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Candidiasis: Changes and Challenges in Its Epidemiology, Pathogenesis, Diagnosis, Treatment...
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Candidiasis: Changes and Challenges in Its Epidemiology, Pathogenesis, Diagnosis, Treatment and Prevention

A special issue of Journal of Fungi (ISSN 2309-608X). This special issue belongs to the section "Fungal Pathogenesis and Disease Control".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 3042

Special Issue Editor

Prof. Dr. Guillermo Quindos

E-Mail Website
Guest Editor
Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursing, University of the Basque Country, UPV/EHU, 48080 Bilbao, Spain
Interests: medical mycology; mycoses; candida; candidiasis; mycobiome; biofilms; diagnosis; antifungal agents

Special Issue Information

Dear Colleagues,

Candidiasis presents a serious threat to public health and is associated with prolonged hospitalizations and considerable morbidity and mortality rates. The epidemiology of candidiasis has changed significantly in recent decades. Candida albicans remains the most frequent etiology, but its relative prevalence has decreased. Candidozyma auris (Candida auris) is a new emerging antifungal resistant species, with a great capacity for persistence and nosocomial transmission, causing candidiasis outbreaks in hospitals worldwide. For these reasons, the World Health Organization has included both species in their list of priority fungal pathogens. Candidiasis caused by C. albicans and C. auris have similarities, but there are also important differences in their epidemiology, pathogenesis, diagnostics and therapeutics. The aim of this Special Issue is to provide the latest knowledge on candidiasis induced by both species to improve the diagnostic and therapeutic management of these patients through comprehensive reviews, original studies, and novel perspectives.

Prof. Dr. Guillermo Quindos
Guest Editor

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Keywords

  • medical mycology
  • mycoses
  • candida
  • candidiasis
  • mycobiome
  • biofilms
  • diagnosis
  • antifungal agents

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Published Papers (5 papers)

