Search Results (263)

Introduction: A group of approximately 15 Candida species are frequently found to be responsible for human invasive candidiasis, an infection that appears in patients with prolonged hospitalization, particularly in Intensive Care Units, and in immunosuppressed individuals. Given the considerable burden if not rapidly treated, clinicians face diagnostic challenges in distinguishing infection. The objective of this narrative review is to summarize the clinically applicable biomarkers used for invasive candidiasis and to evaluate their performance and create a diagnostic algorithm for clinical practice. Methods: This narrative review was conducted by searching PubMed and Scopus for studies published between 1990 and 2025, using keywords related to invasive candidiasis and non-culture diagnostic biomarkers. Clinical guidelines and consensus documents from major infectious diseases societies were additionally reviewed to supplement. Results: Blood cultures, which are considered the “gold standard” for diagnosis, face important fallouts caused by the limited sensitivity of 50%. Polymerase Chain Reaction assays can identify Candida species at an early stage when compared to blood cultures, demonstrating high specificity that ranges between 91% and 98, due to their high cost, and the limitations regarding only the identification of certain species, their widespread use remains limited. Non-culture serological tests such as mannan, anti-mannan and 1-3-β-D-glucan can detect fungal cell wall components or antibodies directed towards them. These tests have the advantage of being performed directly from blood samples. Reported sensitivity and specificity are 83% and 86% for mannan/anti-mannan, and 73% and 80% for 1-3-β-D-glucan, respectively. They are used for early detection of candidemia in high-risk patients, including immunocompromised individuals. Conclusions: Our report suggests that the traditional “gold standard” for diagnosing invasive candidiasis can be improved by integrating and combining novel biomarkers in the diagnostic pathways, and, thus, potentially reducing the time spent for diagnosing and facilitating early treatment access. Full article

Background and Clinical Significance: Cerebral candidiasis (Candida albicans meningoencephalitis) is a rare but severe central nervous system (CNS) infection, usually associated with neurosurgical procedures or indwelling devices. Diagnosis is challenging due to frequent negativity of cerebrospinal fluid (CSF) cultures, and mortality remains high despite antifungal therapy. Case Presentation: We describe a 64-year-old woman who underwent retrosigmoid resection of a left vestibular schwannoma. The early postoperative course was complicated by fever, neurological deterioration, and hydrocephalus requiring external CSF drainage. Multiple lumbar punctures revealed inflammatory CSF profiles but persistently negative cultures. One month post-surgery, intraoperative samples from mastoid repair material grew Candida albicans, prompting antifungal therapy. Despite treatment, the patient experienced fluctuating neurological status and required multiple external ventricular drains. Three months after surgery, she clinically deteriorated and died. Autopsy showed diffuse meningeal thickening and purulent exudates at the brain base and posterior fossa. Histopathology confirmed chronic lympho-histiocytic meningitis with necrotizing foci containing Candida albicans. Conclusions: This case underscores the diagnostic and therapeutic challenges of post-neurosurgical Candida CNS infections. Repeatedly negative CSF cultures delayed diagnosis, emphasizing the value of ancillary tests such as β-d-glucan and molecular assays. Even with antifungal therapy, prognosis is poor. Autopsy remains essential for uncovering fatal healthcare-associated fungal infections and informing clinical vigilance and medico-legal assessment. Full article

Biomaterials derived from natural-origin polymers often lack the desired functionality and additional features, such as antibacterial properties, which could be beneficial in the design of modern wound dressings. Our research aimed to fabricate biosafe antibacterial dressings through the modification of curdlan-based hydrogels with triangle-shaped silver nanoparticles (AgTNPs) and poly(L-DOPA) (PL). The prepared hydrogels, including physicochemical, structural, biological, and antibacterial assessments, were thoroughly characterized. All formulations were confirmed to be non-toxic toward eukaryotic cells. The presence of PL in the hydrogels significantly reduced mortality in the zebrafish larvae model, highlighting the improved biocompatibility of the hydrogels. The three-component hydrogel (CUR-PL-AgT) demonstrated a high antibacterial effectiveness against Staphylococcus aureus and Pseudomonas aeruginosa. Additionally, the same three-component material outperformed a hydrogel containing only AgTNPs in promoting blood clot formation. Furthermore, PL enhanced the heat generating capability of hydrogels, showing their potential in medical applications where the temperature effects can stimulate biological processes of different natures. Full article

