TABLE 4.

Correlation between Sap production and activity with C. albicans virulence

Main findings	Reference(s)
Oral candidiasis
Increased Sap activity occurred in C. albicans strains isolated from HIV-positive patients with oral candidiasis compared with HIV-negative C. albicans carriers	46, 252
C. albicans from HIV-positive patients with oropharyngeal candidiasis produced more proteinase activity than did C. albicans from HIV-negative asymptomatic oral carriers or HIV-negative subjects with oral candidiasis.	166
Vaginal candidiasis
C. albicans isolates from patients with vaginal candidiasis were significantly more proteolytic than isolates from asymptomatic vaginal carriers.	4, 28, 43
C. albicans isolates from HIV-positive women with vaginitis produced significantly higher levels of Sap than did C. albicans strains isolated from HIV-positive asymptomatic carriers or HIV-negative subjects with candidal vaginitis.	49
Animal models
High-Sap-producing oral and vaginal C. albicans strains from HIV-positive patients were more pathogenic in the mouse and rat vaginitis models than were lower-Sap-producing C. albicans strains from HIV-negative patients.	48, 49
There was a correlation between C. albicans adherence to buccal epithelial cells, proteinase production, and lethality in mice. Higher-Sap-producing strains showed higher levels of tissue colonization in the liver, kidneys, and spleen	2
Other diseases
There was no difference in Sap production from oral C. albicans isolated from patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy and healthy controls	87
Production of Sap did not differ between patients with antibiotic-associated diarrhea and control subjects.	118
Higher levels of Sap were produced by C. albicans from children with acute diarrhea than those with chronic diarrhea, which may account for the more severe symptoms.	136