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Microbiology. 2015 Jan;161(Pt 1):168-181. doi: 10.1099/mic.0.083485-0. Epub 2014 Oct 20.

Systemic Staphylococcus aureus infection mediated by Candida albicans hyphal invasion of mucosal tissue.

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1Department of Restorative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Goethestrasse 70, 80336 Munich, Germany.
2Department of Microbial Pathogenesis, University of Maryland - Baltimore, Dental School, 650 W. Baltimore Street, Baltimore, MD 21201, USA.
3Graduate Program in Life Sciences, Molecular Microbiology and Immunology Program, University of Maryland - Baltimore, 660 W. Redwood Street, Baltimore, MD 21201, USA.
4Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Free University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands.
5Department of Immunology, Ruprecht Karls University Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany.
6Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W. Carson St., Torrance, CA 90502, USA.
7Department of Oncology and Diagnostic Sciences, Dental School, University of Maryland - Baltimore, 650 W. Baltimore Street, Baltimore, MD 21201, USA.
8Department of Microbiology and Immunology, School of Medicine, University of Maryland - Baltimore, 660 W. Redwood Street, Baltimore, MD 21201, USA.


Candida albicans and Staphylococcus aureus are often co-isolated in cases of biofilm-associated infections. C. albicans can cause systemic disease through morphological switch from the rounded yeast to the invasive hyphal form. Alternatively, systemic S. aureus infections arise from seeding through breaks in host epithelial layers although many patients have no documented portal of entry. We describe a novel strategy by which S. aureus is able to invade host tissue and disseminate via adherence to the invasive hyphal elements of Candida albicans. In vitro and ex vivo findings demonstrate a specific binding of the staphylococci to the candida hyphal elements. The C. albicans cell wall adhesin Als3p binds to multiple staphylococcal adhesins. Furthermore, Als3p is required for C. albicans to transport S. aureus into the tissue and cause a disseminated infection in an oral co-colonization model. These findings suggest that C. albicans can facilitate the invasion of S. aureus across mucosal barriers, leading to systemic infection in co-colonized patients.

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