Chronic kidney disease (CKD) is estimated to affect 843.6 million people, accounting for more than 10% of the world’s population, making it a serious public health issue. Dietary therapy is important for suppressing CKD progression risk factors such as hypertension. Fruits granola (FGR), which is rich in dietary fiber, including β-glucan and polyphenols, is expected to contribute to improving the intestinal environment and providing anti-inflammatory effects. We previously reported that FGR consumption improves blood pressure and the intestinal environment in hemodialysis patients. However, the safety and efficacy of FGR for patients with moderate CKD remain unclear. Therefore, we examined the effects of FGR by replacing the breakfast of 24 patients with moderate CKD at least 5 days per week over a total of 2 months. Patients with moderate CKD who were attending outpatient appointments at the Department of Nephrology at Juntendo University Hospital and whose condition was stable were included. Patients with cancer or poor nutritional status were excluded from this study. The results revealed lower systolic blood pressure, low-density lipoprotein cholesterol (LDL-C) levels, and LDL-C/HDL-C ratios after FGR intake. Furthermore, N-acetyl-β-D-glucosaminidase (NAG), a marker of renal tubular damage, was also reduced. Regarding the intestinal environment, improved bowel movements and stool quality were observed. Based on the results of this FGR intervention study, consuming dietary fiber, which is often deficient in moderate CKD patients, may have contributed to reducing risks for cardiovascular disease and urinary tubular dysfunction through FGR intake. Full article

Fruit and coffee industries are responsible for huge quantities of agro-industrial wastes which is of great environmental and public health concern. Therefore, the aim of this work involves the use of such wastes for the production of β-D-glucan from basidiomycete strains which are powerful biological response modifiers in several clinical disorders. Experimental planning for optimization of several parameters was carried out by a full factorial of two levels of three factors for production of beta-glucans and basidiomycete species, where waste concentration and interaction between species and agro-industrial waste were the most important factors. The best conditions involved a basidiomycete strain of Lentinula edodes in a culture medium containing 400 g/L of waste coffee grounds which revealed the production of extracellular β-glucans (141.16 mg/L) at the 3rd day of fermentation. Intrinsic fluorescence properties of mushroom β-D-glucan were investigated by fluorescence spectroscopy as well as a fluorescence microtiter plate reader exhibiting emission peaks at 492 and 528 nm. Differential chromatographic behavior of β-D-glucan was investigated by immobilized metal affinity chromatography (IMAC) using epoxy-activated Sepharose 6B containing different chelating agents, spacer arms, and metal ions. One-step purification of β-D-glucan was devised using a column of epoxy-activated Sepharose 6B-IDA-Cu (II). FTIR analysis of several β-D-glucans from the chromatographic fractions was carried out to investigate their structural properties. Full article

Background: Aspergillus endocarditis is a rare but life-threatening form of infective endocarditis that typically occurs in patients with a history of cardiac surgery, prosthetic valve implantation, or profound immunosuppression. Native valve involvement in non-traditional hosts remains exceptionally rare and is diagnostically challenging. Case presentation: We describe a 56-year-old woman with CREST syndrome and advanced liver disease awaiting transplantation who developed native aortic valve endocarditis. Blood cultures and serum biomarkers (galactomannan and β-d-glucan) were also negative. Transthoracic echocardiography revealed vegetation on the aortic valve. Valve replacement was performed, and Aspergillus fumigatus was isolated from two valve cultures. Liposomal amphotericin B was initiated; however, the patient died of multiorgan failure two weeks later. Systematic review: To contextualise this case, we conducted a systematic review of the literature following the PRISMA guidelines. We included microbiologically confirmed cases of native valve Aspergillus endocarditis based on valve or embolic tissue analysis. Forty-three studies met the inclusion criteria, comprising 45 patients in total. Data were independently extracted by two reviewers and narratively synthesised due to clinical heterogeneity. Conclusions: This case illustrates the diagnostic and therapeutic challenges of native-valve Aspergillus endocarditis in patients without classical risk factors for the disease. Early imaging and a high index of suspicion are crucial for diagnosis. Combined surgical and antifungal therapy remains the cornerstone of management, although the mortality rate remains high. Full article

