a balance between the host immune system and the virulence factors of C. albicans. This paper presents the virulence traits of Candida albicans and clinical manifestations of specific candidiasis.
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“The infection advance of C. albicans to the host is determined by the joint action of growth ability and virulence factors [56], but not all factors play an equally important role in the pathogenic process.”
From The F 1 F o -ATP synthase α subunit of Candida albicans induces inflammatory responses by controlling amino acid catabolism (2023) · cites this paper as [56]
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“Superficial candida skin infection tends to occur where the skin is moist such as the axillae, groin, perineum, web spaces, and other skin folds where the conditions permit the yeast to colonise and proliferate (14) (Figure 2).”
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BackgroundCandidiasis: Insights into Virulence Factors, Complement Evasion and Antifungal Drug Resistance
Gaffar, N. R., Valand, N., & Girija, U. V. (2025) · Microorganisms · doi:10.3390/microorganisms13020272 · Cited by 50
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Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes
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“This fungus is frequently found in healthy people’s oral cavities and gastrointestinal tracts, but it can cause serious disease (Talapko et al. 2021).”
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“This superficial pseudo membrane can be rubbed off by gentle rubbing of lesion leaving an erythematous area, while erythematous candidiasis is manifested as painful localized erythema-tous area [28], oropharyngeal candidiasis was diagnosed by using a tongue depressor and headlight.”
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InfluentialThe impact of bioactive textiles on human skin microbiota
Oliveira, C. S., & Tavaria, F. K. (2023) · European Journal of Pharmaceutics and Biopharmaceutics · doi:10.1016/j.ejpb.2023.05.004 · Cited by 40
Alqahtani, M. J., Elekhnawy, E., Negm, W. A., Mahgoub, S., & Hussein, I. A. (2022) · Journal of Fungi · doi:10.3390/jof8050521 · Cited by 33
“However, it is also an opportunistic pathogen capable of causing superficial and disseminated lifethreatening infections such as candidemia [2].”
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“Candida albicans is the most frequent species that causes invasive infections with severe repercussions on patient prognosis, morbidity, and mortality and the economic health system [10].”
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“The Candida infections are more common on the body’s mucosal surfaces, including the oral cavity, gastrointestinal tract, and female genital tract (Talapko et al. 2021).”
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“Invasive infections are often associated with the formation of biofilms on tissues or implanted medical devices [23,24,26].”
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New insights into immunity to skin fungi shape our understanding of health and disease
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“albicans.(96) Discussing them in detail here would exceed the scope of this review.”
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Antimicrobial Photodynamic Therapy for Superficial, Skin, and Mucosal Fungal Infections: An Update
da Silva, L. B. B., Castilho, I. G., Silva, F. A. D. S., Ghannoum, M. A., Garcia, M. T., & do Carmo, P. H. F. (2025) · Microorganisms · doi:10.3390/microorganisms13061406 · Cited by 32
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Pokhrel, S., Boonmee, N., Tulyaprawat, O., Pharkjaksu, S., Thaipisuttikul, I., Chairatana, P., Ngamskulrungroj, P., & Mitrpant, C. (2022) · Journal of Fungi · doi:10.3390/jof8101014 · Cited by 29
“During this process, virulence characteristics, namely, the transition between yeast and hyphal forms; biofilm formation; the secretion of enzymes such as phospholipases and proteinases; the expression of adhesins and invasins on the cell surface; and phenotypic switching, are crucial to establishing infection [5].”
BackgroundP. aeruginosa interactions with other microbes in biofilms during co-infection
Oliveira, M., Cunha, E. S., Tavares, L. M., & Serrano, I. D. (2023) · AIMS Microbiology · doi:10.3934/microbiol.2023032 · Cited by 31
“albicans can be found in superficial mucocutaneous disorders, in parenteral nutrition feeding tubes [77], in denture stomatitis [73] and dental caries [72], and in CF [226].”
BackgroundShahabudin, S., Azmi, N. S., Lani, M. N., Mukhtar, M., & Hossain, M. S. (2024) · Mycoses · doi:10.1111/myc.13753 · Cited by 39
“23 26 Many medical conditions, including diabetes, can weaken cellular immunity and increase susceptibility to infectious agents such as ubiquitous C. albicans .”
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“Our findings, supported by Talapko et al. [36] and Tulasidas et al. [37], highlighted a correlation between Candida isolation sites and virulence factor expression.”
ResultBiofilms and oral health: nanotechnology for biofilm control
Govindarajan, D. K., Mohanarangam, M., Kadirvelu, L., Sivaramalingam, S. S., Jothivel, D., Ravichandran, A., Periasamy, S., & Kandaswamy, K. (2025) · Discover Nano · doi:10.1186/s11671-025-04299-3 · Cited by 27
“Conditions such as xerostomia (dry mouth) and neutropenia further increase susceptibility to C. albicans infection [350].”
