BACKGROUND Invasive fungal diseases (IFDs) have traditionally been regarded as complications of classical immunosuppression. However, IFDs are increasingly recognized in adults who are apparently immunocompetent or non-neutropenic, particularly in the setting of severe viral pneumonia, critical illness, diabetes, structural lung disease, surgery, trauma or burns, injection or inhalational drug use, invasive devices, broad-spectrum antibiotics, and previously unrecognized immune dysregulation. OBJECTIVE This narrative review summarizes emerging patterns and clinical challenges of IFD in apparently immunocompetent adults, integrating invasive molds, endemic dimorphic fungi, and invasive yeasts. KEY OBSERVATIONS The current landscape includes influenza- and COVID-19-associated pulmonary aspergillosis, COVID-19-associated mucormycosis, acute invasive mold disease in critically ill patients, tissue-injury- and trauma-associated mold infections, severe endemic mycoses after relevant environmental exposure, and an expanding spectrum of invasive yeasts. The label "immunocompetent" often conceals situational immune dysfunction or an undiagnosed inborn or acquired immune defect. Cohort data are available for several non-classical host groups, whereas evidence for truly healthy adults remains dominated by small series and case reports. CONCLUSION In adults without classical immunosuppression, IFD should be suspected when clinical deterioration occurs in the setting of acute illness, disruption of skin or mucosal barriers, indwelling catheters, healthcare exposure, unusual clinical syndromes, relevant geographic exposure, or unrecognized immune defects.
Antimicrobial resistance (AMR) is a major global health threat that compromises the effectiveness of existing antibiotics and highlights the urgent need for alternative and adjunctive therapeutic strategies. Probiotics have emerged as potential adjunctive strategies because of their ability to modulate host-microbe interactions and influence microbial ecology without promoting resistance. This review examines the current evidence on the potential role of probiotics in combating multidrug-resistant organisms, based on findings from in vitro studies, animal models, and clinical investigations. The review is based on a narrative literature search of the PubMed database, covering studies published between 2020 and 2025, with earlier landmark studies. The mechanisms discussed include competitive exclusion of pathogens, the production of antimicrobial compounds, the enhancement of intestinal barrier function, and the modulation of host immune responses. In addition, probiotics are evaluated for their capacity to interfere with quorum sensing and inhibit biofilm formation, thereby reducing pathogen virulence and colonization. The review also addresses key limitations, including strain-specific variability, safety concerns in vulnerable populations, and the lack of standardized clinical protocols. Current evidence suggests that probiotics may represent a useful adjunct to existing AMR management strategies. However, their broader clinical application requires larger research to establish their efficacy and safety.