Medicinal mushrooms are recognised as a source of bioactive polysaccharides and proteins with potential health benefits. This study presents the first comparative evaluation of wheat bread fortified with powdered fruiting bodies of three medicinal mushroom species: Hericium erinaceus (Lion’s Mane), Ganoderma lucidum (Reishi), and Ophiocordyceps sinensis (Cordyceps). Wheat flour was partially substituted at levels of 3–12%, and the resulting breads were analysed for (1→3)(1→6)-β-D-glucan content as well as in vitro protein and starch digestibility. Mushroom enrichment significantly increased β-glucan concentration in bread, with the greatest enhancement observed for 12% Reishi substitution (5.67% d.m.). Starch digestibility decreased across all fortified breads, accompanied by a substantial increase in resistant starch, particularly for Reishi bread (+427% relative to control). Protein digestibility was also reduced, most prominently in Cordyceps bread (−32.7 percentage points), although these products still provided up to ~52% more total protein than the control. The results confirm that incorporating medicinal mushrooms into wheat bread effectively increases its content of bioactive components, such as β-glucans, resistant starch and protein, indicating its potential as a nutrient-enriched bakery product with improved functional value. Full article

Invasive candidiasis (IC) is a life-threatening fungal infection predominantly affecting critically ill patients in intensive care units (ICUs). Despite advances in antifungal therapies, IC remains a diagnostic and therapeutic challenge, with a mortality rate exceeding 40%. The current reliance on blood cultures as the diagnostic gold standard is limited by low sensitivity and prolonged turnaround times, often delaying effective treatment. This often leads to the overuse of empirical antifungal therapies, increasing resistance, healthcare costs, and inconsistent outcomes. To address these issues, this paper introduces a five-step diagnostic strategy developed by an expert panel to optimise IC diagnosis and management. The strategy integrates predictive risk scores, biomarkers, and antifungal susceptibility testing to streamline diagnosis, identify high-risk patients, and promote antifungal stewardship. It also addresses barriers such as resource disparities and variability in clinical practices, offering a practical, standardised strategy for ICUs in the UK and Ireland. The clinical utility of this approach is highlighted through two patient cases. One describes the safe discontinuation of antifungal therapy after a negative (1,3)-β-D-glucan (BDG) assay ruled out IC, reducing unnecessary treatment and adverse effects. The other showcases the use of rapid in-house antifungal susceptibility testing to precisely tailor therapy for a patient with Nakaseomyces glabratus, ensuring effective treatment and preventing resistance. This pragmatic five-step guide simplifies and standardises IC diagnosis, aiming to lower mortality, optimise therapies, and promote judicious antifungal use. Full article

Mushroom diversity is essential for maintaining ecological balance and provides valuable bioactive compounds for human use. Beyond their nutritional value, mushrooms contribute to functional foods and have applications in nutraceuticals, pharmaceuticals, and biotechnology. For example, β-glucans from Lentinula edodes are commercialized as immune-enhancing nutraceuticals, polysaccharide Krestin (PSK) from Trametes versicolor is used as an adjuvant in cancer therapy, and enzymes such as laccases from Pleurotus species are widely applied in biotechnological processes. One of the abundant compounds found in mushrooms is ergosterol, which is a sterol present in the cell membrane of the fungal body. Ergosterol has significant health benefits due to its antioxidant, immunomodulatory, and anti-inflammatory properties. Furthermore, ergosterol is a precursor to vitamin D₂ (ergocalciferol), which can be synthesized through exposure to ultraviolet (UV) light and thermal radiation. This review highlights the importance of Himalayan mushroom biodiversity, particularly the wild edible mushrooms traditionally collected and used. This review thoroughly discusses the ergosterol and vitamin D₂ content, their biosynthesis in mushrooms, and the role of environmental factors used to enhance biosynthesis. We also discuss the sustainable cultivation of Himalayan mushrooms and their nutraceutical properties. Several Himalayan mushrooms have been reported to possess health-promoting properties, and their incorporation into functional foods may contribute to improved public health. Furthermore, the future research directions are highlighted. Full article

