Vulvovaginal candidiasis is a common fungal infection, mainly due to Candida species, affecting two-thirds of women globally at least once in their lifetime. Here, we conducted a systematic review and meta-analysis (PROSPERO ID: CRD420261368975) of the epidemiology, aetiology, and drug resistance profiles of vulvovaginal Candida infections and VVC in Cameroon. Databases were queried to identify all eligible papers. Data were extracted, and the quality bias of studies was assessed. Random effect models were used to estimate pooled proportions of primary outcomes. Thirty-four studies were included. The pooled proportions of vulvovaginal Candida infections and VVC were 33.3% (95% CI 25.5 - 41.6%, p < 0.0001) and 31.6% (95% CI 26.9 - 36.4%, p < 0.0001), respectively. Candida albicans (23.3%, 95%CI 17.9 - 29.1%, p < 0.0001) was the most frequently isolated causative species, followed by Nakaseomyces glabratus (formerly C. glabrata) (2.3%, 95%CI 0.9 - 4.2%, p < 0.0001) and Pichia kudriavzevii (formerly C. krusei) (1.3%, 95%CI 0.5 - 2.5%, p < 0.0001). Pregnancy status, diagnostic methods, and human immunodeficiency virus infection influenced the proportions of these species. Two primary azoles were least effective against C. albicans, with the following resistance levels: fluconazole (51.1%, 95% CI 21.2 - 80.7%, p < 0.0001) and itraconazole (50.5%, 95% CI 41.3 - 100%, p < 0.0001). Evidence of drug profiles for non-albicans species is limited. The findings highlight the substantial burden of VVC, the predominance of C. albicans, and high azole resistance in Cameroon. They underscore the need for standardised diagnostic approaches, broader epidemiological surveillance, and evidence-based preventive strategies.

Penguins are highly susceptible to airborne mycoses, and aspergillosis due to Aspergillus fumigatus (recently classified as priority pathogen by WHO) is common in captivity; however, environmental fungal diversity and exposure risk in natural, non-temperate breeding habitats remain poorly described. We aimed to characterize the seasonal burden and diversity of culturable fungi in wild king penguin (Aptenodytes patagonicus) colonies and to assess A. fumigatus diversity and phenotypes. During one year, monthly environmental sampling was performed from four different soils of Crozet archipelago, in French Southern Territories, around three penguin colonies. Samples were cultured on malt extract agar at 35 ± 2°C. Isolates were quantified (CFU) and identified by microscopy, MALDI-TOF MS, and DNA sequencing. A. fumigatus isolates underwent genotyping and phenotyping for antifungal susceptibility, as well as for tolerance to high salinity and extreme temperatures. Overall, fungal loads in penguin environments showed marked seasonality (3-1 100 CFU/month), peaking during breeding/chick rearing summer period (∼22% positive sites). After April, fungal burden declined (mean 150 CFU/month; 8.8% positive sites). Aspergillus section Fumigati represented 21-100% of isolates (150-950 CFU/month). A. fumigatus genotypes were diverse, with no detected antifungal resistance or extreme growth phenotypes. Fungal burden in penguin natural habitats was closely linked to bird presence and breeding activity. These findings provide new insights into fungal exposure in wild groups and emphasize the importance of a One Health approach to better understand the interactions between environment, wildlife, and infectious disease risk in fragile ecosystems.

Recurrent vulvovaginal candidiasis (RVVC) is a condition characterized by recurrent episodes of vulvovaginal candidiasis, caused primarily by Candida albicans. Host genetic variations may play a role in the susceptibility to this disease. We performed whole-exome sequencing (WES) in patients with RVVC to identify potentially deleterious genetic variants in candidate genes, assess their impact on gene expression. We searched for patients with severe RVVC (>10 episodes per year) and who had additional affected family member(s). WES was performed on gDNA from the index patients. Vaginal scraping samples were obtained from the affected females, and total RNA was obtained to evaluate the expression of candidate genes by qPCR. We identified 12 adult females affected with severe RVVC across 11 families, of whom three had more than one affected female. In silico analyses of WES results revealed potentially deleterious variants in MUC4, MUC5B, and MUC21 genes. A significant decrease in the expression of the MUC5B and MUC21 genes was observed in patients with RVVC compared to healthy women. These results suggest that potentially deleterious variants could affect the expression of the genes encoding different members of the mucin family, indicating that mucins may play a significant role in the pathogenesis of RVVC.

