Efficacy of antifungal therapy in invasive aspergillosis relies primarily on mortality, overlooking critical measures of treatment response. We used the Mycoses Study Group Education & Research Consortium (MSG) Desirability of Outcome Ranking (DOOR) framework to assess efficacy of antifungal therapies by integrating mortality, treatment failure, and severe adverse events. Voriconazole achieved better overall outcomes than amphotericin B using the DOOR approach.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection that can affect the renal parenchyma, collecting system, or perinephric tissue. Although typically caused by enteric Gram-negative bacteria, infections secondary to Candida occur rarely. We present the case of a 72-year-old female who was transferred from an outside hospital with a chief complaint of abdominal pain in the setting of dislodged percutaneous nephrostomy tube for chronic hydronephrosis. Clinically, she presented without evidence of septic shock but was found to have elevated creatinine (6.04), concerning for acute renal failure. Urology was consulted and performed cystoscopy that showed a large bilateral mass consistent with fungal ball formation. Subsequent urine cultures speciated Candida tropicalis and Candida glabrata. Per infectious disease recommendations, the patient was initially started on treatment with fluconazole and flucytosine; however, fluconazole was switched to amphotericin B deoxycholate after sensitivities reported resistance to fluconazole for Candida tropicalis. Additionally, urology performed a bilateral percutaneous nephroscopy with ultrasonic lithotripsy for removal of her fungal bezoar on Day 22 of her hospitalization with subsequent nephrostograms that showed a patent genitourinary system. This case demonstrates successful treatment of EPN secondary to azole-resistant Candida species using combined systemic antifungal therapy and an endourologic approach. This avoided the use of percutaneous nephrostomy irrigation with amphotericin deoxycholate as recommended in current guidelines and prevented potential complications this procedure carries.

Cryptococcus gattii complex has emerged as an important cause of invasive fungal disease in both immunocompetent and immunocompromised hosts, yet robust clinical and epidemiological data remain limited, particularly in Latin America. An observational study was conducted to describe and analyze the clinical characteristics and outcomes of all proven and probable cases of C. gattii complex infection managed at a tertiary referral center in southern Brazil from 1992 to 2025. A total of 39 cases were identified. The median age was 54 years, and 61.5% were male. Most patients (61.5%) were considered immunocompetent, although comorbidities were common. Headache (61.5%), altered mental status (33.3%), and fever (30.8%) were the most frequent symptoms overall. Pulmonary disease was the predominant clinical form (76.9%), but meningitis/meningoencephalitis was also common (69.2%). Nearly half (46.2%) had both pulmonary and neurological disease. Cryptococcomas were frequent (76.9%); the majority were managed without surgical intervention. Severe impairment of consciousness at presentation and cerebrospinal fluid protein levels above 92.15 mg/dl were significantly associated with mortality. Amphotericin B deoxycholate plus fluconazole was the most prescribed induction regimen, with a median duration of 3 weeks. The overall mortality was 20.5%. Immune reconstitution inflammatory syndrome occurred only among patients with cryptococcomas and was managed with glucocorticoids in most cases. The performance of the cryptococcal antigen (CrAg) test was excellent in both neurological and pulmonary diseases. This study highlights the clinical spectrum of C. gattii complex infection and supports the potential utility of shorter induction regimens (< 4 weeks), as well as the role of CrAg as a valuable diagnostic tool.

Canine protothecosis is an uncommon opportunistic infection, most frequently reported in warm, humid climates. In dogs, it typically presents as disseminated disease following primary colonic involvement and carries a poor prognosis for clinical cure. No standardised treatment protocol exists in veterinary medicine. Regimens that maintain an acceptable quality of life often incorporate posaconazole, while amphotericin B may be used with curative intent in selected cases. We report the first documented case of localised cutaneous protothecosis due to Prototheca wickerhamii in a dog from Tasmania, Australia, together with its successful management. A 2-year-old neutered male Chihuahua cross presented with painful swelling and ulceration of the metacarpal and metatarsal pads, resulting in marked lameness. Diagnosis was established by cytology, histopathology, culture and MALDI-ToF mass spectrometry on samples from affected pads. Three sequential treatment protocols were trialled: (i) modified pulsed itraconazole therapy, (ii) oral posaconazole and (iii) intralesional amphotericin B deoxycholate. Itraconazole was ineffective. Posaconazole led to the resolution of clinical signs, although ongoing therapy was required, and relapse occurred after cessation of therapy. Subsequent treatment with intralesional amphotericin B achieved sustained clinical remission, consistent with sustained clinical remission and possible cure. This case expands the recognised geographic and clinical spectrum of canine protothecosis, documenting infection in a temperate region and in a localised cutaneous form. It highlights the importance of considering protothecosis in atypical dermatological presentations and supports the use of posaconazole for disease control and amphotericin B, specifically intralesional administration, for definitive therapy in clinical veterinary practice settings.