Background: The presence of (1→3)-β-D-Glucan (BDG) in serum may be indicative of invasive fungal disease (IFD), but even without IFD, elevated BDG can be associated with adverse patient outcomes. Methods: COVID-19-infected patients (n = 125) who were screened for IFD with fungal biomarkers were evaluated to assess the prognostic value of BDG. BDG was correlated with patients’ mortality, considering the influences of IFD and anti-fungal therapy (AFT). Results: A BDG concentration > 31 pg/mL was associated with significant mortality in the absence of documented IFD and without subsequent antifungal therapy (≤31 pg/mL: 28% vs. >31 pg/mL: 91%; p = 0.0001). In patients without IFD but with BDG > 31 pg/mL, mortality dropped to 50% when AFT was administered. In patients with BDG > 31 pg/mL and neither IFD nor AFT, the average probability of death was 3.38-fold greater. Conclusions: Elevated serum BDG is associated with significant mortality in COVID-19-infected patients without IFD, irrespective of AFT. A BDG-associated proinflammatory response might be driving the high mortality. BDG serves as a prognostic marker in COVID-19-infected patients with or without IFD. When BDG is very low (≤31 pg/mL) the likelihood of death remains consistent with the background mortality rates for COVID-19 within the ICU. Full article

Background/Objectives: Fungal endocarditis (FE), is a rare yet life-threatening disease, which predominantly affects immunocompromised individuals, prosthetic valve recipients, and injection drug users. The purpose of this review is to summarize the evolving epidemiological trends, diagnostic challenges, and treatment strategies, by identifying evidence that supports the optimal clinical approach. Methods: A literature search was performed, drawing from sources such as PubMed and Google Scholar and included articles published between January 2015 and March 2025. Clinical studies, case series, and meta-analyses reporting on FE epidemiology, diagnostics, or treatment were included. Results: The majority of FE cases is caused by Candida species, predominantly C. albicans, while Aspergillus accounted for a lesser percentage of cases. While blood cultures showed limited sensitivity, adjunctive diagnostic tools such as serum biomarkers (β-D-glucan, galactomannan) and advanced imaging modalities (18F-FDG PET/CT) are increasingly used to guide the diagnostic process. Early surgical intervention combined with antifungals improved survival, particularly for Aspergillus, although comprehensive data regarding this approach remains limited due to the rarity of the disease. Conclusions: Fungal endocarditis requires an aggressive treatment strategy, integrating early surgery, targeted antifungals, and long-term suppression, especially for prosthetic valves. Despite advances, the complexity of the condition and the variety of the pathogens involved, continue to impede progress towards effective management of FE. Future research must prioritize rapid diagnostics, standardized treatment protocols, and novel antifungals to address this critical condition. Full article

Background/Objectives: Recent shifts in dietary patterns have led to reduced fiber consumption, corresponding with increasing rates of obesity and metabolic disorders. Barley-based cereals with high fiber content, particularly β-glucan, may provide superior metabolic and satiety benefits compared to corn-based alternatives. This study investigated whether barley-based cereals provide superior metabolic and satiety benefits compared to corn-based alternatives in overweight Korean adults. Methods: After selecting the most optimal cereal in the phase 1 study (acute postprandial research), a 6-week randomized controlled trial (RCT) was conducted in phase 2. In the phase 2 trial, overweight adults (n = 30; mean age of 43 ± 10.89 years; 36.7% female) were randomly assigned to consume either barley (n = 15) or corn cereal (n = 15) daily for 6 weeks. Participants consumed approximately 50 g of available carbohydrates (either barley or corn cereal) in 190 mL milk. Outcome measures included anthropometric parameters, fasting blood glucose, homeostasis model assessment of insulin resistance (HOMA-IR), postprandial glucose, subjective satiety, and gut health. Results: After 6 weeks, between-group comparisons revealed significant differences favoring the barley group in body weight (barley: −0.33 kg vs. corn: +0.85 kg; difference: −1.18 kg, p = 0.027), BMI (barley: −0.14 kg/m² vs. corn: +0.03 kg/m²; difference: −0.17 kg/m², p = 0.014), and glycated albumin (barley: −0.78% vs. corn: +0.09%; difference: −0.87%, p = 0.032). Within-group analyses showed that the barley group exhibited significant reductions in percent body fat (−1.03%, p = 0.004), waist circumference (−3.64 cm, p = 0.003), waist-to-hip ratio (−0.02, p = 0.012), glycated albumin (−0.78%, p = 0.029), and LDL cholesterol (−10.57 mg/dL, p = 0.033). Conversely, the corn group showed significant increases in body weight (+0.85 kg, p = 0.026) and percent body fat (+0.84%, p = 0.020), with a significant decrease in HDL cholesterol (−2.84 mg/dL, p = 0.020). Conclusions: Barley-based cereals offer significant metabolic and satiety benefits for overweight adults compared to corn-based alternatives. These findings suggest that barley-based cereals may be an effective dietary intervention for managing obesity and metabolic disorders. Full article

