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Public Health Action on Fungal Infections and Antimicrobial Resistance
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Public Health Action on Fungal Infections and Antimicrobial Resistance

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: closed (31 March 2025) | Viewed by 9022

Special Issue Editors

Dr. Colin S Brown

E-Mail Website
Guest Editor
National Infection Service, Public Health England, London, UK
Interests: AMR; infectious disease epidemiology; emerging and re-emerging infections; global health; policy
Dr. Christopher R. Jones

E-Mail Website
Guest Editor Assistant
HCAI, Fungal, AMR, AMU, and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
Interests: AMR; infectious disease epidemiology; emerging and re-emerging infections; global health; policy
Dr. Emma Budd

E-Mail Website
Guest Editor Assistant
HCAI, Fungal, AMR, AMU, and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
Interests: AMR; surveillance; antimicrobial stewardship; fungal epidemiology

Special Issue Information

Dear Colleagues,

Fungal infections increasingly threaten human health and global food security. Despite this, fungal infections remain under-represented on the global health and research agenda. The development of the first World Health Organisation (WHO) Fungal Priority Pathogens List is an important landmark, building on work to incorporate fungal infections into the WHO Essential Medicines List and Essential Diagnostic List. However, several challenges remain. The population of susceptible hosts is increasing; novel threats continue to emerge, e.g., Candida auris; climate change is altering the ecology of fungal organisms; antifungal use in the environment drives resistance in potential human pathogens; antifungal resistance combined with a limited antifungal drug armamentarium limits treatment options and affects clinical outcomes; despite policy advances, access to diagnostics and therapeutics is limited, often where it is most needed; and so on. Although fungal infections are being incorporated into the WHO’s Global Antimicrobial Surveillance System (GLASS) through the development of the GLASS-Fungi module, few countries have effective surveillance systems for fungal infections and their associated diseases.

A rapidly growing and perennially vocal community of academics, clinicians, policymakers, public health professionals, and other advocates interested in fungal infections continue to highlight the importance of fungi within their respective spheres of influence. The aim of this Special Issue is to highlight the important work being performed globally to raise the profile of fungal infections and antimicrobial resistance across all One Health domains—humans, animals, plants, and the environment. We invite colleagues to submit original research articles, reviews, short communications, and perspectives that fall within any of the following domains related to fungal infections and antimicrobial resistance across the One Health sphere, with clear relevance to public health measures:

  • Policy;
  • Advocacy;
  • Surveillance;
  • Public health interventions;
  • Innovation;
  • Antifungal stewardship;
  • Laboratory capacity development;
  • Patient and public engagement;
  • Infection prevention and control;
  • Fungal disease burden;
  • Ecology of fungi.

Dr. Colin S Brown
Guest Editor

Dr. Christopher R. Jones
Dr. Emma Budd
Guest Editor Assistants

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Fungi is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • fungal infections
  • antimicrobial resistance
  • policy
  • advocacy
  • surveillance
  • innovation
  • ecology
  • One Health
  • disease burden
  • infection prevention and control
  • stewardship
  • laboratory capacity
  • patient and public engagement
  • education

