Candidemia is an important but under-characterised bloodstream infection in Indonesia, occurring in a context of expanding populations at risk, emerging antifungal resistance and gaps in prevention and control. An estimated 7.7 million Indonesians (2.89% of the population) are affected by serious fungal diseases annually; this figure is not an estimate of candidemia incidence. The epidemiology of candidemia is complex, with various Candida species contributing to the disease burden. Early and accurate diagnosis is crucial for appropriate antifungal therapy. Conventional blood culture remains the reference method for diagnosing candidemia; however, the availability and routine use of CHROMagar Candida, VITEK and advanced diagnostic platforms across Indonesia have not been systematically characterised. Potential diagnostic approaches include serological assays, mass spectrometry, and molecular methods such as real-time PCR and sequencing. Frequently reported species in Indonesian studies include C. tropicalis, C. albicans and C. parapsilosis, although study populations and case definitions vary. Indonesian evidence for C. auris is limited to one molecularly confirmed archived isolate and other isolate reports lacking sufficient specimen, confirmatory or patient-level data to determine the number of affected patients or the national clinical burden. Where available, molecular methods may aid identification when phenotypic methods are inconclusive; results should be interpreted alongside culture findings and clinical data.
BACKGROUND:Oral candidiasis is a common opportunistic fungal infection in pediatric cancer patients, which can lead to severe invasive infections. To manage and treat oral candidiasis effectively, it is vital to address risk factors, accurately identify Candida species, and provide suitable topical or systemic antifungal therapy. METHODS:This study included all patients aged ≤ 18 years with cancer from April to September 2024. Oral examinations were conducted along with the collection of microbial swabs. Species identification was performed using both conventional and molecular methods. The in vitro antifungal activity of six common agents was investigated using the Clinical & Laboratory Standards Institute guidelines. RESULTS:Of the 102 pediatric patients with cancer, 39 (38.2%) had positive cultures. Among those with a positive culture, 9 patients (23.1%) were diagnosed with oral candidiasis, while 30 (76.9%) exhibited oral Candida colonization. No statistically significant link was found between age or gender and oral candidiasis, while dexamethasone and ceftazidime were significantly associated. Among 41 obtained Candida isolates, C. albicans was the most common (51.2%), followed by C. dubliniensis (21.9%), C. africana (12.1%), C. tropicalis (7.3%), N. glabratus (2.4%), K. marxianus (2.4%), and P. kudriavzevii (2.4%). Amphotericin B and caspofungin demonstrated the highest in vitro activity against all Candida isolates. Fluconazole showed the highest resistance rate at 28.6% for C. albicans. CONCLUSION:This study provides valuable insights into risk factors, molecular epidemiology, and antifungal susceptibility patterns associated with oral Candida colonization and infection in pediatric cancer patients. It also underscores the importance of continued surveillance of antifungal susceptibility patterns to support antifungal stewardship efforts in this population.
Terbinafine (TBF) remains a frontline therapeutic agent for dermatophytosis; however, resistance in Trichophyton rubrum is emerging as a significant clinical challenge. Here we present the mass spectrometry based lipidomic signatures of select clinical isolates of T.rubrum and draw attention to lipidomic changes related to TBF resistance. While there was no change in sterol content, an extensive lipid remodeling in PGL molecular species was observed. For example, a decreased unsaturation index, LPS/PS ratio, and LPA/PA ratio was observed in TBF resistant isolate. These changes were balanced by an increased odd fatty acyl containing and saturated -PGL molecular species, LPG/PG ratio, and LPI/PI ratio in TBF resistant isolate. Among SLs, PCer(t18:0/18:0(2OH)) species showed significant decrease in TBF resistant isolate. Additionally, decreased DAG and increased TAG contents point to the fact that lipid biosynthesis shifts from polar lipid synthesis towards TAG synthesis in the resistant isolate, while making necessary adjustments in PGL and SL molecular species to maintain membrane homeostasis and keep the sterol synthesis at optimum levels. Further, upon correlating the variations with phenotypes and enzymatic activities, a compensatory adaptation of stress in resistant isolates of T. rubrum is evident. Together, these datasets should be useful to understand the role of lipid homeostasis in the underlying mechanisms of TBF resistance and emphasize the potential lipid biosynthetic pathways to develop therapeutic interventions.