Deciphering internal and external factors influencing intestinal junctional complexes
Markovich, Z., Abreu, A., Sheng, Y., Han, S. M., & Xiao, R. (2024) · Gut Microbes · doi:10.1080/19490976.2024.2389320 · Cited by 26
“148 In a mouse model of DSS-induced colitis, supplementation with C. albicans has been found to worsen colitis severity and heighten intestinal barrier permeability.”
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A Comparative Review of Eugenol and Citral Anticandidal Mechanisms: Partners in Crimes Against Fungi
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“The major opportunistic fungal pathogen Candida albicans typically resides on and within the human host as a commensal organism, but overgrowth of the natural host niche can lead to debilitating mucosal infections and systemic bloodborne infections associated with significant mortality [1].”
Candida albicans: the current status regarding vaginal infections
Faustino, M., Ferreira, C., Pereira, A. M., & CARVALHO, A. P. F. D. (2025) · Applied Microbiology and Biotechnology · doi:10.1007/s00253-025-13478-2 · Cited by 34
“…from harmless to pathogenic under certain conditions such as microbiota dysbiosis, impaired immune system, damage to the skin or mucosal barriers, changes in environmental pH or nutrient availability, and virulence gene expression by the fungus (Fidel 1999; Talapko et al. 2021; Jacobsen 2023).”
AlEraky, D. M., Abuohashish, H. M., Gad, M. M., Alshuyukh, M. H., Bugshan, A., Almulhim, K. S., & Mahmoud, M. M. (2022) · Biomedicines · doi:10.3390/biomedicines10092078 · Cited by 24
“albicans are responsible for the advanced fungal infections in the oral cavity and digestive tract, in addition to mucocutaneous, systemic, and invasive infections [2].”
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Jin, P., Wang, L., Chen, D., & Chen, Y. (2024) · Journal of Oral Microbiology · doi:10.1080/20002297.2024.2339161 · Cited by 25
“Nystatin, an antifungal agent with both fungicidal and fungistatic properties, is commonly used topically in dentistry [72].”
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“Dec-1B labelled with 5(6)-carboxyfluorescein was used to investi-”
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Oral Candidal Colonization in Patients with Different Prosthetic Appliances
Devčić, M. K., Simonić‐Kocijan, S., Prpić, J., Pasković, I., Ćabov, T., Kovač, Z., & Glažar, I. (2021) · Journal of Fungi · doi:10.3390/jof7080662 · Cited by 24
Jaiswal, N., & Kumar, A. (2022) · Microchemical Journal · doi:10.1016/j.microc.2022.107572 · Cited by 22
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“Throughout the past few decades, it has consistently been the main contributor to invasive infections that can be fatal [8].”
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Holzknecht, J., Dubrac, S., Hedtrich, S., Galgóczy, L., & Marx, F. (2022) · Microbiology Spectrum · doi:10.1128/spectrum.00299-22 · Cited by 22
“and systemic treatment may be needed, whereupon the less-tolerated polyene amphotericin B is administered in salvage therapy (9, 13).”
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“Once adhesion occurs, biofilm development progresses through cell proliferation (filamentation), morphological changes, and EPS production, all of which shape the biofilm’s final structure (Cavalheiro and Teixeira 2018; Pereira et al. 2021; Talapko et al. 2021).”
A Comprehensive Overview of Candida albicans as the Leading Pathogen in Vulvovaginal Candidiasis
Srb, N., Talapko, J., Meštrović, T., Fureš, R., Stupnišek, M., Srb, A. M., & Škrlec, I. (2025) · Journal of Fungi · doi:10.3390/jof11090632 · Cited by 26
“At the same time, the last phase involves the dispersion of non-adherent cells, which may disseminate and form novel biofilms [14].”
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Candidemia in Internal Medicine: Facing the New Challenge
Brescini, L., Mazzanti, S., Morroni, G., Pallotta, F., Masucci, A., Orsetti, E., Montalti, R., & Barchiesi, F. (2022) · Mycopathologia · doi:10.1007/s11046-022-00624-x · Cited by 23
“of hydrolytic enzymes which make it more pathogenic than other species [18].”
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“Introduction Candida species are the most common human fungal pathogens.(1,2) Although clinical infections caused by non-albicans Candida spp.”
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Innate Lymphoid Cells and Their Role in the Immune Response to Infections
Fol, M., Karpik, W., Zabłotni, A., Kulesza, J., Kulesza, E., Godkowicz, M., & Druszczyńska, M. (2024) · Cells · doi:10.3390/cells13040335 · Cited by 25
“C. albicans’ pathogenic properties include biofilm formation and phenotypic switching [149].”
