{
  "abstract": "Candida parapsilosis is a major human fungal pathogen, with recent global outbreaks driven by fluconazole-resistant (FLCR-Cp) isolates that are difficult to eradicate and associated with poor clinical outcomes. However, the microbial traits enabling persistence of these outbreak lineages remain poorly defined. Here, we show that FLCR-Cp isolates responsible for prolonged, multi-country outbreaks consistently exhibit a striking low-biofilm-producing (LBP) phenotype. Contrary to the prevailing view that robust biofilm formation promotes persistence, LBP strains displayed enhanced stress tolerance, increased cell wall masking, and reduced immune recognition. These traits conferred resistance to neutrophil and macrophage killing and enhanced survival in immune cell-rich organs during systemic infection. Genome-wide transcriptomic profiling revealed extensive metabolic and regulatory rewiring in LBP strains. Whole-genome sequencing (WGS) of a global isolate collection further demonstrated that the LBP phenotype has emerged independently multiple times, supporting convergent evolution under host selection. Functional genomic analyses suggest that biofilm attenuation arises through multigenic changes, and disruption of key biofilm-associated transcriptional regulators enhanced fitness during immune interactions. Together, our findings overturn the assumption that robust biofilm formation drives outbreak persistence and instead identify biofilm attenuation as an adaptive tradeoff that promotes immune evasion and long-term survival. These results redefine our understanding of C. parapsilosis adaptation during healthcare-associated outbreaks and shift attention toward host-driven evolutionary processes than environmental persistence alone.\n\nDrug-resistant Candida parapsilosis is an increasing problem in hospitals, but what traits help fungus survive? This study shows that reduced biofilm formation is repeatedly selected for during infection and helps C. parapsilosis evade immune defenses and persist in the host.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands",
    "Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America",
    "Department of Molecular and Cell Biology, School of Natural Sciences, University of California Merced, Merced, California, United States of America",
    "School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland",
    "Department of Biology, University of Pisa, Pisa, Italy",
    "Quantitative and Systems Biology Graduate Program, University of California Merced, Merced, California, United States of America",
    "Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China",
    "The Center for Fungal Infectious Diseases Basic Research and Innovation of Medicine and Pharmacy, Ministry of Education, Shanghai, China",
    "Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom",
    "Department of Biotechnology and Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary",
    "Department of Medical Microbiology, Ege University Faculty of Medicine, Izmir, Türkiye",
    "Health Sciences Research Institute, University of California Merced, Merced, California, United States of America",
    "Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany",
    "Special Mycology Laboratory, Federal University of São Paulo, São Paulo, Brazil",
    "Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil",
    "Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Bari, Italy",
    "Public Health Ontario, Toronto, Ontario, Canada",
    "Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada",
    "Life Sciences Programme, Supercomputing Center (BSC-CNS), Barcelona, Spain",
    "Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain",
    "Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal",
    "ICVS/3B’s-PT Government Associate Laboratory, Guimarães/Braga, Portugal",
    "Department of Industrial Engineering, Faculty of K.N., Toosi University of Technology, Tehran, Iran",
    "Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, United States of America",
    "Fralin Biomedical Research Institute, Virginia Tech FBRI Cancer Research Center, Washington, District of Columbia, United States of America",
    "Department of Biomedical Sciences and Pathobiology, College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States of America",
    "Department of Biomedical Sciences, East Tennessee State University Quillen College of Medicine, Center of Excellence in Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, Tennessee, United States of America",
    "Catalan Institution for Research and Advanced Studies, Barcelona, Spain",
    "Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain",
    "National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology—Hans-Knoell-Institute, Jena, Germany",
    "Georgetown University Lombardi Comprehensive Cancer Center, Washington, United States of America",
    "Center for Cellular and Biomolecular Machines, University of California Merced, Merced, California, United States of America",
    "Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America",
    "University Hospital Wuerzburg, Medical Hospital II, Würzburg, Germany"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 37,
  "authors": [
    {
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        0
      ],
      "name": "Farnaz Daneshnia"
    },
    {
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        1