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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10 pages, 590 KiB  
Article
External Validation of Risk Prediction Score for Candidemia in Critically Ill Patients: A Retrospective Observational Study
by Nurul Mazni Abdullah, Saw Kian Cheah, Raha Abdul Rahman, Nadia Md Nor, Muhammad Maaya and Qurratu Aini Musthafa
J. Fungi 2025, 11(3), 204; https://doi.org/10.3390/jof11030204 - 6 Mar 2025
Viewed by 814
Abstract
Candidemia is associated with high mortality in critically ill patients. Early diagnosis of candidemia is imperative for starting treatment. Therefore, this study was designed to externally validate the candidemia risk prediction scores. This single-center, retrospective observational study included all critically ill patients admitted [...] Read more.
Candidemia is associated with high mortality in critically ill patients. Early diagnosis of candidemia is imperative for starting treatment. Therefore, this study was designed to externally validate the candidemia risk prediction scores. This single-center, retrospective observational study included all critically ill patients admitted to the intensive care unit at a tertiary referral center from January 2018 to December 2023. The risks and patient outcomes were analyzed using bivariate and multivariate regression analysis. A total of 500 patients were analyzed with 2 dropouts due to incomplete data. Candidemia incidence was 8.86%, with parenteral nutrition and candida colonization identified as independent risk factors. Compared to an established risk prediction score, this study demonstrated a sensitivity of 75.0% [59.7–86.8], a specificity of 65.4% [60.8–69.8], a negative predictive value of 96.4% [94.2–97.8], and a positive predictive value of 17.3% [14.5–20.5]. The candidemia group had a significantly higher mean SOFA score, longer time in ICU, longer hospital length of stay, and higher rates of both ICU and in-hospital mortality. This study shows that the risk prediction score is more effective as a tool for excluding rather than predicting candidemia. We recommend against using it as the sole diagnostic guide. Full article
(This article belongs to the Special Issue Public Health Action on Fungal Infections and Antimicrobial Resistance)
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10 pages, 735 KiB  
Article
Culture-Dependent and -Independent Wastewater Surveillance for Multiple Pathogenic Yeasts
by Tyla Baker, Phillip Armand Bester, Olihile Moses Sebolai, Jacobus Albertyn and Carolina Henritta Pohl
J. Fungi 2025, 11(2), 86; https://doi.org/10.3390/jof11020086 - 23 Jan 2025
Viewed by 852
Abstract
Wastewater surveillance is a promising tool to monitor potential outbreaks and determine the disease burden within a community. This system has been extensively used to monitor polio and COVID-19 infection levels, yet few attempts have been made to apply it to monitoring pathogenic [...] Read more.
Wastewater surveillance is a promising tool to monitor potential outbreaks and determine the disease burden within a community. This system has been extensively used to monitor polio and COVID-19 infection levels, yet few attempts have been made to apply it to monitoring pathogenic yeast. This study aimed to investigate the application of wastewater surveillance for potentially pathogenic yeast in wastewater treatment plant influent. This was done by comparing culture-dependent data with culture-independent data and investigating the fluconazole concentration in wastewater. Additional studies on the growth of isolated strains were conducted. We found that a multiplex PCR system to detect multiple yeasts holds promise as a molecular detection tool for wastewater surveillance. Culture-dependent results indicated that Candida spp. specifically C. krusei and C. glabrata, were most prominent. Growth studies supported that these species grow well in this environment while the less frequently isolated yeasts grew poorly. The data from culture-dependent and independent techniques showed some correlation, with similar species being identified with both, further promoting the use of molecular tools for surveillance. This study highlights the presence of potentially pathogenic yeasts in wastewater, which may indicate the prevalence of these yeasts in the environment or community. This wastewater may also be a potential source of infection for persons encountering it due to poor wastewater management. Full article
(This article belongs to the Special Issue Public Health Action on Fungal Infections and Antimicrobial Resistance)
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16 pages, 2787 KiB  
Article
Tracking Candidemia Trends and Antifungal Resistance Patterns across Europe: An In-Depth Analysis of Surveillance Systems and Surveillance Studies
by Karin Odoj, Jacopo Garlasco, Maria Diletta Pezzani, Cristina Magnabosco, Diego Ortiz, Federica Manco, Liliana Galia, Sarah K. Foster, Fabiana Arieti and Evelina Tacconelli
J. Fungi 2024, 10(10), 685; https://doi.org/10.3390/jof10100685 - 29 Sep 2024
Cited by 2 | Viewed by 2298
Abstract
Background: The WHO fungal priority list classifies Candida species as critical and high-priority pathogens, and the WHO GLASS fungi initiative seeks to establish a standardised global framework for antifungal resistance monitoring. We aimed to review resistance rates and antifungal resistance patterns across European [...] Read more.