Microbial metabolites offer a multitude of mechanisms for alleviating diabetes, particularly type 2 diabetes (T2D). However, the metabolites of yeasts recognised as safe remain under-explored and are receiving less attention in the treatment of T2D. In addition to the recognised probiotic status of certain yeasts, their genetic feature is responsible for many of the effects observed. Branched and non-branched short-chain fatty acids, bioactive peptides, carotenoids, and polysaccharides (β-glucans, mannans, and peptides derived from them) have vital properties that modulate intestinal permeability, soothe inflammation, and directly influence insulin sensitivity. Their action mechanism ranges from hepatic lipogenesis via the induction of hormone-sensitive lipase and the inhibition of α-glucosidase or DPP-IV to promoting the secretion of GLP-1 (Glucagon-Like Peptide-1) and GIP (Gastric Inhibitory Polypeptide), orchestrating immune modulation, and nourishing the gut microbiota. The richness of the yeast metabolome suggests that a concentrated fermentate could be developed to potentiate the functional effects in vitro in the treatment of T2D. The purpose of this review is to take stock of the current state of knowledge of probiotic yeast metabolites and outline their potential for the treatment of diabetes via the development of food supplements or nutraceuticals. Full article

Candidemia is a highly prevalent invasive fungal infection caused primarily by C. albicans, C. parapsilosis, C. glabrata (currently Nakaseomyces glabratus), C. tropicalis, and C. krusei (currently Pichia kudriavzevii). Risk factors for the development of candidemia include steroid-induced immunosuppression used in solid organ or hematopoietic transplantation, and neutropenia secondary to infectious or tumorous processes. Alterations in the gut microbiota in people living with HIV, caused by antiretroviral therapy, increase the possibility of colonization by C. albicans. Likewise, the presence of a central venous catheter, parenteral nutrition, and abdominal surgery stand out as the main risk factors for the development of candidemia. New diagnostic tools have been developed for the diagnosis of this mycosis that allow the identification of the main species, from improvements in conventional stains such as calcofluor white, which increases sensitivity, as well as technologies such as T2 Candida, MoiM assay, biomarker panel (1,3 β-D-glucan, C-reactive protein, presepsin, and procalcitonin), and, more recently, the development of biosensors for the identification of Candida spp. Regarding treatment, the use of micafungin and anidulafungin in patients with obesity defined by a BMI > 30 kg/m² has shown higher survival rates and therapeutic success. Meanwhile, newer antifungals such as rezafungin and fosmanogepix have demonstrated excellent results in the treatment of these patients. Therefore, this review aims to update the epidemiology and risk factors of candidemia, as well as analyze the diagnostic tools and treatments currently available. Full article

An 89-year-old male developed a persistent high fever (around 39 °C) approximately two weeks following endoscopic reduction of sigmoid volvulus. He had no history of hypercalcemia but was using diuretics and proton pump inhibitors. Renal and thyroid status were normal. He was largely bedridden and asymptomatic except for fever. Laboratory tests demonstrated elevated C-reactive protein (4.75 mg/dL), but some tumor markers (including CEA, CA19-9, and CA125), anti-nuclear antibodies, MPO-ANCA, PR3-ANCA, β-D-glucan, and interferon-gamma release assay were all negative. Urinalysis was unremarkable. Blood cultures obtained from two sets were negative. Chest–abdomen–pelvis contrast-enhanced computed tomography (CT), and echocardiography did not reveal any evident neoplastic lesions or focal sites of infection. Despite various antibiotic therapies, the patient’s spike fever persisted for nearly one month, leading to a diagnosis of fever of unknown origin (FUO). The patient experienced partial symptomatic relief with corticosteroid therapy, though mild fever continued. Two months after the volvulus onset, diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) was performed, revealing hyperintensities at the right sternoclavicular joint, leading to a diagnosis of sternoclavicular arthritis. Neck CT revealed calcification in this joint. Despite difficulty in joint fluid analysis, low infection risk and the patient’s prolonged bedridden state and advanced age led to suspicion of pseudogout. Nonsteroidal anti-inflammatory drugs relieved fever and normalized inflammatory markers. DWIBS may be a valuable tool for detecting potential focus sites in FUO. Full article