Search Results (455)

Background: Fungal infection of pancreatic fluid collections (PFCs) in severe acute pancreatitis (SAP) is under-recognized and associated with poor outcomes. Overlap with bacterial infections and the need for invasive sampling often delay diagnosis, leading to prolonged antibiotic use without the use of antifungal agents. Methods: We report three cases of SAP complicated by fungal infection of PFCs. Two patients, one with alcohol-related pancreatitis and the other with biliary pancreatitis, developed symptomatic encapsulated necrosis. Both were successfully managed with endoscopic drainage and targeted antifungal therapy against Candida albicans, achieving full resolution. The third patient, with necrotizing biliary pancreatitis, underwent multiple surgical and endoscopic interventions and developed an infection with a non-albicans Candida species. Reduced susceptibility requires individualized antifungal adjustment guided by susceptibility testing. Despite aggressive multimodal therapy, the patient progressed to multiorgan failure and died subsequently. Results: These cases emphasize the clinical impact of fungal infections in patients with SAP, particularly their association with severe disease, prolonged hospitalization, and prior antibiotic exposure. These findings highlight the prognostic value of early microbiological sampling, species-level identification, and prompt initiation of antifungal therapy. Infections caused by non-albicans species pose additional challenges due to their reduced sensitivity to standard antifungal agents. Conclusions: Fungal infection of PFCs is a clinically significant and frequently underestimated complication of SAP. Early recognition and species-directed antifungal therapy are critical for improving outcomes in high-risk patients. Full article

Invasive fungal disease (IFD) is one of the leading causes of morbidity and mortality in immunocompromised pediatric patients. This is a multicenter prospective cohort study with a nested retrospective analysis aimed at identifying risk factors for IFD in immunocompromised children with cancer and episodes of persistent high-risk febrile neutropenia (HRFN). One hundred and seventy-four episodes of persistent HRFN were analyzed, of which 34 (19.5%) were confirmed as IFD, 52.9% were caused by filamentous fungi, and 47.1% by yeasts. Logistic regression and survival analyses identified the following significant risk factors for IFD: male sex (OR 4.04), adolescence (OR 4.65), C-reactive protein ≥ 90 mg/L at admission (OR 3.13), and transfer to a critical care unit (OR 10.73). The predictive model demonstrated strong discriminatory capacity (AUC 0.84), with 79.4% sensitivity and 82.1% specificity. These findings highlight that adolescents, particularly males with severe clinical conditions and elevated inflammatory markers, are at the highest risk for IFD during episodes of HRFN. The proposed risk factor-based model may support early risk stratification and guide targeted antifungal prophylaxis or therapy, potentially improving outcomes in this population. Validation an external cohort is required to confirm these results and optimize clinical applicability. Full article

(1) Background: Invasive fungal diseases (IFDs) represent significant challenges in clinical practice, particularly among immunocompromised individuals, leading to substantial morbidity and mortality. The present document aims to provide evidence-based consensus for the timely initiation of antifungal treatment, focusing on early empiric approaches among immunocompromised patients. (2) Methods: A multidisciplinary expert panel of nine healthcare professionals (HCPs) reviewed the literature, including guidelines and consensus reports (2013–2023; PubMed, Scopus). The panel defined appropriate empiric antifungal approaches for invasive candidiasis, aspergillosis, and mucormycosis among hematological and critically ill patients. Consensus was defined as ≥75% agreement. (3) Results: A total of 47 statements were included. The experts recommend that early targeted antifungal therapy is critical for high-risk patients with suspected IFDs. Empiric therapy may be initiated before definitive diagnosis, considering the local fungal prevalence and the patient’s risk category. Close monitoring is essential, and switching between antifungal classes may be necessary for patients who experience deterioration or side effects. The transition from intravenous to oral therapy depends on the specific infection, the availability of therapeutic drug monitoring, and the patient’s progress. (4) Conclusions: Implementing this targeted, early approach may improve the outcomes of vulnerable patients with IFDs. Full article