      ],
      "name": "Deepika Gunasekaran"
    },
    {
      "affs": [
        2
      ],
      "name": "Sean Bergin"
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    {
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        3
      ],
      "name": "Lisa Lombardi"
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        4
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      "name": "Austin M. Perry"
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        5
      ],
      "name": "Liuyang Cai"
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        6
      ],
      "name": "Louise A. Walker"
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        7
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      "name": "Tibor Nemeth"
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    {
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        8
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      "name": "Süleyha Hilmioglu-Polat"
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    {
      "affs": [
        9
      ],
      "name": "Letal I. Salzberg"
    },
    {
      "affs": [
        10
      ],
      "name": "Arefeh Ebadati"
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    {
      "affs": [
        11
      ],
      "name": "Tobias Köhler"
    },
    {
      "affs": [
        12
      ],
      "name": "Gabriel Braune"
    },
    {
      "affs": [
        13
      ],
      "name": "João N. de Almeida"
    },
    {
      "affs": [
        14
      ],
      "name": "Giuseppina Caggiano"
    },
    {
      "affs": [
        15
      ],
      "name": "Julianne V. Kus"
    },
    {
      "affs": [
        16
      ],
      "name": "Pegah Mosharaf Ghahfarokhy"
    },
    {
      "affs": [
        17
      ],
      "name": "Julieta Munoz"
    },
    {
      "affs": [
        18
      ],
      "name": "Daniel J. Floyd"
    },
    {
      "affs": [
        19
      ],
      "name": "Diego Fuentes-Palacios"
    },
    {
      "affs": [
        20
      ],
      "name": "Samuel M. Gonçalves"
    },
    {
      "affs": [
        21
      ],
      "name": "Relber A. Gonçales"
    },
    {
      "affs": [
        22
      ],
      "name": "Mostafa Salehi"
    },
    {
      "affs": [
        23
      ],
      "name": "Jigar V. Desai"
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    {
      "affs": [
        24
      ],
      "name": "Agostinho Carvalho"
    },
    {
      "affs": [
        25
      ],
      "name": "Shenglin Mei"
    },
    {
      "affs": [
        26
      ],
      "name": "Carol A. Munro"
    },
    {
      "affs": [
        27
      ],
      "name": "Alex Hopke"
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    {
      "affs": [
        28
      ],
      "name": "Toni Gabaldón"
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    {
      "affs": [
        29
      ],
      "name": "Attila Gacser"
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    {
      "affs": [
        30
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      "name": "Oliver Kurzai"
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    {
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        31
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      "name": "Geraldine Butler"
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    {
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        32
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      "name": "David S. Perlin"
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        33
      ],
      "name": "Wenjie Fang"
    },
    {
      "name": "Clarissa J. Nobile"
    },
    {
      "name": "Michael K. Mansour"
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    {
      "name": "Amir Arastehfar"
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  "bibtex": "https://research.draconitic.com/paper/a3y91te93t9qr.bib",
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  "doi": "10.1371/journal.pbio.3003973",
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      "2725|Antifungal resistance and susceptibility"
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      "/Biology and life sciences/Cell biology/Cell processes/Phagocytosis"
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  "pmcid": null,
  "pmid": null,
  "published": "2026-09-01",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/a3y91te93t9qr.ris",
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    {
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  "subjects": [
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      "origin": "plos:cell biology",
      "subfield": "cell-biology"
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      "origin": "plos:immunology",
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    {
      "field": "biology",
      "origin": "plos:microbiology",
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  "title": "Outbreaks of fluconazole-resistant Candida parapsilosis are driven by low-biofilm-producing isolates that emerge under host selection",
  "title_text": "Outbreaks of fluconazole-resistant Candida parapsilosis are driven by low-biofilm-producing isolates that emerge under host selection",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
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  "venue": "PLOS Biology",
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