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Antifungal resistance and virulence properties of  Candida albicans  are a growing health problem worldwide. To study the expression of virulence and azole resistance genes in 39 clinical strains of  C. albicans , we used a model of infection of human vaginal epithelial cells with  C. albicans  strains isolated from Mexican women with vulvovaginal candidiasis (VVC). The strains were identified by PCR amplification of the ITS1 and ITS2 regions of rRNA. The detection and expression of virulence genes and azole resistance genes  MDR1  and  CDR1  were performed using PCR and RT-PCR, respectively. All strains were sensitive to nystatin and 38 (97.4%) and 37 (94.9%) were resistant to ketoconazole and fluconazole, respectively.  ALS1 ,  SAP4–SAP6 ,  LIP1 ,  LIP2 ,  LIP4 ,  LIP6 ,  LIP7 ,  LIP9 ,  LIP10 , and  PLB1 - PLB2  were present in all strains;  SAP1  was identified in 37 (94.8%) isolates,  HWP1  in 35 (89.7%),  ALS3  in 14 (35.8%), and  CDR1  in 26 (66.6%). In nearly all of the strains,  ALS1 ,  HWP1 ,  SAP4–SAP6 ,  LIP1–LIP10 ,  PLB1 , and  PLB2  were expressed, whereas  CDR1  was expressed in 20 (51.3%) and  ALS3  in 14 (35.8%). In our in vitro model of infection with  C. albicans , the clinical strains showed different expression profiles of virulence genes in association with the azole resistance gene  CDR1 . The results indicate that the strains that infect Mexican patients suffering from VVC are highly virulent and virtually all are insensitive to azoles.

High Virulence and Antifungal Resistance in Clinical Strains ofCandida albicans