Candida albicans: Virulence factors, pathogenesis, and ways to diagnose and control its infection




Candida albicans; Candidiasis; Diagnosis; Virulence factors.


The objective of this study was to provide a review on Candida albicans, focusing on its main virulence factors, pathogenesis, and methods of diagnosis and control of infections caused by this microorganism, known as candidiasis. Its main virulence factors are adhesion, polymorphism and dimorphism, which aid in tissue invasion, phenotypic variability, tolerance to toxins, and the presence of enzymes such as proteases and phospholipases. These factors confer the fungus with the ability to colonize, establish itself, and consequently, cause infections. C. albicans can proliferate on the skin and mucous membranes of the oropharyngeal cavity, gastrointestinal tract, and vaginal tract. The result of this colonization is the formation of white plaques or nodules with erythematous borders in the infected area. Additionally, it may cause pain and burning or be asymptomatic. The diagnosis of candidiasis is based on the symptoms presented by the host. Cultures, histopathological examinations, blood cultures, and serum beta-glucan tests can also be used. The treatment of candidiasis is carried out with antifungals such as nystatin, clotrimazole, fluconazole, itraconazole, and amphotericin B. However, research on medicinal plant products has been conducted to provide an integrative and complementary approach to controlling this pathogen. Thymus vulgaris L. is a good example of this. It is a plant with various phytochemicals and recognized biological activities, including antifungal effects. Thus, this study demonstrated some morphological and pathological characteristics of C. albicans. It was also possible to understand how candidiasis manifests, and how it can be diagnosed and treated both conventionally and integratively.


Allert, S., Förster, T. M., Svensson, C.-M., Richardson, J. P., Pawlik, T., Hebecker, B., Rudolphi, S., Juraschitz, M., Schaller, M., Blagojevic, M., Morschhäuser, J., Figge, M. T., Jacobsen, I. D., Naglik, J. R., Kasper, L., Mogavero, S., & Hube, B. (2018). Candida albicans-induced epithelial damage mediates translocation through intestinal barriers. mBio, 9(3).

Al-Shahrani, M. H., Mahfoud, M., Anvarbatcha, R., Athar, M. T., & Al Asmari, A. (2017). Evaluation of antifungal activity and cytotoxicity of Thymus vulgaris essential oil. Pharmacognosy Communications, 7(1), 34–40.

Bailly, S., Maubon, D., Fournier, P., Pelloux, H., Schwebel, C., Chapuis, C., Foroni, L., Cornet, M., & Timsit, J.-F. (2016). Impact of antifungal prescription on relative distribution and susceptibility of Candida spp. – Trends over 10 years. The Journal of Infection, 72(1), 103–111.

Bakhshi, M., Taheri, J.-B., Basir Shabestari, S., Tanik, A., & Pahlevan, R. (2012). Comparison of therapeutic effect of aqueous extract of garlic and nystatin mouthwash in denture stomatitis. Gerodontology, 29(2).

Baumgardner, D. J. (2019). Oral fungal Microbiota: To thrush and beyond. Journal of Patient-Centered Research and Reviews, 6(4), 252–261.

Bezerra, L. S., Silva, J. A. da, Santos-Veloso, M. A. O., Lima, S. G. de, Chaves-Markman, Â. V., & Jucá, M. B. (2020). Antifungal Efficacy of Amphotericin B in Candida Albicans Endocarditis Therapy: Systematic Review. Revista Brasileira de Cirurgia Cardiovascular: Orgao Oficial Da Sociedade Brasileira de Cirurgia Cardiovascular, 35(5).

Birmpa, A., Vantarakis, A., Paparrodopoulos, S., Whyte, P., & Lyng, J. (2014). Efficacy of three light technologies for reducing microbial populations in liquid suspensions. BioMed Research International, 2014, 1–9.

Borugă, O., Jianu, C., Mişcă, C., Goleţ, I., Gruia, A. T., & Horhat, F. G. (2014). Thymus vulgaris essential oil: chemical composition and antimicrobial activity. Journal of Medicine and Life, 7 Spec No. 3, 56–60.

Brito, E. H. S. de, Fontenelle, R. O. dos S., Brilhante, R. S. N., Cordeiro, R. de A., Sidrim, J. J. C., & Rocha, M. F. G. (2009). Candidose na medicina veterinária: um enfoque micológico, clínico e terapêutico. Ciencia Rural, 39(9), 2655–2664.

Cavalheiro, M., & Teixeira, M. C. (2018). Candida biofilms: Threats, challenges, and promising strategies. Frontiers in Medicine, 5.

César de Souza Vasconcelos, L., Sampaio, M. C. C., Sampaio, F. C., & Higino, J. S. (2003). Use of Punica granatum as an antifungal agent against candidosis associated with denture stomatitis. Mycoses, 46(5–6), 192–196.

Colombo, A. L., Guimarães, T., Camargo, L. F. A., Richtmann, R., de Queiroz-Telles, F., Salles, M. J. C., da Cunha, C. A., Yasuda, M. A. S., Moretti, M. L., & Nucci, M. (2013). Brazilian guidelines for the management of candidiasis – a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical. The Brazilian Journal of Infectious Diseases: An Official Publication of the Brazilian Society of Infectious Diseases, 17(3), 283–312.

