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Background  The aim of this study was to determine the biofilm formation, the extracellular enzymatic activities of 182 clinical isolates of the  Candida parapsilosis  complex.Methods  Molecular identification of the  C. parapsilosis  species complex was performed using PCR RFLP of SADH gene and PCR sequencing of ITS region. The susceptibility of ours isolates to antifungal agents and molecular mechanisms underlying azole resistance were evaluated.    Results  63.5% of  C. parapsilosis  were phospholipase positive with moderate activity for the majority of strains. None of the  C. metapsilosis  or  C. orthopsilosis  isolates was able to produce phospholipase. Higher caseinase activities were detected in  C. parapsilosis  (Pz = 0.5 ± 0.18) and  C. orthopsilosis  (Pz = 0.49 ± 0.07) than in  C. metapsilosis  isolates (Pz = 0.72 ± 0.1). 96.5% of  C. parapsilosis  strains and all isolates of  C. metapsilosis  and  C. orthopsilosis  produced gelatinase. All the strains possessed the ability to show haemolysis on blood agar.  C. metapsilosis  exhibited the low haemolysin production with statistical significant differences compared to  C. parapsilosis  and  C. orthopsilosis . The biofilm forming ability of  C. parapsilosis  was highly strain dependent with important heterogeneity, which was less evident with both  C. orthopsilosis  and  C. metapsilosis .  Some  C. parapsilosis  isolates met the criterion for susceptible dose dependent to fluconazole (10.91%), itraconazole (16.36%) and voriconazole (7.27%). Moreover, 5.45% and 1.82% of  C. parapsilosis  isolates were respectively resistant to fluconazole and voriconazole. All strains of  C. metapsilosis  and  C. orthopsilosis  were susceptible to azoles; and isolates of all three species exhibited 100% of susceptibility to caspofungin, amphotericin B and 5-flucytosine.    Conclusions  A combination of molecular mechanisms, including the overexpression of ERG11, and genes encoding efflux pumps (CDR1, MDR1, and MRR1) were involved in azole resistance in  C. parapsilosis .

journal of biomedical science

Virulence factors, antifungal susceptibility and molecular mechanisms of azole resistance among Candida parapsilosis complex isolates recovered from clinical specimens