Environmental continuum of Candidozyma auris: From sapronotic ecology to outbreak prediction and control with a One Health perspective
Abstract
Candidozyma auris (formerly Candida auris) has emerged within just over a decade as one of the most relevant multidrug-resistant fungal pathogens affecting human health worldwide. Its pathogenicity, capacity for skin colonization, environmental persistence, and resistance to antifungal drugs and disinfectants have all contributed to its consolidation as a leading cause of healthcare-associated outbreaks. Nevertheless, increasing evidence indicates that C. auris should not be viewed solely as a nosocomial yeast, but rather as part of a broader environmental continuum encompassing natural habitats, anthropogenic niches, and multiple host species. Environmental isolates have been documented in coastal wetlands, wastewater systems, agricultural products, as well as in diverse animals - including companion animals, reptiles, amphibians, and insects - supporting its classification as a sapronotic pathogen. The near-simultaneous emergence of distinct clades across continents strongly suggests that climate change, agricultural azole exposure, and ecological adaptation have collectively selected strains exhibiting thermotolerance, antifungal resistance, and cross-kingdom persistence, thereby enabling recurrent spillover into human populations. Recent advances in wastewater-based epidemiology demonstrate that C. auris can be detected at the community level, often preceding clinical recognition, while animal colonization underscores its overlooked role in pathogen maintenance and…
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