INTRODUCTION:Intra-abdominal infections caused by Candida spp. (IAC) represent a major clinical challenge requiring a multidisciplinary approach due to difficulties in diagnosis, severity of disease, and the limited availability of therapeutic options. In the field of antifungal therapy, the armamentarium has recently been expanded with rezafungin, a novel echinocandin. The favourable pharmacokinetic and pharmacodynamic profile of rezafungin may support a potential role for this agent in the treatment of IAC. METHODS:We performed a retrospective review of all consecutive patients treated with rezafungin as first- or second-line therapy for IAC during 2025 at IRCCS Humanitas Research Hospital, Rozzano, Italy. In addition, a narrative review of the English-language literature on the role of rezafungin in the management of IAC was conducted. RESULTS:A total of eight patients with IAC were included (75% male; median age [Q1-Q3]: 65 years (61-76)). Six patients were diagnosed with concomitant Candida bloodstream infection. Rezafungin was administered as first-line therapy in 37.5% (3/8) of cases. Microbiological eradication was achieved within 5 days in 50% (4/8), within 14 days in 87.5% (7/8) of patients, including those with incomplete source control. Two patients died within 30 days. No recurrence at 30 days were reported. No adverse events occurred. CONCLUSION:Based on our experience, rezafungin may be considered for the treatment of IAC both as first-line and salvage therapy. Further studies and clinical trials are needed to confirm and support these findings.
Candida albicans biofilms are intrinsically tolerant to antifungals due to coordinated regulation of hyphal morphogenesis, adhesins/matrix, and sterol biosynthesis. We conducted a PRISMA 2020-guided in vitro systematic review restricted to full-text-assessed studies (18 studies) and a meta-analysis of five studies with extractable quantitative outcomes to estimate pooled inhibition and compare mechanistic classes across natural and synthetic agents. Across the eligible evidence base, effective compounds converged on multi-target pathways, including repression of hyphal transcriptional programs (e.g., EFG1/CPH1/TEC1 axes), interference with adhesins and extracellular matrix integrity (ALS3/HWP1; matrix disruption), and perturbation of ergosterol biosynthesis (e.g., ERG11). Phenotypic readouts consistently included reduced initial adhesion, impaired biofilm maturation, and dispersion/viability loss in mature biofilms. The pooled effect among studies eligible for meta-analysis indicated consistent inhibition (log-odds ratio -2.05; 95% CI -2.60 to -1.51; I² = 60.4%), although inference remains limited by the small number of studies and assay heterogeneity. Evidence is restricted to in vitro C. albicans models; non-albicans outcomes were summarized qualitatively when reported in eligible full-text studies. Quantification suggests that dual targeting of gene regulation and biofilm integrity yields reproducible in vitro inhibition, but future studies should standardize endpoints, report variance measures, validate in vivo and non-albicans taxa, and translate mechanistic readouts to actionable efficacy metrics. LAY SUMMARY: Candida albicans biofilms resist drugs. Across 18 full-text-assessed in vitro studies (with five pooled), diverse compounds reduced biofilms by targeting multiple weak spots - growth programs, adhesion, matrix integrity, and sterols. Promising, but standardized reporting and clinical/in vivo testing are still needed.
BACKGROUND:Tinea capitis is a superficial dermatophytic infection of the scalp and hair shafts, predominantly affecting children. The distribution of etiological agents varies with geography, climate, and socioeconomic factors. Emerging changes in lifestyle and hygiene practices necessitate region-specific epidemiological data. OBJECTIVES:To determine the prevalence, clinico-epidemiological characteristics, and mycological spectrum of tinea capitis in a tertiary care centre in Southern India, and to evaluate clinico-etiological correlations. METHODS:A descriptive cross-sectional study was conducted among 70 clinically and mycologically confirmed cases of tinea capitis attending a tertiary care hospital in Madurai, Tamil Nadu, India, from October 2018 to September 2019. Specimens were subjected to 10% potassium hydroxide (KOH) microscopy and fungal culture on modified Sabouraud's dextrose agar. Dermatophytes were identified based on colony morphology and lactophenol cotton blue mount findings. Statistical analysis was performed using the chi-square test, with p < 0.05 considered significant. RESULTS:The prevalence of tinea capitis was 0.4% among dermatophytosis cases. Most patients (95.6%) were ≤15 years, with male predominance (M:F = 2.04:1). Common risk factors included sharing of combs/caps (44.2%) and tonsuring (38.5%). Non-inflammatory variants predominated (75.7%), with grey patch as the most common presentation (44.3%). Culture positivity was observed in 67.2% of cases. Trichophyton tonsurans (34%) was the predominant isolate, followed by T. violaceum (25.5%) and T. rubrum (14.9%). A significant association was observed between clinical patterns and etiological agents (p < 0.05). CONCLUSION:Tinea capitis remains a significant pediatric infection in Southern India, with a predominance of anthropophilic dermatophytes, particularly Trichophyton tonsurans, indicating a shift in epidemiological trends. Continuous surveillance and improved hygiene practices are essential for effective control.