Candida albicans (C. albicans) meningoencephalitis is a rare but diagnostically challenging infection that usually occurs in immunocompromised individuals, although life-threatening disease can also develop in immunocompetent patients. The absence of specific clinical features and the limited sensitivity of conventional microbiological methods frequently lead to diagnostic delays. We describe a 79-year-old woman with no known immunodeficiency who presented with symptoms initially suggestive of bacterial meningitis and failed to improve after empirical ceftriaxone, meropenem, and vancomycin therapy, while repeated blood and cerebrospinal fluid (CSF) cultures remained negative. Her history of endoscopic transsphenoidal surgery raised concern for an atypical postoperative infection. Targeted next-generation sequencing (tNGS) of the CSF subsequently provided important etiological evidence for C. albicans and supported timely initiation of amphotericin B deoxycholate and flucytosine, followed by oral fluconazole, resulting in marked clinical and biochemical improvement. This case highlights the diagnostic difficulty of intracranial Candida infection. In this patient, CSF tNGS provided important etiological evidence when routine microbiological tests remained negative and contributed to timely targeted antifungal treatment.

Fungemia caused by rare fungal species has been increasingly recognized in both immunocompromised and immunocompetent children. Our aim is to characterize the clinical and microbiological features of rare fungal bloodstream infections in hospitalized pediatric patients. A retrospective, descriptive study was conducted including all cases of fungemia due to rare yeasts in patients admitted to two tertiary pediatric hospitals between 2021 and 2025. Fungal species identification, anatomical sites of infection, antifungal therapeutic regimens, and clinical outcomes were systematically analyzed. In total, 13 cases of rare fungal bloodstream infections were identified among 13 patients from 2,555 blood cultures obtained during the study period, representing an incidence of 0.5%. The predominant species isolated were Saccharomyces cerevisiae (n=5), Wickerhamomyces anomalus (n=3), Candid orthopsilosis (n=2), Yarrowia lipolytica (n=1), Meyerozyma guilliermondii (n=1), and Trichosporon asahii (n=1). The median age at infection was 31 months (range: 0-178 months), with 92.3% (12/13) of patients presenting underlying medical conditions. The median interval from hospital admission to fungemia onset was 19 days (range: 0-73 days). Amphotericin B deoxycholate was the most frequently employed initial antifungal agent (n=5), followed by liposomal amphotericin B (n=4). Modification of antifungal therapy was required in five cases (38.5%). Microbiological clearance was achieved in all patients on subsequent blood cultures. The 30-day all-cause mortality rate was 15.4% (2/13). We concluded that rare fungal bloodstream infections occurred predominantly in patients with underlying comorbidities and prolonged hospital stays; nevertheless, the majority showed favorable clinical responses with appropriate antifungal therapy and achieved fungal eradication from the bloodstream.