The Aspergillus galactomannan chemiluminescence immunoassay (GM-CLIA) is a novel non-culture-based test applied in the detection of GM antigen in serum and bronchoalveolar lavage fluid (BALF). This multicenter, retrospective, and controlled study aims to investigate its diagnostic value for invasive aspergillosis (IA). A total of 246 serum and 228 BALF samples were obtained from IA patients (n = 229) and non-IA (n = 236) patients between March 2023 and July 2024. The performance of GM-CLIA was compared with that of Aspergillus GM sandwich enzyme immunoassay (GM-EIA) through Spearman rank correlation analysis and assessed via sensitivity, specificity, positive/negative predictive values (PPV/NPV), and receiver operating characteristic (ROC) curve analysis. Analytical performance was evaluated through interference, precision, limit of detection (LoD), and cross-reactivity experiments.The sensitivity, specificity, PPV, and NPV of serum GM-CLIA were 93.97%, 97.46%, 97.32%, and 94.26%, respectively. For BALF GM-CLIA, the corresponding values were 93.58%, 95.76%, 95.33%, and 94.17%. ROC analysis yielded high area under the curve (serum: 0.977; BALF: 0.982) with optimal cut-offs of 0.625 (serum) and 0.615 (BALF). The levels of GM by CLIA and EIA (rs = 0.838, P < 0.0001) strongly correlated. No interference was observed from hemoglobulin, bilirubin, or triglycerides at certain concentrations. Repeatability, indoor, and inter-batch precision met predefined criteria, with no cross-reactivity in non-Aspergillus pathogens. The LoD for detecting GM-CLIA was 0.09 ng/mL. In summary, GM-CLIA was evaluated in both sample types, demonstrating high specificity and sensitivity in diagnosing IA. Thus, clinical implementation of CLIA may significantly improve diagnostic efficiency and patient outcomes.

Candida albicans is a commonly encountered dimorphic fungus that normally resides in the human body. Once the host is immune-compromised or endures long-term antibiotic treatment, C. albicans will transform into an opportunistic pathogen that can cause from superficial mucosal diseases (e.g., oropharyngeal candidiasis) to life-threatening invasive infections (e.g., candidemia). Since the resistance rate of clinical C. albicans is rapidly increasing, there is an urgency to expand the current antifungal armamentarium. It has been shown that a growing body of host receptors can recognize the cell wall components of C. albicans (e.g., β-glucan, chitin, and mannan), and trigger potent innate immune responses with enhanced phagocytosis, reactive oxygen species, and inflammatory cytokine production. In this review, we classify the host receptors into two categories: the receptors that directly interact with the epitopes of C. albicans, and those that act as co-receptors to aid in epitope recognition. The former receptors include Dectin-1/2/3, Mincle, MR, DC-SIGN, MBL, CR3, LYSMD3, NKp30, and SPINK7, whereas the latter ones consist of TLR2/4, EphA2/B2, galectin-3, gC1qR, AhR, EGFR, and HER2. We not only characterize the antifungal modes of these host receptors during C. albicans infection, but also summarize the features underlying the recognition of C. albicans epitopes by these receptors. The advancements in PRRs can largely expand our scientific understanding of antifungal mechanisms, and lay a solid foundation for the development of new antifungal agents for the clinical treatment of systemic infections caused by C. albicans.