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

Artificial intelligence (AI) and machine learning (ML) are transforming medical diagnostics, but human nail, an easily accessible and rich biological substrate, is still not fully exploited in the digital health field. Nail pathologies are easily diagnosed, non-invasive disease biomarkers, including systemic diseases such as anemia, diabetes, psoriasis, melanoma, and fungal diseases. This review presents the first big synthesis of image analysis for nail lesions incorporating AI/ML for diagnostic purposes. Where dermatological reviews to date have been more wide-ranging in scope, our review will focus specifically on diagnosis and screening related to nails. The various technological modalities involved (smartphone imaging, dermoscopy, Optical Coherence Tomography) will be presented, together with the different processing techniques for images (color corrections, segmentation, cropping of regions of interest), and models that range from classical methods to deep learning, with annotated descriptions of each. There will also be additional descriptions of AI applications related to some diseases, together with analytical discussions regarding real-world impediments to clinical application, including scarcity of data, variations in skin type, annotation errors, and other laws of clinical adoption. Some emerging solutions will also be emphasized: explainable AI (XAI), federated learning, and platform diagnostics allied with smartphones. Bridging the gap between clinical dermatology, artificial intelligence and mobile health, this review consolidates our existing knowledge and charts a path through yet others to scalable, equitable, and trustworthy nail based medically diagnostic techniques. Our findings advocate for interdisciplinary innovation to bring AI-enabled nail analysis from lab prototypes to routine healthcare and global screening initiatives. Full article

The potential of invasive plants to serve as reservoirs for plant pathogenic fungi has been confirmed, but studies examining the seasonal effects on the community structure and transmission patterns of leaf pathogens within invasive plant populations remain scarce. In this study, we characterised the seasonal dynamics of pathogenic fungal communities in the leaf tissue of the invasive plant A. adenophora via culture-dependent and culture-independent methods. The study confirmed that fresh leaves of A. adenophora accumulate diverse pathogenic fungi, including Colletotrichum, Epicoccum, Toxicocladosporium, Mycosphaerella and Didymella. These genera are globally distributed and act as pathogens for a wide range of wild plants and economic crops. The pathogenic fungal communities exhibited seasonal dynamics, though the magnitude of change was less pronounced than that of the overall fungal community. Among four common environmental factors, namely, temperature, relative humidity, wind speed and precipitation, temperature had a greater effect on the overall community than the other environmental factors, whereas precipitation had the least effect. However, relative humidity has the strongest effect on the pathogenic fungal community; moreover, relative humidity distinctively affects the same species occurring in different microenvironments. Most foliar pathogenic fungi are actively transmitted in spring and autumn, and very few genera can transmit across all seasons. Moreover, most fungal genera can transmit from fresh leaves to dead leaves, suggesting that most foliar fungal pathogens associated with A. adenophora are likely necrotrophic. Our study strongly confirms the potential of the invasive plant A. adenophora to act as a reservoir of pathogenic fungi and provides preliminary insights into their potential transmission patterns. These findings underscore that, under suitable climatic and environmental conditions, A. adenophora may pose a latent risk of triggering disease transmission within ecosystems. Full article

Background/Objectives: Mucormycosis is a rapidly progressive invasive fungal infection that commonly involves the sinonasal region and skull base in patients with systemic comorbidities, yet robust ENT data from middle-income settings are scarce. Methods: We performed a single-center retrospective review of all patients with histopathologically confirmed mucormycosis treated in the Otorhinolaryngology Department of Dicle University between 2010 and 2023, covering a 14-year period. Eligible patients had paranasal sinus computed tomography at presentation and received surgical and/or systemic antifungal therapy. Demographic data, comorbidities, disease subtype, radiological extent, treatment modality and survival were extracted from records. Survival was estimated using Kaplan–Meier analysis, and group differences were tested with chi-square statistics (p ≤ 0.05). Results: Fifty-two patients met the inclusion criteria (mean age 56.5 ± 15.2 years; 57.7% male); 73.1% had at least one systemic comorbidity, most frequently diabetes mellitus (65.4%) and hematological malignancy (19.2%). Disease was sinonasal in 42.3%, rhino-orbital in 28.8% and rhino-orbito-cerebral in 28.8%. Baseline CT showed intracranial extension in 26.9%. Overall survival was 59.6% and differed markedly by subtype, highest in isolated sinonasal disease (81.8%) and lowest in rhino-orbito-cerebral disease (26.7%). Intracranial extension was associated with higher mortality (71.4% vs. 28.9%). Combined surgical debridement plus systemic antifungal therapy, used in 84.6% of patients, yielded lower mortality than antifungal therapy alone (31.8% vs. 87.5%). Conclusions: In this ENT cohort, prognosis was mainly determined by anatomical extent and treatment strategy. Our findings suggest that timely combined surgical and antifungal management, when feasible and in appropriately selected patients, is associated with improved survival outcomes. Full article