Background: The WHO fungal priority list classifies Candida species as critical and high-priority pathogens, and the WHO GLASS fungi initiative seeks to establish a standardised global framework for antifungal resistance monitoring. We aimed to review resistance rates and antifungal resistance patterns across European surveillance systems and studies in response to these recent calls for action. Methods: A systematic review of national and international surveillance systems and peer-reviewed surveillance studies available up to June 2024 was conducted. Descriptive and trend analyses were performed on surveillance data reporting resistance to different antifungals in Candida spp. Results: In total, 6 national surveillance systems and 28 studies from 13 countries provided candidemia resistance data, mostly about the C. albicans, C. glabrata and C. parapsilosis complex. Azole resistance was most frequently reported (6/6 surveillance systems and 27/28 studies) with the highest resistance rate, especially for C. glabrata, in Croatia (100%, 28/28 isolates) and Slovenia (85.7%, 82/96) and C. parapsilosis in Croatia (80.6%, 54/67) and Italy (72.6%, 106/146). Echinocandin and polyene resistance rates were nearly zero. The number of isolates included in the surveillance systems increased over the years, particularly for C. albicans (+40–60 isolates/year), C. glabrata, and C. parapsilosis (+15–30 isolates/year). No surveillance system or study reported resistance data for C. auris. Pooled data from national surveillance revealed a decreasing trend in azole resistance in C. albicans and C. glabrata. The increasing azole-resistance trend in C. parapsilosis disappeared after adjusting for between-country heterogeneity. Overall, echinocandin and polyene resistance trends appeared relatively stable. Conclusions: Awareness of antifungal resistance is growing, but further actions are needed to strengthen surveillance capacity and knowledge-sharing networks across Europe. Full article
(This article belongs to the Special Issue Public Health Action on Fungal Infections and Antimicrobial Resistance)
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15 pages, 1546 KiB  
Article
Mapping the Burden of Fungal Diseases in the United Arab Emirates
by Fatima Al Dhaheri, Jens Thomsen, Dean Everett and David W. Denning
J. Fungi 2024, 10(5), 353; https://doi.org/10.3390/jof10050353 - 15 May 2024
Cited by 3 | Viewed by 3492
Abstract
The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected proportions, we have modelled the burden of fungal disease for the first time. The most prevalent serious [...] Read more.
The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected proportions, we have modelled the burden of fungal disease for the first time. The most prevalent serious fungal conditions are recurrent vulvovaginitis (~190,000 affected) and fungal asthma (~34,000 affected). Given the UAE’s low prevalence of HIV, we estimate an at-risk population of 204 with respect to serious fungal infections with cryptococcal meningitis estimated at 2 cases annually, 15 cases of Pneumocystis pneumonia (PCP) annually, and 20 cases of esophageal candidiasis in the HIV population. PCP incidence in non-HIV patients is estimated at 150 cases annually. Likewise, with the same low prevalence of tuberculosis in the country, we estimate a total chronic pulmonary aspergillosis prevalence of 1002 cases. The estimated annual incidence of invasive aspergillosis is 505 patients, based on local data on rates of malignancy, solid organ transplantation, and chronic obstructive pulmonary disease (5.9 per 100,000). Based on the 2022 annual report of the UAE’s national surveillance database, candidaemia annual incidence is 1090 (11.8/100,000), of which 49.2% occurs in intensive care. Fungal diseases affect ~228,695 (2.46%) of the population in the UAE. Full article
(This article belongs to the Special Issue Public Health Action on Fungal Infections and Antimicrobial Resistance)
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9 pages, 3533 KiB  
Brief Report
Trends in Antifungal Resistance Among Candida Species: An Eight-Year Retrospective Study in the Galveston–Houston Gulf Coast Region
by Michael D. Nguyen and Ping Ren
J. Fungi 2025, 11(3), 232; https://doi.org/10.3390/jof11030232 - 19 Mar 2025
Viewed by 578
Abstract
Fungal systemic infections are a growing global health concern, particularly among immunocompromised individuals. Candida species are the leading cause of invasive fungal infections, with C. albicans historically being the most prevalent. The emergence of C. auris, known for its multidrug resistance, presents [...] Read more.
Fungal systemic infections are a growing global health concern, particularly among immunocompromised individuals. Candida species are the leading cause of invasive fungal infections, with C. albicans historically being the most prevalent. The emergence of C. auris, known for its multidrug resistance, presents additional challenges for treatment and infection control. This study retrospectively analyzed minimal inhibitory concentration (MIC) data for common Candida species isolated from patients in the Galveston–Houston Gulf Coast region from the EPIC Laboratory Information System (LIS) between October 2016 and September 2024. Antifungal susceptibility was assessed using the SensititreTM YeastOneTM YO9 AST Plate and interpreted per Clinical and Laboratory Standard Institute (CLSI) guidelines. A total of 1206 clinical yeast isolates from over 29 species were identified, with Candida species accounting for 94.5% (1140). C. albicans (30.7%), C. glabrata (23.5%), C. parapsilosis (12.2%), and C. tropicalis (10.4%) were the most prevalent. C. auris (6.2%) emerged in late 2021 in our region, showing high MICs against fluconazole (92%) and amphotericin B (32.2%). While C. albicans, C. parapsilosis, and C. tropicalis remained susceptible to echinocandins, fluconazole resistance showed an increasing trend. C. glabrata exhibited variable susceptibility to both echinocandins and azoles. These findings highlight the urgent need for enhanced antifungal stewardship, improved diagnostics, and novel therapeutic strategies. Continued regional surveillance and targeted interventions are essential to mitigating the impact of antifungal resistance. Full article
(This article belongs to the Special Issue Public Health Action on Fungal Infections and Antimicrobial Resistance)
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