Candidozyma auris (formerly Candida auris) is an emerging multidrug-resistant fungus with limited genomic epidemiological data from Malaysia. This study investigated the genomic epidemiology, clinical characteristics and antifungal susceptibility of C. auris outbreak isolates using an integrated whole-genome sequencing (WGS) approach. Eleven clinical C. auris isolates from five healthcare facilities across three Malaysian states were analysed alongside clinical and epidemiological data. Antifungal susceptibility testing was performed for azoles, echinocandins, amphotericin B, flucytosine, and manogepix. Among 11 patients, seven had candidemia and four were colonized. Median age was 48 years, with diabetes mellitus, chronic kidney disease, and hypertension as the most common comorbidities. All candidemia patients had urinary and central venous catheters; 71% required mechanical ventilation, 43% had haemodialysis and recent surgery, respectively. Recent antibiotic exposure was common, whereas none had prior antifungal therapy. All isolates belonged to Clade I but separated into distinct genomic clusters, supporting healthcare-associated transmission within clusters and simultaneous circulation of multiple genomic groups. All Johor-associated isolates were fluconazole resistant and carried ERG11 K143R and CDR1 V704L substitutions. An ERG5 variant was detected in non-Johor isolates with amphotericin B minimum inhibitory concentrations (MICs) ≥ 1 µg/ml. The MICs for other antifungals remained low across isolates. Echinocandin therapy was initiated in 27% of patients, with one survivor. Our C. auris showed genomic diversity, distinct healthcare-associated clustering, and variable antifungal susceptibility. Integrating WGS with clinical and susceptibility data enhanced outbreak investigation of C. auris.

Fungal pneumonias and tuberculosis (TB) remain major causes of mortality among people living with advanced HIV disease (PLWHA). Their overlapping clinical manifestations delay diagnosis in developed and resource-limited settings, with greater impact where access to rapid diagnostic tools is limited. This study evaluated the performance of a multiplex quantitative PCR (qPCR) assay for simultaneous detection of Histoplasma capsulatum, Cryptococcus neoformans, Pneumocystis jirovecii, and Mycobacterium tuberculosis complex in respiratory samples from PLWHA. A cross-sectional study was conducted at the Instituto Nacional de Infectologia Evandro Chagas (Rio de Janeiro, Brazil) between December 2023 and March 2025. Adults with HIV infection (CD4 < 200 cells/mm[3]) and clinical or radiological evidence of pulmonary infection were enrolled. Standard diagnostic methods included culture, microscopy, antigen detection (CrAg-LFA, urinary Histoplasma antigen, TB-LAM), GeneXpert® MTB/RIF, and commercial qPCR for P. jirovecii. The multiplex assay targeted the ITS region (H. capsulatum and C. neoformans), mtLSU (P. jirovecii), and IS6110 (M. tuberculosis). Among 198 screened participants, 88 met inclusion criteria (mean CD4 count: 56 cells/µl). Diagnosis included TB (56.8%), pneumocystosis (34.1%), histoplasmosis (10.2%), and cryptococcosis (11.4%); 25% presented coinfections. The multiplex qPCR showed 100% sensitivity for histoplasmosis, 80% for pneumocystosis, and 40% for both cryptococcosis and TB, with specificities ≥ 82% and 100% for TB. Overall accuracy ranged from 66% to 86%. Mortality was 12.5%, highest among cryptococcosis cases (20%). The assay provided accurate detection of H. capsulatum and P. jirovecii, although performance was limited for TB and cryptococcosis, supporting its use as a complementary molecular tool for differential diagnosis in PLWHA.