Honeyberry plants (Lonicera caerulea L., family Caprifoliaceae), which produce small, highly nutritious berries, have recently been subject to an outbreak of root rot, resulting in a drastic decrease in fruit yield. In this study, we isolated the fungal community from the roots of diseased plants and analyzed the mechanisms of interaction between key fungi and honeyberry plants. Nine fungal morphotypes were identified via observation of cultures and internal transcribed spacer gene sequence analysis. Pathogenicity assays showed that infection with isolates from the genus Fusarium reproduced the typical root rot symptoms, and Fusarium foetens caused the most severe inhibition of root growth. Transcriptomic analysis of infected plants and Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that the biosynthesis of secondary metabolites was enriched in roots of honeyberry plants infected with F. foetens. This study elucidates that when honeyberry is affected by root rot disease, it produces secondary metabolites to defend against pathogenic invasion, providing a theoretical basis and molecular targets for the green management of this disease. Full article

Background: Liver transplant recipients are highly susceptible to invasive fungal infections, particularly candidemia, due to intensive immunosuppressive therapy and postoperative complications. However, few studies have comprehensively examined postoperative antimicrobial and immunosuppressive factors in this context. Aim: This study aimed to identify perioperative and postoperative factors associated with the development of candidemia in living donor liver transplant (LDLT) recipients, with a particular focus on antimicrobial and immunosuppressive regimens during initial hospitalization. Methods: A retrospective case–control analysis was conducted involving 36 LDLT recipients who developed candidemia (candidemia group) and 72 matched controls without candidemia (non-candidemia group) between January 2019 and November 2023. Demographic and clinical variables were compared using univariate and multivariate logistic regression analyses to identify independent associations. A post hoc power analysis demonstrated a high statistical power (97.3%) to detect large effect sizes. Results: Univariate analysis revealed significant associations with prolonged intubation (p < 0.001), bile leaks (p < 0.001), relaparotomy (p < 0.001), chronic renal disease (p = 0.011), hepatocellular carcinoma (p = 0.011), and the use of antimicrobials including meropenem (p = 0.048), linezolid (p = 0.005), tigecycline (p = 0.045), third-generation cephalosporins (p = 0.003), anidulafungin (p < 0.001), fluconazole (p = 0.006), mycophenolate (p = 0.011), and total parenteral nutrition (TPN) (p = 0.049). CMV prophylaxis (p < 0.001) and CMV-PCR positivity (p = 0.015) were also significantly associated with candidemia. Multivariate logistic regression analysis identified prolonged intubation (OR = 1.07; p = 0.019), bile leaks (OR = 10.9; p = 0.002), anidulafungin use (OR = 4.70; p = 0.032), fluconazole use (OR = 35.8; p = 0.005), and absence of CMV prophylaxis (OR = 11.7; p = 0.021) as independent factors associated with increased odds of candidemia. Conclusions: Prolonged intubation, bile leaks, antifungal exposure, and lack of CMV prophylaxis are independently associated with higher odds of candidemia after LDLT. Targeted prophylaxis, prudent antimicrobial stewardship, and timely biliary intervention may reduce fungal morbidity and mortality in post-transplant patients. Full article

We present a case report of invasive fungal infection in an immunocompromised host, which required a multidisciplinary approach. Mucormycosis is a mold infection caused by a fungi belonging to the order Mucorales. Various forms of the disease have been described, and rhino-orbital-cerebral infection is the most common manifestation. Diabetes, corticosteroid use, malignancy, and a recent history of COVID-19 are well-established immunosuppressive factors that predispose individuals to mucormycosis. Our patient was a forty-five-year-old man with chronic pancreatitis and untreated diabetes mellitus. He presented with sinusitis extending into the right orbit and complicated by central retinal artery occlusion. On admission, the patient complained of three weeks of right-sided headache and eye pain followed by sudden vision loss. He was in good general condition, was alert, oriented, and afebrile. Endoscopic examination revealed the nasal cavity completely filled with pathological tissue displaying fungal morphology. Computed tomography and magnetic resonance imaging revealed a massive orbit infiltration with extraocular muscles and optic nerve invasion. The patient underwent urgent endoscopic debridement. Histopathological examination of the specimens confirmed fungal infiltration. Significant growth of Rhizopus arrhizus was obtained from tissue samples. The surgical procedure was followed by a prolonged antifungal therapy with intensive diabetes management. Full article