Costa, M., de Fátima Lisboa Fernandes, O., & do Rosârio Rodrigues Silva, M. (2003). Candidiase vulvovaginal: aspectos clinicos, tratamentos oral com azólicos e suscetibilidade in vitro. Revista de patologia tropical, 32(2), 145–162.

C., Carretto, P., Aparecida Ferraz De Araujo Navas, E., Paradella, C., Dias De Oliveira, L., Campos Junqueira, J., Olavo, A., & Jorge, C. (2007). Efeitos do chá de tomilho sobre a aderência in vitro de Streptococcus mutans ao esmalte dentário e. Com.Br.

Donnelly, R. F., McCarron, P. A., & Tunney, M. M. (2008). Antifungal photodynamic therapy. Microbiological Research, 163(1), 1–12.

Dorsa, A. C. (2020). O papel da revisão da literatura na escrita de artigos científicos.

Ellis, M. E., Al-Abdely, H., Sandridge, A., Greer, W., & Ventura, W. (2001). Fungal endocarditis: Evidence in the world literature, 1965-1995. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 32(1), 50–62.

Gad, M., & Fouda, S. (2020). Current perspectives and the future of Candida albicans-associated denture stomatitis treatment. Dental and Medical Problems, 57(1), 95–102.

Gulati, M., & Nobile, C. J. (2016). Candida albicans biofilms: development, regulation, and molecular mechanisms. Microbes and Infection, 18(5), 310–321.

Hani, U., Shivakumar, H., Vaghela, R., M. Osmani, R., & Shrivastava, A. (2015). Candidiasis: A fungal infection- current challenges and progress in prevention and treatment. Infectious Disorders Drug Targets, 15(1), 42–52.

Jafri, H., & Ahmad, I. (2020). Thymus vulgaris essential oil and thymol inhibit biofilms and interact synergistically with antifungal drugs against drug resistant strains of Candida albicans and Candida tropicalis. Journal de Mycologie Medicale, 30(1), 100911.

Jakiemiu, E. A. R., Scheer, A. D. P., Oliveira, J. S. de, Côcco, L. C., Yamamoto, C. I., & Deschamps, C. (2010). Estudo da composição e do rendimento do óleo essencial de tomilho (Thymus vulgaris L.). Semina. Ciencias Agrarias, 31(3), 683.

Jean L. Bolognia, Julie V. Schaffer, Lorenzo Cerroni. (2017). Dermatology. Elsevier 4th ed.; Elsevier: Amsterdam, The Netherlands, 2018; Volume 2, ISBN 978-0-7020-6275-9.

Kadosh, D. (2019). Regulatory mechanisms controlling morphology and pathogenesis in Candida albicans. Current Opinion in Microbiology, 52, 27–34.

Kowalczyk, A., Przychodna, M., Sopata, S., Bodalska, A., & Fecka, I. (2020). Thymol and thyme essential oil—new insights into selected therapeutic applications. Molecules (Basel, Switzerland), 25(18), 4125.

Labib, G., & Aldawsari, H. (2015). Innovation of natural essential oil-loaded Orabase for local treatment of oral candidiasis. Drug Design, Development and Therapy, 3349.

Lewis, M. A. O., & Williams, D. W. (2017). Diagnosis and management of oral candidosis. British Dental Journal, 223(9), 675–681.

Lohse, M. B., Gulati, M., Johnson, A. D., & Nobile, C. J. (2018). Development and regulation of single- and multi-species Candida albicans biofilms. Nature Reviews. Microbiology, 16(1), 19–31.

Lu, Y., Su, C., & Liu, H. (2014). Candida albicans hyphal initiation and elongation. Trends in Microbiology, 22(12), 707–714.

Marqués-Calvo, M. S., Codony, F., Agustí, G., & Lahera, C. (2017). Visible light enhances the antimicrobial effect of some essential oils. Photodiagnosis and Photodynamic Therapy, 17, 180–184.

Martins, N., Ferreira, I. C. F. R., Barros, L., Silva, S., & Henriques, M. (2014). Candidiasis: Predisposing factors, prevention, diagnosis and alternative treatment. Mycopathologia, 177(5–6), 223–240.

Maubon, D., Garnaud, C., Calandra, T., Sanglard, D., & Cornet, M. (2014). Resistance of Candida spp. to antifungal drugs in the ICU: where are we now? Intensive Care Medicine, 40(9), 1241–1255.

Micucci, M., Protti, M., Aldini, R., Frosini, M., Corazza, I., Marzetti, C., Mattioli, L. B., Tocci, G., Chiarini, A., Mercolini, L., & Budriesi, R. (2020). Thymus vulgaris L. essential oil solid formulation: Chemical profile and spasmolytic and antimicrobial effects. Biomolecules, 10(6), 860.

