A 32-year-old woman with poorly controlled diabetes mellitus presents with vulvovaginal candidiasis. Regarding Candida species and their clinical significance, all of the following statements are correct EXCEPT:

Explanation

## Candida Species: Clinical Epidemiology and Antifungal Susceptibility **Key Point:** Candida albicans remains the most common cause of candidiasis globally, including vulvovaginal candidiasis (VVC), accounting for 80–90% of cases. While non-albicans species are emerging, C. parapsilosis is NOT the leading cause of VVC or overall candidiasis. ### Epidemiology and Clinical Significance of Major Candida Species | Species | Clinical Significance | Antifungal Profile | Key Feature | |---------|----------------------|-------------------|-------------| | **C. albicans** | Most common cause of VVC, oral thrush, invasive disease | Fluconazole-susceptible | Polymorphic, germ tube+ | | **C. auris** | Emerging, multidrug-resistant, high mortality, nosocomial outbreaks | Resistant to azoles, variable echinocandin susceptibility | Notifiable pathogen; contact precautions | | **C. tropicalis** | Higher propensity for invasive disease in immunocompromised; candidemia | Fluconazole-susceptible to intermediate | Pseudohyphae formation; angioinvasive | | **C. glabrata** | Vaginal, urinary, bloodstream infections; increasing prevalence | Intrinsically fluconazole-resistant; echinocandin-susceptible | Lacks pseudohyphae | | **C. parapsilosis** | Catheter-associated infections, neonatal infections, bloodstream | Fluconazole-susceptible | Biofilm former; low virulence | **High-Yield:** The shift from C. albicans dominance to non-albicans species (especially C. glabrata and C. auris) is a major epidemiologic trend in hospitalized and immunocompromised populations. However, C. albicans still accounts for 50–60% of invasive candidiasis and >80% of VVC. **Clinical Pearl:** C. parapsilosis is notably associated with **catheter-related candidemia** and **neonatal infections** (often via contaminated parenteral nutrition or healthcare worker hands), not with VVC. C. glabrata is increasingly seen in vaginal infections, particularly in older women and those with recurrent VVC. **Warning:** Do not confuse epidemiologic shift in hospitalized/ICU populations with overall prevalence. C. albicans remains the gold standard cause of VVC in the community and primary care setting. ### Why the Distractor is Wrong C. parapsilosis is a common cause of catheter-associated and neonatal candidemia, but it is NOT the most common cause of VVC or the leading Candida species overall. C. albicans holds both titles. C. parapsilosis is also typically fluconazole-susceptible and has lower virulence than C. albicans or C. tropicalis.