Invasive fungal disease (IFD) remains a life-threatening complication in patients with hematological diseases. Isavuconazole was approved by the FDA for primary treatment of invasive aspergillosis and mucormycosis. While clinical trials have demonstrated its efficacy, data on its use in hematology patients remain limited. This study aims to evaluate the real-world effectiveness and safety of isavuconazole in this population. We conducted a single-center, retrospective study of hematology patients who received isavuconazole for IFD between 1 June 2022, and 31 July 2024, at West China Hospital, Sichuan University. A total of 66 patients with proven (n = 9), probable (n = 17), or possible (n = 40) IFD were included in the study. Acute leukemia (AL) was the most common underlying disease, affecting 27 patients (40.9%), followed by non-Hodgkin’s lymphoma (NHL) and myelodysplastic syndrome (MDS). Over 80.0% of patients received oral isavuconazole. At 6 weeks of follow-up, a favorable response was observed in 57.6% of patients, increasing to 71.2% at 12 weeks. Factors associated with achieving complete response in isavuconazole treatment included receiving isavuconazole as primary treatment (OR = 0.10, p = 0.01) and reaching complete/partial remission (CR/PR) of the primary hematological disease (OR = 0.07, p = 0.003). The all-cause mortality rates were under 30.0%. The use of isavuconazole as primary antifungal therapy (p < 0.05) and achieving CR/PR in the underlying hematological disease (p < 0.05) were two independent predictors of improved clinical outcomes. Adverse events were reported in 33.3% of patients, and no adverse events led to discontinuation of treatment. Our study demonstrated that isavuconazole is an effective and well-tolerated treatment for IFD in hematology patients. The oral formulation provided comparable efficacy and enhanced compliance, potentially leading to improved outcomes and optimizing the management strategy. The generalizability of our findings may be limited by the single-center, retrospective nature; further validation through prospective, multi-center studies is needed. Full article

Background and Clinical Significance: Atrophic rhinitis (AR) is a rare, chronic inflammatory condition characterized by progressive atrophy of the nasal mucosa and underlying bone. The present report describes a case of severe secondary AR as a sequela of COVID-19-associated necrotizing rhinitis, highlighting the diagnostic and management challenges posed by multi-drug resistant pathogens and extensive anatomical destruction. Case Presentation: A 75-year-old female developed progressive necrotizing rhinosinusitis with osteomyelitis following a COVID-19 infection. Computed tomography (CT) confirmed an osteolytic process and subsequent profound anatomical destruction, while histopathology ruled out invasive fungal disease. The resulting cavity was colonized by multi-drug resistant Pseudomonas aeruginosa and Staphylococcus aureus. Management and Outcome: Management focused on preventing crust formation through a structured “nasal rest” protocol, supplemented by cleansing nasal douching with a surfactant (baby soap) and mechanical crust removal. This treatment led to significant clinical improvement, with reduced crusting and complete resolution of ozena symptoms. Conclusions: This case illustrates the potential for SARS-CoV-2 infection to precipitate severe necrotizing sinonasal complications leading to secondary AR. It demonstrates the efficacy of a management strategy focused on mechanical cleansing and nasal rest, particularly when conventional antibiotic therapy is limited by extensive drug resistance. Full article

