{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:02:07Z","timestamp":1790179327415,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Recent reports of the emergence of fluconazole resistance in\n                      <jats:italic>Candida parapsilosis species<\/jats:italic>\n                      complex poses a challenge, more specifically in settings where echinocandin\u2010based treatment regime is not feasible.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This study reported emergence of fluconazole resistance in\n                      <jats:italic>C.\u2009parapsilosis species<\/jats:italic>\n                      complex strains isolated from blood cultures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective observational study was conducted from 2018 to 2020 at a tertiary care laboratory from Pakistan. Fluconazole\u2010resistant\n                      <jats:italic>C.\u2009parapsilosis species<\/jats:italic>\n                      complex fungemia cases were identified from laboratory database and clinical details were collected. Identification of\n                      <jats:italic>C.\u2009parapsilosis species<\/jats:italic>\n                      complex was done using API 20C AUX and Cornmeal Tween80 agar morphology. Minimum inhibitory concentrations (MICs) were determined using Sensititre YeastONE and interpretation was done with CLSI M60 ED1:2017.\n                      <jats:italic>ERG11<\/jats:italic>\n                      gene region was amplified and sequenced by Sanger sequencing and analysed by MEGA 11 Software.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 13 (8.5%) fluconazole\u2010resistant isolates were identified from 152\n                      <jats:italic>C.\u2009parapsilosis species<\/jats:italic>\n                      complex candidemia cases. Fluconazole MICs of resistant isolates ranged between 8 and 256\u2009\u03bcg\/mL. Analysis of\n                      <jats:italic>ERG11<\/jats:italic>\n                      gene revealed nonsynonymous mutations at position Y132F in 86% of the fluconazole\u2010resistant isolates. Diabetes and hospitalization were important risk factors for candidemia with fluconazole\u2010resistant\n                      <jats:italic>C.\u2009parapsilosis<\/jats:italic>\n                      complex.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This is the first report of the emergence and molecular mechanisms of fluconazole resistance in\n                      <jats:italic>C. parapsilosis species<\/jats:italic>\n                      complex from Pakistan. Y132F mutation in the\n                      <jats:italic>ERG11<\/jats:italic>\n                      gene was the most common mutation in fluconazole\u2010resistant strains. These findings are concerning and necessitate better diagnostics, newer antifungals, ongoing surveillance and further insights on resistance mechanisms in the country.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/myc.13677","type":"journal-article","created":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T18:38:55Z","timestamp":1700764735000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Fluconazole\u2010resistant\n                    <i>Candida parapsilosis<\/i>\n                    complex candidemia and analysis of mutations in the\n                    <i>ERG11<\/i>\n                    gene from Pakistan"],"prefix":"10.1111","volume":"67","author":[{"given":"Mohammad","family":"Zeeshan","sequence":"first","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba","family":"Memon","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Malick","sequence":"additional","affiliation":[{"name":"Aga Khan University Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Faheem","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joveria","family":"Farooqi","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najia Karim","family":"Ghanchi","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2497-7847","authenticated-orcid":false,"given":"Kauser","family":"Jabeen","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/jof3040057"},{"key":"e_1_2_12_3_1","unstructured":"Organization WH.WHO fungal priority pathogens list to guide research development and public health action.2022."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2079"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-019-0702-9"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1348-0421.12957"},{"issue":"4","key":"e_1_2_12_7_1","first-page":"291","article-title":"Prevalence and antifungal drug resistance of dermatophytes in the clinical samples from Pakistan","volume":"68","author":"Usman B","year":"2021","journal-title":"Acta Microbiol Immunol Hung"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.29261\/pakvetj\/2020.053"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw691"},{"key":"e_1_2_12_10_1","first-page":"e470","article-title":"Worldwide emergence of fluconazole\u2010resistant Candida parapsilosis: current framework and future research roadmap. 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