Molecular characterization of Candida spp. in ready-to-eat foods at mass gatherings: an overlooked public health threat.

Candidiasis is globally increasing in clinical settings whereas food is least considered as its potential source. Mass gatherings (MGs) can be potential source of microbial transmission of public health concern, however, there is scarcity of data on Candida spp. prevalence in ready to eat (RTE) food. The current study found potentially pathogenic Candida spp. with 8 % (6/74) prevalence in RTE food from 22.7 % MGs with Candida krusei being prominent specie (57.1 %) followed by Candida tropicalis (42.8 %). Overall prevalence of Candida spp. was found to be significantly associated with cooked pulses having eight-fold risk. Food handlers' hygienic practices and food storage practices were found to be linked to Candida spp. prevalence. Virulence profiling showed that, all Candida tropicalis isolates exhibited hydrolytic enzyme activity, indicating pathogenic potential. Compared to Candida tropicalis (14.2 %), Candida krusei (28.5 %) were found to be more biofilm formers. In case of Candida tropicalis, 14.2 % was found to be resistant to fluconazole (Diflucan), while 28.5 % Candida krusei were found to be fluconazole (Diflucan) resistant and 14.2 % were also voriconazole resistant. Molecular characterization of isolates showed that all Candida tropicalis possessed both ASL 1 and HPW 1 gene whereas 50 % of Candida krusei isolates were positive for HPW1gene. Moreover, it was also found that virulent Candida isolates had co-carriage of both ASL1 and HPW1 genes (p = 0.041). Interestingly, 1/3 Candida tropicalis isolate was convergent for both pathogenic potential by expressing all virulence factors and fluconazole (Diflucan) resistance. Co-existence of virulent and fluconazole (Diflucan) resistant Candida strain in RTE food is a major concern for public health as it can serve as potential source for spread to large number of attendees. MGs need to have strict surveillance and compliance to the food safety regulation as such MGs can be source of transmission of non albican Candida spp. to local and international community.