Candida Urinary Tract Infection: Pathogenesis

Candida species are unusual causes of urinary tract infection (UTI) in healthy individuals, but common in the hospital setting or among patients with predisposing diseases and structural abnormalities of the kidney and collecting system. The urinary tract may be invaded in either an antegrade fashio...

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Bibliographic Details
Published in:Clinical infectious diseases 2011-05, Vol.52 (suppl_6), p.S437-S451
Main Authors: Fisher, John F., Kavanagh, Kevin, Sobel, Jack D., Kauffman, Carol A., Newman, Cheryl A.
Format: Article
Language:English
Subjects:
Animals
Bacterial infections
Candida
Candida - pathogenicity
Candida - ultrastructure
Candida albicans
Candidiasis - immunology
Candidiasis - microbiology
Carrier State - microbiology
Catheters - adverse effects
Catheters - microbiology
Disease Progression
Enterobacteriaceae - pathogenicity
Epithelial cells
Female
Fungal infections
Humans
Hyphae
Infections
Kidney - microbiology
Kidneys
Male
Mice
Molecular biology
Pathogenesis
Pathology
Rabbits
Urinary bladder
Urinary tract
Urinary tract diseases
Urinary Tract Infections - immunology
Urinary Tract Infections - microbiology
Urogenital system
Virulence Factors - physiology
Yeast
Yeasts
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Summary:Candida species are unusual causes of urinary tract infection (UTI) in healthy individuals, but common in the hospital setting or among patients with predisposing diseases and structural abnormalities of the kidney and collecting system. The urinary tract may be invaded in either an antegrade fashion from the bloodstream or retrograde via the urethra and bladder. Candida species employ a repertoire of virulence factors, including phenotypic switching, dimorphism, galvano - and thigmotropism, and hydrolytic enzymes, to colonize and then invade the urinary tract. Antegrade infection occurs primarily among patients predisposed to candidemia. The process of adherence to and invasion of the glomerulus, renal blood vessels, and renal tubules by Candida species was elegantly described in early histopathologic studies. Armed with modern molecular biologic techniques, the various virulence factors involved in bloodborne infection of the kidney are gradually being elucidated. Disturbances of urine flow, whether congenital or acquired, instrumentation of the urinary tract, diabetes mellitus, antimicrobial therapy, and immunosuppression underlie most instances of retrograde Candida UTI. In addition, bacterial UTIs caused by Enterobacteriaceae may facilitate the initial step in the process. Ascending infections generally do not result in candidemia in the absence of obstruction.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cir110