OBJECTIVE:Candida species are opportunistic pathogens that can cause life-threatening infections, especially in immunocompromised patients. Azole antifungals are widely used for treatment, but resistance is increasing and often due to mutations in the ERG11 gene that compromises their efficacy. This study aimed to determine the prevalence of azole-resistant Candida spp. among immunocompromised patients and identify mutations in the ERG11 gene associated with resistance. METHODS:In this cross-sectional study, clinical samples were processed from immunocompromised patients at two University Hospitals in Egypt. Identification of Candida spp. was done using culture on Sabouraud's Dextrose agar as well as Candida Differential agar supplemented by automated identification by the mass spectrometry method (MALDI-TOF, Vitek MS, bioMérieux, France). Susceptibility to fluconazole and voriconazole was assessed using broth microdilution method. Resistant isolates were subjected to PCR amplification and Sanger sequencing of ERG11 hot spot regions. RESULTS:Out of 1404 eligible samples, 90 (6.4%) yielded Candida spp., predominantly C. tropicalis (44.4%) and C. albicans (41.1%). Resistance to fluconazole and voriconazole was observed in 14.4% and 13.3% of isolates, respectively. ERG11 sequencing revealed multiple mutations. Common missense mutations included Y132F (50%) and S154F (33.3%). A novel mutation (M306R) was identified in two C. tropicalis isolates. CONCLUSION:Azole resistance among Candida isolates is notable in immunocompromised patients. The present study highlights both known and novel ERG11 mutations, emphasizing the need for routine molecular surveillance to guide antifungal therapy.
Naganishia globosa (formerly Cryptococcus saitoi) is an environmental basidiomycetous yeast rarely associated with human disease. We report the first case worldwide of N. globosa isolated from pleural fluid in a patient with T-cell acute lymphoblastic leukemia (T-ALL), an immunocompromised host, hospitalized in Türkiye. The isolate was identified by MALDI-TOF MS and confirmed by molecular sequencing. The patient received antifungal therapy following diagnosis. Liposomal amphotericin B, isavuconazole, fluconazole, and voriconazole were used in the patient's treatment and were modified according to drug tolerance and clinical condition. The absence of yeast growth in follow-up pleural cultures and the patient's survival 1.5 months after discharge indicate a favorable response to therapy. This case highlights the clinical relevance of this uncommon yeast in immunocompromised individuals and underscores the importance of advanced diagnostic tools for accurate identification and increased awareness of rare fungal pathogens.
Introduction Patients undergoing solid organ and hematopoietic stem cell transplants are at an increased risk for invasive fungal infections (IFI), which constitute the primary cause of mortality in this population. The epidemiology and risk factors for invasive fungal infections differ according to the type of transplant. There are limited studies from India concerning the spectrum of invasive mold infections (IMI) in transplant recipients. This study aims to elucidate the clinical microbiological spectrum of mold infections in transplant recipients. Materials and Methods This study was a retrospective analysis of solid organ transplant (SOT) and hematopoietic stem cell transplant patients (HSCT) with mold infections from January 2023 to December 2025 at a tertiary care center in southern India. Patients with IMI were included in the study according to the EORTC/MSG criteria. Clinical and microbiological data were extracted from records and analyzed. Results During the study period, a total of 3.6% IMI was observed. Of these, 3.8% were from renal transplants, 2.4% from hematopoietic stem cell transplants (HSCT), and 33.3% from lung transplant recipients. Among the IMI cases, 37.5% were proven, whereas 62.5% were classified as probable IMI cases. The male population was predominant, with a median age of 37 years. The lungs were the most frequently affected site, followed by subcutaneous infections. The predominant mold infection was mucormycosis in 43.7% cases, followed by aspergillosis in 31.25%. The majority of infections occurred within the initial six months post-transplantation. Conclusion In the current study, Mucorales is the predominant mold isolated, accompanied by rare molds. Clinicians must recognize invasive mold infections (IMI), including the uncommon molds responsible for transplant-related infections, to enable rapid and appropriate treatment, crucial for survival.