Contemporary data on risk factors for invasive candidiasis (IC) in solid organ transplant recipients (SOTr) are rare. This follow-up study on a large multicenter cohort study, nested within the Swiss Transplant Cohort Study, identifies risk factors for IC during the first year posttransplant. Among 4755 and 4519 SOTr identified between 0-3 months (early) and 4-12 months (late) posttransplant, 90 (1.9%) and 48 (1.1%) had 109 and 50 episodes of IC, respectively. Posttransplant Candida colonization (HR: 3.2; 95% CI: 1.67-6.14; P < .001), and posttransplant anastomosis (HR: 3.14; 95% CI: 1.74-5.69; P < .001) and bleeding/vascular complications (HR: 3.66; 95% CI: 2.38-5.62; P < .001) were independent risk factors for early IC, while transplantation between 2015 and 2020 (HR: 0.57; 95% CI: 0.38-0.88, P = .011) and male sex (HR: 0.63; 95% CI: 0.59-0.88; P = .026) demonstrated lower risk for early IC in multivariable analysis for all transplant types. Systemic antifungal prophylaxis (HR: 30.9; 95% CI: 4.9-194; Padj = .003) was associated with increased risk of early IC in kidney/kidney-pancreas recipients in univariable analysis. Posttransplant anastomosis (HR: 4.39; 95% CI: 2.49-7.72; Padj < .001) and surgical site/surgical other complications (HR: 3.62; 95% CI: 2.03-6.46; Padj < .001) were independent risk factors for late IC in univariable analysis for all transplant types. In conclusion, this study highlights the impact of posttransplant Candida colonization and posttransplant surgical complications on the occurrence of IC. These findings can support the design of more effective prophylactic strategies and inform clinical practice in this vulnerable patient population.

Mucormycosis is a severe fungal infection with high mortality in immunocompromised patients. Although most cases occur sporadically in the community setting, there are reports of healthcare-associated outbreaks of mucormycosis. We describe the investigation and clinical features of an outbreak of mucormycosis caused by Rhizomucor pusillus in a hematopoietic stem cell transplant (HSCT) unit in Brazil. Cases were screened through the hospital records, defined according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium criteria, and classified as HSCT unit-acquired or not. Mucormycosis incidence was monitored from 2 years before the index case until 2 years after the last case. The clinical course of identified cases and potential environmental exposure data were recorded. Microbiological samples were identified with conventional methods and internal transcribed spacer sequencing; whole genome sequencing was performed for phylogenetic analysis. Potential source investigation was conducted according to the US Centers for Disease Control recommendations. Four proven cases of HSCT-unit-acquired mucormycosis were identified over a 10-month period. Rhizomucor pusillus was identified in three of the four patients. Disseminated disease, beginning with pulmonary infection, was the most common clinical presentation. Survivors (75%) received treatment with lipid complex amphotericin B, isavuconazole, and/or surgical resection. Environmental investigation was negative and phylogenetic analysis demonstrated that isolates were not clonal. Following air system maintenance, no further cases were identified. We characterize the first reported outbreak investigation of mucormycosis caused by R. pusillus in a Brazilian HSCT unit, with favorable outcomes in most cases despite aggressive clinical presentation. Despite the lack of clonality and negative environmental investigation, epidemiological evidence strongly suggests nosocomial transmission.

Candidozyma auris (Candida auris) candidemia is a serious healthcare-associated infection with substantial mortality and limited treatment options. We retrospectively evaluated adult patients with C. auris candidemia at a tertiary care center between June 2022 and December 2025 to describe clinical management, microbiological outcomes, antifungal susceptibility, and factors associated with 28-day mortality. The descriptive cohort included 108 patients; mortality status was available for 107. Most patients (92.6%) were in intensive care at candidemia onset, and among evaluable patients, 76.1% had prior C. auris colonisation detected. Twenty-eight-day mortality was 41.1% (44/107). Non-survivors were older and had higher Charlson Comorbidity Index, Pitt bacteremia, and Sequential Organ Failure Assessment (SOFA) scores. Central venous catheter removal was more frequent among survivors (72.7% vs. 45.0%; P = .012), although removal timing and time to initiation of effective antifungal therapy did not differ significantly between groups. In multivariable analysis, Charlson Comorbidity Index (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.02-1.44) and SOFA score (aOR, 1.16; 95% CI, 1.05-1.27) were independently associated with 28-day mortality. Resistance rates were 95.1% for fluconazole, 31.2% for amphotericin B, and 1.3% for both anidulafungin and micafungin; multidrug resistance rate was 28.6%, and no isolate met the definition of pandrug resistance. Mortality in C. auris candidemia was mainly associated with baseline comorbidity burden and acute organ dysfunction. Local susceptibility surveillance and early recognition of high-risk patients may support treatment and infection-control strategies.

