In recent years, a progressive increase in the incidence of invasive fungal infections (IFIs) caused by Candida glabrata has been observed. The objective of this literature review was to study the epidemiology, drug resistance, and virulence factors associated with the C. glabrata complex. For this purpose, a systematic review (January 2001–February 2021) was conducted on the PubMed, Scielo, and Cochrane search engines with the following terms: “C. glabrata complex (C. glabrata sensu stricto, C. nivariensis, C. bracarensis)” associated with “pathogenicity” or “epidemiology” or “antibiotics resistance” or “virulence factors” with language restrictions of English and Spanish. One hundred and ninety-nine articles were found during the search. Various mechanisms of drug resistance to azoles, polyenes, and echinocandins were found for the C. glabrata complex, depending on the geographical region. Among the mechanisms found are the overexpression of drug transporters, gene mutations that alter thermotolerance, the generation of hypervirulence due to increased adhesion factors, and modifications in vital enzymes that produce cell wall proteins that prevent the activity of drugs designed for its inhibition. In addition, it was observed that the C. glabrata complex has virulence factors such as the production of proteases, phospholipases, and hemolysins, and the formation of biofilms that allows the complex to evade the host immune response and generate fungal resistance. Because of this, the C. glabrata complex possesses a perfect pathogenetic combination for the invasion of the immunocompromised host.

中文翻译：

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光滑念珠菌抗真菌抗性和毒力因子，完美的致病组合

近年来，观察到由光滑念珠菌引起的侵袭性真菌感染 (IFI) 的发生率逐渐增加。本文献综述的目的是研究与光滑念珠菌复合体相关的流行病学、耐药性和毒力因素。为此，在 PubMed、Scielo 和 Cochrane 搜索引擎上使用以下术语进行了系统评价（2001 年 1 月至 2021 年 2 月）：“ C. glabrata complex ( C. glabrata sensu stricto , C. nivariensis , C. bracarensis)”与“致病性”或“流行病学”或“抗生素耐药性”或“毒力因素”相关，并有英语和西班牙语的语言限制。在搜索过程中找到了 199 篇文章。根据地理区域的不同，C. glabrata复合体发现了对唑类、多烯类和棘白菌素类的各种耐药机制。发现的机制包括药物转运蛋白的过度表达、改变耐热性的基因突变、由于粘附因子增加而产生的超毒力，以及产生细胞壁蛋白的重要酶的修饰，这些酶阻止了旨在抑制其抑制的药物的活性。此外，观察到C. glabrata复合物具有毒力因子，如蛋白酶、磷脂酶和溶血素的产生，以及生物膜的形成，使复合物能够逃避宿主免疫反应并产生真菌抗性。正因为如此，C. glabrata复合体具有完美的致病组合，可以入侵免疫功能低下的宿主。