BACKGROUND:The incidence of central nervous system (CNS) talaromycosis, an emerging complication in patients with acquired immunodeficiency syndrome (AIDS), is increasing, accompanied by a high mortality rate. Limited understanding of whether its clinical manifestations differ from those of common AIDS-associated CNS infections, such as cryptococcal meningitis (CM) and tuberculous meningitis (TBM), makes diagnosis challenging. Therefore, we aimed to systematically elucidate the key differences in clinical manifestations, diagnostic approaches, and treatment strategies among CNS talaromycosis, CM, and TBM. METHODOLOGY/PRINCIPAL FINDINGS:A cross-sectional analysis was conducted on monomicrobial-pathogen CNS talaromycosis, CM, and TBM in patients with human immunodeficiency virus/AIDS, comparing demographics, clinical features, and cerebrospinal fluid (CSF). Patients with CNS talaromycosis (n = 16) were predominantly male (87.5 %) with advanced immunosuppression (median CD4+ T-cell count 107.00 cells/μL). Compared to CM (n = 50), CNS talaromycosis had higher antiretroviral treatment coverage (62.50 % vs. 18.00 %) and CD4+ counts (107.00 vs. 23.50 cells/μL), a lower incidence of fever (25 % vs. 74 %) and headache (31 % vs. 84 %), and similar CSF findings. Compared to those with TBM (n = 14), patients with CNS talaromycosis had a lower incidence of fever (25 % vs. 86 %), and distinct CSF profiles (lower lactate dehydrogenase [LDH]: 26.00 vs. 79.50 U/L; and lower adenosine deaminase [ADA]: 0.98 vs. 5.50 U/L). CONCLUSIONS:CNS talaromycosis patients primarily present with a mild meningeal inflammatory response, less pronounced than in CM and TBM. Due to the similarities in clinical symptoms and CSF findings, microbiological tests are crucial for differentiating CNS talaromycosis from CM. When differentiating CNS talaromycosis from TBM, the levels of LDH and ADA in CSF can serve as valuable reference indicators.
Trichophyton rubrum is a highly prevalent dermatophyte re for superficial mycoses affecting keratinized tissues such as skin, hair and nails. Its ability to colonize these tissues is attributed to its keratolytic activity and adaptability to different environmental conditions. Materials and methods This retrospective study included cases of dermatophytosis caused by Trichophyton rubrum diagnosed at the Parasitology-Mycology Laboratory of the Mohammed VI University Hospital in Oujda over a period of four and a half years, from January 7, 2020, to July 7, 2024. Each sample was examined by direct microscopy after clarification with 30% KOH and cultured on Sabouraud media at 25°C.This study aims to investigate the epidemiological and mycological characteristics of patients diagnosed with Trichophyton rubrum dermatophytosis. Results Trichophyton rubrum dermatophytosis was mycologically confirmed in 287 of the 1328 samples received during the study period. The mean age of our patients was 52 years, with extremes ranging from 7 to 98 years. Our series was characterized by a M/F sex ratio of 1. Onychomycosis represented 67.8% of all collected samples. Among the affected patients, 168 cases (58.74%) involved onychomycosis of the feet, while 25 cases (8.74%) involved onychomycosis of the hands. Additionally, 71 patients (24.83%) presented with scales, and 22 patients (7.69%) exhibited intertrigo. Among all collected samples, 68.64% were positive on direct examination after clarification with KOH 30%. Conclusion Trichophyton rubrum is the most widespread dermatophyte worldwide. Direct examination and mycological culture are complementary techniques for accurate diagnosis. Further epidemiological studies across Morocco are needed for meaningful comparisons.