Invasive mold disease is associated with high mortality in immunosuppressed patients. While Aspergillus spp. and the Mucorales are well known, several other molds have emerged that cause infections and even outbreaks in susceptible hosts. These include Fusarium spp., Scedosporium spp., Lomentospora prolificans, and several others. The principles of preventing nosocomial mold infections include use of high-efficiency particulate air filters, removal of any potential sources of contamination, and risk-assessment of construction sites in adjacent areas. However, there is limited information on the approaches to assessment and management of outbreaks when there is a cluster of rare mold infections. The incubation period of rare and emerging molds is unknown and ascertaining whether the origin is nosocomial or community-acquired is difficult. Surveillance may be required to determine whether cases are part of an ongoing problem. The environmental niches of the rare molds are unique; e.g., Fusarium spp. are associated with hospital water distribution systems. They also cause outbreaks of fungal keratitis. Many rare molds are seen in cases of medicinal product contamination and managing such outbreaks requires support from and coordination by national agencies. Environmental precautions around patients and construction activities should be reassessed during outbreaks. A systematic approach is required when evaluating a cluster or even an isolated nosocomial case. Surveillance systems should be strengthened. This review summarizes the information available on outbreaks of rare and emerging molds. We further discuss a set of actions that may be undertaken in the event of an outbreak.

Diabetes mellitus (DM) is a significant risk factor for fungal infections, particularly Candida and dermatophytes, and glycemic control may be associated not only with the presence of these fungi but also the pattern of these infections. This study aimed to evaluate the relationship between glycemic control (HbA1c) and the type of fungal infection among diabetic patients. A cross-sectional study was conducted on 113 diabetic patients with suspected fungal infections. Clinical samples were collected from different body sites and analyzed using phenotypic and molecular methods. Patients were stratified according to glycemic control into good (HbA1c < 6.5%), poor (HbA1c 6.5%-7.9%), and very poor (HbA1c ≥ 8.0%) groups. A significant association was observed between glycemic control and the type of fungal infection (P = 0.015). Dermatophyte infections were more common in patients with good glycemic control (64.1%), while Candida infections increased with poorer glycemic control, reaching their highest prevalence in the very poor control group (83.3%). Dermatophytes were distributed across multiple anatomical sites, whereas Candida was mainly associated with moist and occluded areas. Overall, the interdigital region was the most affected site (37.5%). Candida infections were more common in female patients (20/33, 60.6%), while dermatophyte infections were more common among male patients (28/47, 59.6%). Furthermore, diabetes duration differed significantly across glycemic control groups. These findings demonstrate a significant association between glycemic control and the pattern of superficial fungal infections in diabetic patients. Poor glycemic control was associated with increased Candida infections, whereas dermatophyte infections were more frequent in better-controlled patients, highlighting the role of glycemic status in the distribution of fungal infections.