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“…ed as belonging to diketopiperazine, benzodiazepine, quino-line alkaloids, clavine ergot alkaloids, polycyclic indole alkaloids, amino acid derivatives, polyketides, and terpenes (andrastins and phomenone) [56]. groups, respectively, bind to the positive charge of the nanoparticle surface [53,54].”
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“The symptoms of candidiasis range from mild conditions like oral skin rashes and genital infections to severe cases with fever, chills, and, potentially, organ failure [16,232].”
Role of Candida albicans in chronic inflammation and the development of oral squamous cell carcinoma
Malavika, G., Ravi, S. S. S., Datchanamoorthy, M., Vajravelu, L. K., Lathakumari, R. H., & S, L. P. K. (2025) · Cancer Pathogenesis and Therapy · doi:10.1016/j.cpt.2025.03.002 · Cited by 21
Key fungal coinfections: epidemiology, mechanisms of pathogenesis, and beyond
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Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review
Talapko, J., Meštrović, T., & Škrlec, I. (2022) · World Journal of Diabetes · doi:10.4239/wjd.v13.i10.809 · Cited by 21
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Fungal coexistence in the skin mycobiome: a study involving Malassezia, Candida, and Rhodotorula
Naik, B., Sasikumar, J., Vishal, B., & Das, S. P. (2024) · AMB Express · doi:10.1186/s13568-024-01674-8 · Cited by 21
“Candida albicans is the most prevalent opportunistic fungus, which is also commensal in the gastrointestinal and genitourinary tracts (Talapko et al. 2021).”
BackgroundŞumlu, E., Aydın, M., Korucu, E. N., Alyar, S., & Nsangou, A. M. (2024) · Antibiotics · doi:10.3390/antibiotics13040310 · Cited by 19
“However, these species can cause severe invasive mucosal and systemic infections with high mortality rates in immunocompromised hosts [1,2].”
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Zn2+ and Cu2+ Binding to the Extramembrane Loop of Zrt2, a Zinc Transporter of Candida albicans
Bellotti, D., Miller, A., Rowińska‐Żyrek, M., & Remelli, M. (2022) · Biomolecules · doi:10.3390/biom12010121 · Cited by 19
“in immunocompromised individuals: it is the most common cause of urinary tract, genital, and oral yeast infections, and it can develop antimicrobial resistance and lead to severe systemic and potentially life-threatening candidemia (invasive candidiasis) [3].”
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Deciphering the oxidative stress response in Candida albicans
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Repositioning Antimicrobial Peptides Against WHO‐Priority Fungi
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“Candida albicans is a primary cause of nosocomial infections with mortality rates frequently exceeding 40 percent despite therapy [4,5].”
BackgroundAntifungal efficacy of Citrusfusion mediated silver nanoparticles in Candida species
Harine, A., Ranjani, S., & Hemalatha, S. (2025) · BMC Biotechnology · doi:10.1186/s12896-025-00952-y · Cited by 21
“C. tropicalis , recognized as the second most virulent Candida species, normally colonizes skin and nails but can instigate skin infections [2, 3].”
Doğan, Ş. D., Özcan, E., Çetinkaya, Y., Han, M. İ., Şahın, O., Bogojević, S. Š., Runic, J. N., & Gündüz, M. G. (2023) · Journal of Molecular Structure · doi:10.1016/j.molstruc.2023.136155 · Cited by 17
Metadata
- Authors
- Talapko, J., Juzbašić, M., Matijević, T., Pustijanac, E., Bekić, S., Kotris, I., & Škrlec, I.
- Affiliations
- University of Osijek (HR)
- Klinički bolnički centar Osijek (HR)
- Juraj Dobrila University of Pula (HR)
- Department of Internal Medicine, General County Hospital Vukovar, HR-3200 Vukovar, Croatia
- Corresponding author
- Škrlec, Ivana
- Venue
- Journal of Fungi
- Publisher
- MDPI AG
- Published
- 2021-01-22
- Volume
- 7
- Issue
- 2
- Pages
- 79
- ISSN
- 2309-608X (ISSN-L)
- PMC
- PMC7912069
- OpenAlex
- W3124481512
- Cited by
- 794
- References
- 175
- Citations by year
- 2026: 149 · 2025: 231 · 2024: 187 · 2023: 121 · 2022: 89 · 2021: 15
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Fungi (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
- Keywords
- Candida albicans, virulence factors, candidiasis, oral candidiasis, invasive candidiasis, candidemia, commensalism, dysbiosis, mucosal barrier, host immune response, opportunistic fungal infection, clinical features
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