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Research

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20 pages, 6058 KiB  
Article
The GPI-Anchored Aspartyl Proteases Encoded by the YPS1 and YPS7 Genes of Candidozyma auris and Their Role Under Stress Conditions
by Alvaro Vidal-Montiel, Daniel Clark-Flores, Eulogio Valentín-Gómez, Juan Pedro Luna-Arias, Erika Rosales-Cruz, César Hernández-Rodríguez, Lourdes Villa-Tanaca and Margarita Juárez-Montiel
J. Fungi 2025, 11(8), 573; https://doi.org/10.3390/jof11080573 - 1 Aug 2025
Viewed by 523
Abstract
Candidozyma auris is a multidrug-resistant, thermo- and osmotolerant yeast capable of persisting on biotic and abiotic surfaces, attributes likely linked to its cell wall composition. Here, seven putative genes encoding yapsins, aspartyl proteases GPI-anchored to the membrane or cell wall, were identified in [...] Read more.
Candidozyma auris is a multidrug-resistant, thermo- and osmotolerant yeast capable of persisting on biotic and abiotic surfaces, attributes likely linked to its cell wall composition. Here, seven putative genes encoding yapsins, aspartyl proteases GPI-anchored to the membrane or cell wall, were identified in the genomes of C. auris CJ97 and 20-1498, from clades III and IV, respectively. The C. auris YPS1 gene is orthologous to the SAP9 of C. albicans. The YPS7 gene is orthologous to YPS7 in C. glabrata and S. cerevisiae, so that they may share similar roles. An in silico analysis suggested an interaction between pepstatin and the catalytic domain of Yps1 and Yps7. Although this inhibitor, when combined with caffeine, had a subtle effect on the growth of C. auris, it induced alterations in the cell wall. CauYPS1 and CauYPS7 expression increased under nutrient starvation and NaCl, and at 42 °C. The transcriptome of the 20-1498 strain suggests that autophagy may play a role in thermal stress, probably degrading deleterious proteins or maintaining cell wall and vacuolar homeostasis. Therefore, CauYps1 and CauYps7 may play a role in the cell wall integrity of C. auris in stress conditions, and they could be a target of new antifungal or antivirulence agents. Full article
(This article belongs to the Special Issue Candidiasis: Changes and Challenges in Its Epidemiology, Pathogenesis, Diagnosis, Treatment and Prevention)
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15 pages, 492 KiB  
Article
Head-to-Head Comparison of Etest, MICRONAUT-AM EUCAST and Reference Broth Microdilution-Based CLSI Results for Candida kefyr Antifungal Susceptibility Testing: Implications for Detection of Reduced Susceptibility to Amphotericin B
by Mohammad Asadzadeh, Suhail Ahmad, Jacques F. Meis, Josie E. Parker and Wadha Alfouzan
J. Fungi 2025, 11(8), 570; https://doi.org/10.3390/jof11080570 - 30 Jul 2025
Viewed by 509
Abstract
Invasive infections with rare yeasts are increasing worldwide and are associated with higher mortality rates due to their resistance to antifungal drugs. Accurate antifungal susceptibility testing (AFST) is crucial for proper management of rare yeast infections. We performed AFST of 74 Candida kefyr [...] Read more.
Invasive infections with rare yeasts are increasing worldwide and are associated with higher mortality rates due to their resistance to antifungal drugs. Accurate antifungal susceptibility testing (AFST) is crucial for proper management of rare yeast infections. We performed AFST of 74 Candida kefyr isolates by Etest, EUCAST-based MICRONAUT-AM assay (MCN-AM) and reference Clinical and Laboratory Standards Institute broth microdilution method (CLSI). Essential agreement (EA, ±1 two-fold dilution), categorical agreement (CA), major errors (MEs) and very-major errors (VmEs) were determined using epidemiological cut-off values of ≤1.0 µg/mL, ≤0.03 µg/mL, ≤0.5 µg/mL and ≤1 µg/mL, defining wild-type isolates for fluconazole, voriconazole, micafungin and amphotericin B (AMB), respectively. Results for AMB susceptibility were correlated with ERG2/ERG3 mutations and total-cell sterols. CA of ≥97% was recorded between any two methods while EA varied between 72 and 82%, 87 and 92%, and 49 and 76% for fluconazole, voriconazole and micafungin, respectively. For AMB, CAs between CLSI and Etest; CLSI and MCN-AM; MCN-AM and Etest were 95% (4 ME, 0 VmE), 96% (3 ME, 0 VmE) and 99%, respectively, while EA varied from 32% to 69%. Non-synonymous ERG2/ERG3 mutations and no ergosterol were found in seven of eight isolates of non-wild types for AMB by Etest. Our data show that Etest, CLSI and MCN-AM methods are suitable for AFST of C. kefyr for fluconazole, voriconazole and micafungin. Excellent CAs for AMB between Etest and MCN-AM with concordant sterol profiles but not with CLSI suggest that Etest is also an excellent alternative for the detection of C. kefyr isolates with reduced susceptibility to AMB. Full article
(This article belongs to the Special Issue Candidiasis: Changes and Challenges in Its Epidemiology, Pathogenesis, Diagnosis, Treatment and Prevention)
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20 pages, 3840 KiB  
Article
Vacuolar Proteases of Candida auris from Clades III and IV and Their Relationship with Autophagy
by Daniel Clark-Flores, Alvaro Vidal-Montiel, Ricardo Mondragón-Flores, Eulogio Valentín-Gómez, César Hernández-Rodríguez, Margarita Juárez-Montiel and Lourdes Villa-Tanaca
J. Fungi 2025, 11(5), 388; https://doi.org/10.3390/jof11050388 - 18 May 2025
Cited by 1 | Viewed by 847
Abstract
Candida auris is a multidrug-resistant pathogen with a high mortality rate and widespread distribution. Additionally, it can persist on inert surfaces for extended periods, facilitating its transmissibility in hospital settings. Autophagy is a crucial cellular mechanism that enables fungal survival under adverse conditions. [...] Read more.
Candida auris is a multidrug-resistant pathogen with a high mortality rate and widespread distribution. Additionally, it can persist on inert surfaces for extended periods, facilitating its transmissibility in hospital settings. Autophagy is a crucial cellular mechanism that enables fungal survival under adverse conditions. A fundamental part of this process is mediated by vacuolar proteases, which play an essential role in the degradation and recycling of cellular components. The present work explores the relationship between C. auris vacuolar peptidases and autophagy, aiming to establish a precedent for understanding the survival mechanisms of this emerging fungus. Thus, eight genes encoding putative vacuolar peptidases in the C. auris genomes were identified: PEP4, PRB1, PRC1, ATG42, CPS, LAP4, APE3, and DAP2. Analysis of the protein domains and their phylogenetic relationships suggests that these enzymes are orthologs of Saccharomyces cerevisiae vacuolar peptidases. Notably, both vacuolar protease gene expression and the proteolytic activity of cell-free extracts increased under nutritional stress and rapamycin. An increase in the expression of the ATG8 gene and the presence of autophagic bodies were also observed. These results suggest that proteases could play a role in yeast autophagy and survival during starvation conditions. Full article
(This article belongs to the Special Issue Candidiasis: Changes and Challenges in Its Epidemiology, Pathogenesis, Diagnosis, Treatment and Prevention)
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Review

