Unraveling clade-specific differences in Candida auris: evolution, adaptation, and pathogenicity.

Authors

Preeti Sharma, Vinay Kumar Bari, Ritu Pasrija

Published in

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. Jun 25, 2026. Epub Jun 25, 2026.

Abstract

Since its 2009 emergence, Candida auris (now also known as Candidozyma auris) has evolved from a rare isolate into a global "critical priority" pathogen. This rapid expansion is defined by its unique population structure consisting of six distinct genomic clades with starkly different evolutionary trajectories, phenotypic traits, and clinical risks. We conducted a systematic synthesis of literature from PubMed, Scopus, and Google Scholar (2009-2026), focusing on comparative genomics, clade-specific virulence, and diagnostic accuracy. A total of 64 studies were analyzed to identify patterns in clade divergence and antifungal resistance. Our analysis reveals that C. auris is not a monolithic threat but a complex of diverse lineages with specialized adaptations. Clade I (South Asian) and Clade IV (South American) represent the highest clinical risk due to hyper-virulence and high rates of multi-drug resistant (MDR) strains. In contrast, Clade II (East Asian) was initially associated with localized ear infections; recent genomic data show an expanding pathogenic profile with emerging bloodstream infections. Our review also identifies Clade V (Iranian) as a genetically distinct group and highlights the recent identification of Clade VI (Indomalayan) as a distinct lineage, suggesting a long-standing environmental reservoir. Furthermore, we identify critical "blind spots" in automated diagnostic platforms (VITEK^® 2, BD Phoenix) where phenotypic variations in Clades II and III lead to frequent misidentification as Candida haemulonii or Candida famata. This review proposes a "clade-aware" framework for public health. While frontline antifungal treatment remains standardized regardless of lineage, we argue that effective long-term management and outbreak containment require integrating genomic surveillance with clade-specific infection control. By identifying high-biofilm clades (Clade I) or hyper-virulent lineages (Clade IV), public health systems can implement more targeted containment strategies, moving toward a precision-based approach to managing this fungal pathogen.

PMID:
42348119
Bibliographic data and abstract were imported from PubMed on 25 Jun 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.