Objective: To investigate the bronchoscopic features of invasive pulmonary aspergillosis (IPA) and to summarize the clinical efficacy of comprehensive bronchoscopic interventional therapy. Methods: A retrospective analysis was conducted on the clinical data of 11 patients with IPA who received comprehensive bronchoscopic interventional therapy at Beijing Tsinghua Changgung Hospital between December 2018 and December 2024. The therapeutic efficacy and safety were evaluated. Results: Among the 11 patients, 7 were male and 4 were female, with an age range of 14 to 69 years (mean 45.8±17.6 years). Underlying diseases included diabetes mellitus (4 cases), hematological malignancies (2 cases), solid tumors (2 cases), anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (1 case), high IgE recurrent infection syndrome (1 case) and allergic bronchopulmonary aspergillosis (1 case). Chest CT findings showed multi-lobar involvement in nine cases and single-lobar involvement in two cases. Bronchoscopy revealed obstructive white necrotic material within the airways in four cases, purulent secretions in four cases, and bronchopulmonary cavity fistula in three cases. Pathological examination of the necrotic material confirmed the presence of abundant Aspergillus hyphae. All patients received systemic antifungal therapy. Local treatments included aerosolized amphotericin B deoxycholate inhalation in nine cases and bronchoscopic local drug perfusion in all 11 cases. Bronchoscopic interventional procedures included forceps removal of lesions in four cases, with one case experiencing grade Ⅲ hemorrhage. No severe complications such as pneumothorax occurred. Following treatment, clinical cure was achieved in six cases (54.5%) and significant improvement in five cases (45.5%), with no deaths. During the one-year follow-up, no recurrence was observed in 10 cases. Conclusions: IPA commonly occurs in immunocompromised hosts, with bronchoscopic findings often revealing airway obstruction caused by whitish necrotic material and/or secretions. An integrated therapeutic strategy combining systemic and local antifungal therapy with bronchoscopic interventional treatment can significantly enhance clinical efficacy and demonstrate a favorable safety profile.

HIV-associated talaromycosis (HAT) is a severe fungal infection for which established severity assessment methods are lacking. The Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores were evaluated in 464 patients with HAT to assess their associations with inflammatory markers, hospital stay, and 30-day mortality. SOFA scores were negatively correlated with blood culture positivity time (r = -0.470, P < 0.001) and positively correlated with IL-6, IL-10, and CRP (all P < 0.001). Patients with fungemia had higher SOFA scores (2.3 ± 2.4 vs. 1.2 ± 0.6, P < 0.001). Mortality increased with qSOFA scores: 8.9% (score 0), 16.5% (score 1), and 55.0% (score ≥2; P < 0.001). For SOFA, mortality was 4.5% (scores 0-1), 6.8% (2-3), 22.0% (4-5), 52.2% (6-7), and 85.7% (≥8; P < 0.001), repectively. Survivors' SOFA scores improved by day 7 (1.6 ± 1.6 to 1.0 ± 1.4, P < 0.001), while non-survivors worsened by day 7 (4.8 ± 3.4 to 5.1 ± 5.6, P = 0.027) compared to day 0. Among the surviving patients, the hospital stay days were 21.0 (14.0-27.0) for scores 0-1, 22.0 (16.0-29.0) for scores 2-3, 27.0 (20.3-43.5) for scores 4-6 and 29.0 (5.5-38.0) for scores ≥6 (P = 0.005). Multivariate analysis identified qSOFA [adjusted odds ratio (AOR):1.564, P = 0.018], SOFA [AOR:1.533, P = 0.001], and non-amphotericin B deoxycholate (non-AmBd) therapy [AOR:2.732, P = 0.026] were independent predictors of 30-day mortality. SOFA and qSOFA both predicted poor outcomes in patients with HAT. Early diagnosis and preemptive AmBd therapy should be prioritized for patients with HAT who had high SOFA/qSOFA scores.