Mohammadi, M., Shahisaraee, S. A., Tavajjohi, A., Pournoori, N., Muhammadnejad, S., Mohammadi, S. R., Poursalehi, R., & Delavari H, H. (2019). Green synthesis of silver nanoparticles using Zingiber officinale and Thymus vulgaris extracts: characterisation, cell cytotoxicity, and its antifungal activity against Candida albicans in comparison to fluconazole. IET Nanobiotechnology, 13(2), 114–119.

Moreira, W. (2004). Revisão de literatura e desenvolvimento científico: conceitos e estratégias para confecção. Janus V.1 N.1.

Mukaremera, L., Lee, K. K., Mora-Montes, H. M., & Gow, N. A. R. (2017). Candida albicans Yeast, Pseudohyphal, and Hyphal Morphogenesis Differentially Affects Immune Recognition. Frontiers in Immunology, 8.

Nascimento, G. G. F., Locatelli, J., Freitas, P. C., & Silva, G. L. (2000). Antibacterial activity of plant extracts and phytochemicals on antibiotic-resistant bacteria. Brazilian Journal of Microbiology, 31(4).

Nobile, C. J., & Johnson, A. D. (2015). Candida albicans Biofilms and Human Disease. Annual Review of Microbiology, 69(1), 71–92.

Oliveira, J. R. de, de Jesus Viegas, D., Martins, A. P. R., Carvalho, C. A. T., Soares, C. P., Camargo, S. E. A., Jorge, A. O. C., & de Oliveira, L. D. (2017). Thymus vulgaris L. extract has antimicrobial and anti-inflammatory effects in the absence of cytotoxicity and genotoxicity. Archives of Oral Biology, 82, 271–279.

Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., Zaoutis, T. E., & Sobel, J. D. (2016). Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 62(4), e1–e50.

Pereira, J. V. et al. (2005). Estudos com o extrato da Punica granatum Linn. (Romã): efeito antimicrobiano in vitro e avaliação clínica de um dentifrício sobre microrganismos do biofilme dental / Studies with the extract of the Punica granatum Linn. (Pomegranate): effect antimicrobial. Revista Odonto Ciência, v. 20, n. 49, p. 262-269.

Poulain, D. (2015). Candida albicans, plasticity and pathogenesis. Critical Reviews in Microbiology, 41(2), 208–217.

Rother, E. T. (2007). Revisão sistemática X revisão narrativa. Acta Paulista de Enfermagem, 20(2), v–vi.

Shu, C., Sun, L., & Zhang, W. (2016). Thymol has antifungal activity against Candida albicans during infection and maintains the innate immune response required for function of the p38 MAPK signaling pathway in Caenorhabditis elegans. Immunologic Research, 64(4), 1013–1024.

Smetana, Z., Mendelson, E., Manor, J., van Lier, J. E., Ben-Hur, E., Salzberg, S., & Malik, Z. (1994). Photodynamic inactivation of herpes viruses with phthalocyanine derivatives. Journal of Photochemistry and Photobiology. B, Biology, 22(1), 37–43.

Tamyris B. Silva1*, E. T. R. (2010). Avaliação da atividade antimicrobiana do extrato etanólico do tomilho (Thymus vulgaris L.) invitro. Revista Eletrônica de Farmácia ISSN 1808-0804Vol. VII (2), 48 –58,2010.

Villar, C. C., Kashleva, H., & Dongari-Bagtzoglou, A. (2004). Role of Candida albicans polymorphism in interactions with oral epithelial cells. Oral Microbiology and Immunology, 19(4), 262–269.

Wainwright, M., Phoenix, D. A., Gaskell, M., & Marshall, B. (1999). Photobactericidal activity of methylene blue derivatives against vancomycin-resistant Enterococcus spp. The Journal of Antimicrobial Chemotherapy, 44(6), 823–825.

Wainwright, M., Phoenix, D. A., Laycock, S. L., Wareing, D. R. A., & Wright, P. A. (1998). Photobactericidal activity of phenothiazinium dyes against methicillin-resistant strains ofStaphylococcus aureus. FEMS Microbiology Letters, 160(2), 177–181.

Wainwright, Mark, & Crossley, K. B. (2004). Photosensitising agents—circumventing resistance and breaking down biofilms: a review. International Biodeterioration & Biodegradation, 53(2), 119–126.

Wainwright, Mark, Phoenix, D. A., Nickson, P. B., & Morton, G. (2002). The use of new methylene blue inPseudomonas aeruginosabiofilm destruction. Biofouling, 18(4), 247–249.

Wang, Y. (2015). Looking intoCandida albicansinfection, host response, and antifungal strategies. Virulence, 6(4), 307–308.




How to Cite

SILVA, K. G. dos S.; NASCIMENTO, G. O. do .; SILVA, E. E. M. da .; CABRAL, L. H. V.; FARIA, T. M. R.; OLIVEIRA, J. R. de . Candida albicans: Virulence factors, pathogenesis, and ways to diagnose and control its infection. Research, Society and Development, [S. l.], v. 13, n. 1, p. e6413144781, 2024. DOI: 10.33448/rsd-v13i1.44781. Disponível em: Acesso em: 27 may. 2024.



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