Fungal rhinosinusitis are frequently described in humans and its prevalence appears to be increasing. They mainly involve species of the genus Aspergillus. To date, conventional mycological diagnosis remains challenging, as only 30% and 50% of cultures are positive in cases of fungal balls and invasive rhinosinusitis respectively. Over the past decade, human infections due to the Rasamsonia argillacea species complex are increasingly frequent and mainly concern patients with cystic fibrosis or chronic granulomatous disease. We report here the first case of pseudotumoral R. aegroticola sinusitis in a 66-year-old man with Meniere’s disease requiring repeated corticosteroid cures. The CT scan revealed areas of condensation and thinning of the straight sphenoidal bone walls, whose bone lysis could be confirmed during surgical excision. Direct microscopic examination of samples from different culture media revealed sterile mycelium without fruiting bodies, and was therefore not contributive. However, the sequencing of ITS and β-tubulin regions, performed from mucosal fragments and sterile mycelium, allowed the identification of R. aegroticola.
Dermatophytoses are common superficial fungal infections, most frequently caused by Trichophyton species. Among them, Trichophyton tonsurans is increasingly recognized as an important cause of tinea capitis and other dermatophytic infections. We conducted a retrospective review spanning three- years and six months (January 2022 - June 2025) in the Parasitology-Mycology Laboratory of La Rabta University Hospital (Tunis, Tunisia). The study included patients with dermatophytosis confirmed to be caused by Trichophyton tonsurans. Clinical samples (skin, scalp, nails) were examined by direct microscopy, following potassium hydroxide clarification and cultured on Sabouraud agar with chloramphenicol and with or without actidione at 27 °C. Identification was based on colony morphology, microscopic examinations and confirmed by ITS2 sequencing. Eight cases of T. tonsurans infection were diagnosed during the study period. Patients ranged in age from 8 to 59 years. Seven presented with scaly alopecic patches on the scalp and one with generalized erythematous-squamous lesions associated with onychomycosis. Four patients (three children and one adult) reported similar infections among close contacts, suggesting possible intra-familial or community transmission. Direct microscopy was positive in six cases, revealing endothrix parasitism or septate hyphae. Cultures yielded powdery white to beige colonies with a yellowbrown reverse within 8-14 days. Molecular analysis confirmed the isolates as T. tonsurans. This case series documents the occurrence of T. tonsurans infections identified over a recent three-year period in Tunisia. Accurate laboratory diagnosis and molecular confirmation remain essential for clinical management and for monitoring evolving dermatophyte epidemiology in the region.
Candidozyma auris (C. auris) is an emerging multidrug-resistant fungal pathogen that poses a serious public health threat due to diagnostic challenges, high antifungal resistance rates, and prolonged environmental persistence, which facilitate outbreaks in healthcare settings. This study aimed to evaluate the epidemiological characteristics, risk factors, identification methods, antifungal susceptibility profiles, and infection control measures associated with C. auris cases detected over a four-month period (October 2024-January 2025). Clinical, screening and environmental samples were analyzed. Clinical samples consisted of blood cultures, while screening samples included axillary swabs. Isolate identification was performed using VITEK 2 YST, the BD Phoenix system V7.51A, and VITEK MS PRIME. Antifungal susceptibility testing was performed using the Sensititre™ฏ YeastOne YO10 system. A total of 14 clinical cases were identified, along with two environmental isolates and four axillary screening isolates, one of which was associated with a clinical case. The mean age of clinical cases was 64.8 years (SD 29.2; range 15-95), and the mortality rate was 71.4%. According to the Centers for Disease Control and Prevention (CDC) tentative breakpoints, all clinical isolates were resistant to fluconazole. Amphotericin B minimum inhibitory concentration (MIC) values were 2 µg/mL in 50% of isolates. One isolate showed high MIC values for echinocandins (micafungin and anidulafungin >8 µg/mL). This study reports the first locally documented cases of C. auris in our center and was conducted as part of an ongoing surveillance program. It highlights the clinical and environmental burden of C. auris, underscores its resistance profile, and emphasizes the critical importance of accurate identification and stringent infection control measures. Although clinical cases have continued to occur at a decreasing frequency, no further C. auris has been detected in environmental samples after the implementation of the infection control protocol, suggesting sustained effectiveness in limiting environmental contamination.