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24 pages, 1022 KiB  
Review
Changing Climate, Changing Candida: Environmental and Social Pressures on Invasive Candidiasis and Antifungal Resistance in Latin America
by Juan Camilo Motta, Pilar Rivas-Pinedo and José Millan Onate
J. Fungi 2025, 11(9), 609; https://doi.org/10.3390/jof11090609 - 22 Aug 2025
Abstract
Invasive candidiasis (IC) in Latin America is undergoing a significant epidemiological shift, increasingly driven by non-albicans strains such as Candida tropicalis, Candida parapsilosis, and Candidozyma auris. These pathogens often exhibit multidrug resistance, which complicates treatment and increases mortality. Diagnostic [...] Read more.
Invasive candidiasis (IC) in Latin America is undergoing a significant epidemiological shift, increasingly driven by non-albicans strains such as Candida tropicalis, Candida parapsilosis, and Candidozyma auris. These pathogens often exhibit multidrug resistance, which complicates treatment and increases mortality. Diagnostic limitations, particularly in rural and public hospitals, delay detection and hinder the provision of rapid care. Environmental pressures, such as climate change and the widespread use of azoles in agriculture, appear to favor the selection of resistant and thermotolerant strains. Migratory birds may also play a role in the environmental transmission of pathogenic fungi. These factors are amplified by socioeconomic inequalities that restrict access to diagnostics and first-line antifungals. To help mitigate this emerging challenge, a One Health-oriented framework combining integrated environmental surveillance, robust antifungal-stewardship programmers, broader diagnostic access, and coordinated cross-sector public health actions should be developed. Reinforcing these pillars could lessen the regional burden of IC and slow the advance of antifungal resistance. Full article
(This article belongs to the Special Issue Candidiasis: Changes and Challenges in Its Epidemiology, Pathogenesis, Diagnosis, Treatment and Prevention)
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37 pages, 910 KiB  
Review
Invasive Candidiasis in Contexts of Armed Conflict, High Violence, and Forced Displacement in Latin America and the Caribbean (2005–2025)
by Pilar Rivas-Pinedo, Juan Camilo Motta and Jose Millan Onate Gutierrez
J. Fungi 2025, 11(8), 583; https://doi.org/10.3390/jof11080583 - 6 Aug 2025
Viewed by 839
Abstract
Invasive candidiasis (IC), characterized by the most common clinical manifestation of candidemia, is a fungal infection with a high mortality rate and a significant impact on global public health. It is estimated that each year there are between 227,000 and 250,000 hospitalizations related [...] Read more.
Invasive candidiasis (IC), characterized by the most common clinical manifestation of candidemia, is a fungal infection with a high mortality rate and a significant impact on global public health. It is estimated that each year there are between 227,000 and 250,000 hospitalizations related to IC, with more than 100,000 associated deaths. In Latin America and the Caribbean (LA&C), the absence of a standardized surveillance system has led to multicenter studies documenting incidences ranging from 0.74 to 6.0 cases per 1000 hospital admissions, equivalent to 50,000–60,000 hospitalizations annually, with mortality rates of up to 60% in certain high-risk groups. Armed conflicts and structural violence in LA&C cause forced displacement, the collapse of health systems, and poor living conditions—such as overcrowding, malnutrition, and lack of sanitation—which increase vulnerability to opportunistic infections, such as IC. Insufficient specialized laboratories, diagnostic technology, and trained personnel impede pathogen identification and delay timely initiation of antifungal therapy. Furthermore, the empirical use of broad-spectrum antibiotics and the limited availability of echinocandins and lipid formulations of amphotericin B have promoted the emergence of resistant non-albicans strains, such as Candida tropicalis, Candida parapsilosis, and, in recent outbreaks, Candidozyma auris. Full article
(This article belongs to the Special Issue Candidiasis: Changes and Challenges in Its Epidemiology, Pathogenesis, Diagnosis, Treatment and Prevention)
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