Cryptococcosis is a severe systemic mycosis, and relapse may be influenced by fungal subpopulations that survive fluconazole exposure. This retrospective cohort study investigated whether fluconazole minimum inhibitory concentration (MIC) and the heteroresistant (HetR) phenotype of the first available diagnostic cerebrospinal-fluid isolate were associated with recorded relapse within 6 months in 70 patients with neurocryptococcosis from Amazonas, Brazil. One clinical isolate per patient, comprising 64 Cryptococcus neoformans molecular type VNI and 6 Cryptococcus gattii molecular type VGII isolates, was evaluated by broth microdilution and endpoint-based fluconazole heteroresistance level (HFL) testing. Using an operational criterion of HFL/MIC ≥ 8, corresponding to visible growth at least three twofold dilutions above the MIC, 43 of 70 isolates (61.4%) were classified as displaying a HetR phenotype. Six-month follow-up was available for 69 patients. Recorded relapse occurred in 12 of 42 patients infected with HetR isolates (28.6%) and in 4 of 27 patients infected with non-HetR isolates (14.8%). Although relapse was numerically more frequent in the HetR group, the association was not statistically significant (conditional odds ratio, 2.27; exact 95% confidence interval, 0.59-10.96; two-sided Fisher's exact test, P = .248). The HFL/MIC ratio also did not differ significantly according to recorded relapse status (P = .165). The HetR phenotype of the first available diagnostic isolate, defined operationally in this study as HFL/MIC ≥ 8, was frequent but was not significantly associated with recorded relapse within 6 months in this cohort.

Fungal keratitis (FK) is a sight-threatening corneal infection that leads to corneal blindness. Dematiaceous fungal keratitis (DFK) emerged as the predominant cause of FK, followed by Aspergillus spp. and Fusarium spp. This study aimed the prevalence, species distribution, associated clinical features, risk factors, and antifungal susceptibility for keratitis caused by dematiaceous fungi. A prospective study was conducted on suspected FK patients from June 2023 through November 2025 at PGIMER Chandigarh. The corneal samples were processed for routine mycological investigations, including direct microscopy potassium hydroxide (KOH mount) and culture on SDA (Sabouraud's Dextrose agar), further confirmed by DNA sequencing. Antifungal susceptibility testing (AFST) was performed as per the CLSI (Clinical Laboratory and Standards Institute) broth microdilution method (M38-A2) for a panel of nine drugs, including voriconazole, itraconazole, posaconazole, luliconazole, miconazole, ketoconazole, amphotericin-B, natamycin, and terbinafine. Among 1931 suspected FK patients, 452 were confirmed FK where 75 were DFK and prevalence of DFK was calculated 3.88%. Curvularia spp. was found to be most prevalent (n = 39,52%), followed by Alternaria spp. (n = 9, 12%), Colletotrichum spp. (n = 8,10.66%), and Exserohilum spp. (n = 6, 8%) along with eight other rare genera were isolated. Redness, watering, and a decrease in vision were significantly more common in DFK. Amongst the triazoles, voriconazole showed low minimum inhibitory concentration (MIC) range of 0.03-16 µg/ml. AFST also demonstrated low MICs to luliconazole and terbinafine. The present study showed a prevalence of 3.88% DFK in North India with Curvularia spp. as the predominant causative agent. In vitro susceptibility of voriconazole demonstrated better performance against DFK isolates.

Histoplasma capsulatum, a dimorphic fungus, is the causative agent of histoplasmosis, a respiratory disease with a wide clinical spectrum ranging from asymptomatic infection to severe pulmonary or disseminated disease. Although Ecuador is recognized as an endemic country, histoplasmosis remains underreportesd. This study presents the first investigation in Ecuador assessing occupational exposure to H. capsulatum among field biologists and environmental scientists, a group presumed to be at increased risk due to frequent contact with wildlife, caves, and rural environments. A total of 46 workers underwent histoplasmin intradermal skin testing to assess prior exposure. Positive reactions were defined as induration ≥ 5 mm at 48 h. Histoplasmin positivity was detected in 21 participants (45%), with induration sizes ranging from 5 to 32 mm (mean 15 mm). Among histoplasmin-positive individuals, reported risk factors included cave visitation (83%), contact with dead animals or feces (55%), and contact with live wildlife such as bats, rodents, and birds (50%). Serological testing identified evidence of recent infection in three participants, none of whom presented clinical symptoms at the time of evaluation. Our findings demonstrate substantial occupational exposure to H. capsulatum among Ecuadorian field biologists and highlight the need for improved surveillance, diagnostic capacity, and clinical awareness of histoplasmosis in endemic, resource-limited settings.