Dermatophytosis is a common superficial fungal infection caused by dermatophytes. In recent years, antifungal resistance among dermatophytes has emerged as a growing clinical concern. We report the first documented case of terbinafine-resistant Trichophyton rubrum in Tunisia, occurring in a 50-year-old immunocompromised woman with systemic lupus erythematosus. She presented with a slightly scaly erythematous plaque in the inguinal folds, plantar hyperkeratosis on both feet, and onychodystrophy of the toenails. Despite topical terbinafine treatment, the patient experienced clinical progression. Antifungal susceptibility testing performed using the EUCAST E.Def 11.0 method demonstrated high minimum inhibitory concentrations to terbinafine and itraconazole. Molecular analysis identified the F397L substitution in the squalene epoxydase enzyme. Unfortunately, the patient died of heart failure. This case highlights the emergence of antifungal resistance in dermatophytes and underscores the need for routine susceptibility testing and surveillance programs.
BACKGROUND:Fungal diseases are still not well known in many countries including the Democratic Republic of the Congo. In the Democratic Republic of the Congo, around 5.4 % of people suffer from a serious fungal disease each year. Their occurrence is higher in immunocompromised patients and those with respiratory diseases. A good level of knowledge and management practice of care providers contributes to reducing morbidity and mortality. METHODS:This cross-sectional multicenter study addressed knowledge and practice of care providers in many provinces of the Democratic Republic of the Congo between March and September 2023. A self -administered questionnaire, focused on sensitization and management of fungal infections, was administered to participants. The evaluation was scaled as sufficient and insufficient knowledge and low and high for practice. RESULTS:Overall, 96 % of 3533 participants have some knowledge on fungal infections. Knowledge was greater for invasive candidiasis and aspergillosis than for mucosal candidiasis and dermatophytosis. Knowledge of fluconazole use was greater than for amphotericin B, caspofungin or voriconazole. Multivariate linear mixed regression demonstrated statistically significant differences in knowledge and practice for the specialist physician, general practitioner and head nurse, greater knowledge in younger practitioners, and schools of medicine and nursing as the primary sources of knowledge. CONCLUSION:The majority of participants had a reasonable knowledge and understood management practice of fungal infections. Awareness and improving continuing medical education is essential to meet the challenge of these complex infections, linked to diagnostic tools and access to antifungal drugs.
BACKGROUND:Since mucormycosis is not a notifiable disease in Brazil, its true incidence is likely underestimated; this study aims to assess its prevalence and characterize its epidemiological, clinical, and laboratory features. METHODS:We conducted a retrospective observational study of patients with mucormycosis treated with lipid amphotericin B (AmB) across 156 public healthcare centers in Brazil from 2017 to 2023, using Ministry of Health data. RESULTS:There were 305 AmB distributions for 298 patients: 230 (75 %) lipid complex (ABLC) and 75 (25 %) liposomal formulations (LAmB). The highest number of distributions occurred in 2021 (80/298, 27 %). The median age was 52 years (IQR 33-63), with 65 % male patients. The main comorbidity was diabetes mellitus (42 %), followed by oncohematologic conditions (25 %). Most cases presented with the rhinocerebral (ROC) form (66 %), followed by pulmonary (15 %) and gastrointestinal (5 %). The ROC form predominated among patients with diabetes and COVID-19 (>80 %), while the pulmonary form was more common in solid-organ transplant and HSCT patients (33 % and 27 %, respectively). Histopathology established the diagnosis in 64 % of cases, with Rhizopus spp. causing the majority of infections (31/53, 58 %). The mean AmB dose was 5 mg/kg/day (IQR 1-10.8). Patients with gastrointestinal forms were significantly younger (p = 0.007), and AmB doses did not differ significantly across clinical forms (p = 0.3). CONCLUSION:This study details the Brazilian mucormycosis patient profile, highlighting predominant diabetes-associated cases, the shift from ABLC to LAmB use after 2021, the predominance of the ROC form, pulmonary involvement in immunosuppressed patients, and regional diagnostic disparities.