Mucormycosis ranks third among invasive mycoses after Candidiasis and Aspergillosis and is associated with high mortality. Its incidence has increased with the rising number of immunosuppressed patients. In developing countries, the most common predisposing factor is uncontrolled diabetes mellitus (DM), whereas in developed countries it is immunosuppressive conditions. To examine local epidemiological data, predisposing factors, diagnostic and therapeutic options and survival in our center eighty-six adult mucormycosis patients between 2000 and 2020 were retrospectively analyzed. Thirty-nine (45.35%) were male, 47 (54.65%) were female, and the median age was 52 years (IQR, 42.5-62). The most frequent clinical presentation was sinus involvement, observed in 77 cases (89.53%). Of these, 38 (44.18%) were sinonasal, 5 (5.81%) sinoorbital, 9 (10.47%) rhinocerebral, and 25 (29.07%) rhino-orbito-cerebral mucormycosis. The remaining 9 cases (10.47%) had pulmonary mucormycosis. Predisposing factors included hematologic diseases in 51 patients (59.30%), DM in 33 (38.37%), solid organ transplantation (SOT) in 7 (8.14%), and solid organ malignancy in 7 (8.14%). The most common symptoms were fever (70.93%), swelling around the eyes and face (51.16%), pain (40.7%), erythema (34.88%), nasal discharge (30.23%), and headache (25.58%). Most frequent physical examination findings were necrotic lesions in the oral cavity and sinuses (87.21%), ophthalmoplegia (29.07%), ptosis (26.74%), vision loss (25.58%), and proptosis (22.09%). In all cases, amphotericin B formulations were preferred as initial therapy. Patients who received combination therapy (n = 14), 13 used posaconazole (POS) + liposomal amphotericin B (L-AmB) and one patient used itraconazole (ITC) + L-AmB. POS was administered to 14 patients receiving sequential oral therapy. The median duration of amphotericin B therapy was 46.5 days (IQR, 14.7-84.5), and the median total duration of antifungal therapy was 46.5 days (IQR, 14.7-90.3). The most common adverse effect of amphotericin B formulations was hypokalemia [L-AmB 68.75%, amphotericin B deoxycholate (AmB-D) 54.84%, amphotericin B lipid complex (ABLC) 50%]. At least one surgical intervention was performed in 74.42% of cases. The 12-week mortality rate was 48.84%, overall mortality rate was 61.63%. In analysis advanced age [12-week: OR: 1.04 (95% CI: 1.01-1.07), p = 0.011; overall: OR: 1.04 (95% CI: 1.01-1.07), p = 0.026 respectively], coexistence of both hematologic disease and DM [12-week OR: 5.73 (95% CI: 1.16-28.33), p = 0.032] associated with mortality. No significant difference was observed in 12-week mortality between surgical and non-surgical patients (p = 0.107). In contrast, overall mortality was significantly higher in the non-surgical group (81.8% vs. 54.7%, p = 0.024). In univariable logistic regression analysis, surgical intervention was associated with a 73.2% reduction in the odds of overall mortality (OR: 0.268, 95% CI: 0.082-0.882, p = 0.030). In the multivariable logistic regression analysis, age was the only variable significantly associated with 12-week and overall mortality (respectively, p = 0.004 and p = 0.026). Each one-year increase in age was associated with an OR of 1.05 (95% CI: 1.02-1.09) for 12-week mortality and 1.04 (95% CI: 1.01-1.07) for overall mortality. In conclusion; our study showed that despite advanced diagnostic methods and antifungals, mortality remained high, sinus involvement was the most frequent involvement, surgical debridement increased survival, but increasing age was associated with poor prognosis.

This retrospective cohort study compared the efficacy and safety of lipid-based amphotericin B formulations (amphotericin B colloidal dispersion [ABCD] and liposomal amphotericin B [L-AmB]) versus conventional amphotericin B deoxycholate (AmB-d) for the treatment of non-human immunodeficiency virus (HIV)-associated cryptococcal meningitis (CM). Data from 199 patients were analyzed, divided into three groups based on induction therapy: AmB-d (n = 110), ABCD (n = 44), and L-AmB (n = 45). At baseline, a higher proportion of patients in the lipid-based groups presented with altered mental status. After 2 weeks, the ABCD and L-AmB groups showed significantly better clinical improvement (as measured by British Medical Research Council Stage 1) compared to the AmB-d group (63.6% and 77.8% vs. 35.5%; P < .001), and experienced substantially lower rates of renal impairment (54.5% and 53.3% vs. 79.1%; P = .001). Early fungicidal activity was similar across all groups. Multivariate analysis at 10 weeks indicated that both lipid-based formulations were associated with a lower risk of unsuccessful outcomes compared to AmB-d. Furthermore, 1-year survival analysis for clinical cure demonstrated a significantly higher cumulative incidence in the lipid-based AmB groups (Log-rank test, P = .016). In conclusion, induction regimens based on ABCD or L-AmB were associated with better outcomes than AmB-d for non-HIV-associated CM, offering better long-term outcomes and a more favorable safety profile, particularly regarding kidney toxicity.