Yellow leaf disease (YLD) has been the most severe disease threatening areca palm, commonly known in areca palm cultivation. However, it has not yet been systematically studied in terms of the relationship between infected plants and the structure of rhizosphere microbial communities. In order to systematically study the impact of YLD on the rhizosphere fungi of the areca palm, we implemented high-throughput sequencing technology to analyze the microbial community structure and diversity under different disease conditions. The results indicate that as the severity of the disease increases, the diversity of the fungal community diminishes, with species abundance and richness initially decreasing before subsequently increasing, while phylogenetic diversity increases, and significant changes occur in the structure of the soil fungal community. At the phylum level, the dominant fungal phyla in the rhizosphere of areca palm are Ascomycota and Basidiomycota. At the genus level, the dominant genera are Sarocladium, Roussoella, Penicillium, etc., and their relative abundance increases with the severity of the disease. LEfSe analysis revealed that Archaeorhizomyces, Codinaea, and Albifimbria serve as indicator species for healthy areca palms, with their relative abundance trends consistent with changes in Alpha diversity. FUNGuild prediction results indicated that the fungal nutrient type structures of the three rhizosphere samples were highly similar, with saprotrophs being the absolutely dominant type. With the increase in the severity of the disease, the number of harmful fungi in the soil (such as Plectosphaerella, Fusarium, etc.) increases, thereby limiting the sustainable development of the soil. Network analysis indicates that beneficial microbial communities such as Stachybotrys and Roussoella exhibit extensive negative interactions. Therefore, the YLD of areca palm significantly alters the structure and diversity of the rhizosphere fungal community. Simultaneously, some beneficial microorganisms may be recruited by the areca rhizosphere to resist the invasion of YLD by improving the rhizosphere environment and enhancing plant immunity, such as Trechispora, Saitozyma, and Marasmiellus. This experiment is expected to provide a theoretical basis for the study of the rhizosphere microecology of the areca palm, the exploration of excellent biocontrol resources, and the green control of YLD in the areca palm. Full article

To develop and validate a predictive model for assessing the risk of short-term mortality in patients with invasive fungal diseases (IFDs) following cardiac surgery. This retrospective study analyzed clinical data from patients diagnosed with postoperative IFDs in the cardiac surgical intensive care unit (ICU) of Qilu Hospital of Shandong University (QLH), between January 2020 and December 2023. A total of 98 patients were included and divided into a non-survival group (n = 42) and a survival group (n = 56) based on 28-day mortality. Demographic, clinical, and postoperative parameters were collected. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for variable selection, and selected variables were then entered into multivariate logistic regression to identify independent risk factors. A nomogram was developed, and its predictive performance was evaluated using the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and clinical impact curve (CIC). Multivariate logistic regression, following variable selection by LASSO, identified a history of smoking, an elevated SOFA score, mean arterial pressure (MAP) below 70 mmHg, and tachyarrhythmia as independent risk factors for short-term mortality in this cohort (p < 0.05). The prediction model demonstrated excellent discrimination, with an area under the ROC curve (AUC) of 0.886 (95% CI: 0.816–0.957). The calibration curve showed good agreement between predicted and observed outcomes, with a mean absolute error of 0.023. Decision curve analysis indicated a net clinical benefit across a threshold probability range of 0.1 to 0.87. The clinical impact curve confirmed a high concordance between predicted mortality and actual outcomes. A history of smoking, an elevated SOFA score, MAP below 70 mmHg, and tachyarrhythmia independently predict short-term mortality in patients with IFDs after cardiac surgery. Therefore, the nomogram constructed from these factors provides an accurate and clinically applicable tool for risk stratification. Full article

Alcohol-associated liver disease is a global health burden with high morbidity and mortality, and the fungal microbiome is important for its progression. In particular, Candida albicans and C. albicans-reactive T helper 17 (Th17) cells contribute to alcohol-associated liver disease. Specific C. albicans antigens that activate Th17 cells during this disease are unknown. The C. albicans 65 kDa mannoprotein (CaMp65p) is one of the most abundant and immunodominant proteins of C. albicans, and is capable of eliciting robust T cell and interleukin (IL)-17A responses. The aim of this study was to measure levels of CaMp65p in serum of patients with alcohol use disorder and liver disease. Serum CaMp65p levels were measured in the serum of 60 patients with alcohol use disorder using an indirect competitive Enzyme-Linked Immunoabsorbent Assay (ELISA). Serum CaMp65p levels were correlated with liver disease severity. Serum CaMp65p levels positively correlated with several clinical and biochemical markers of liver injury and disease within the patient group with alcohol use disorder, including serum aspartate aminotransferase (AST; R = 0.33, p = 0.0092), alanine aminotransferase (ALT; R = 0.27, p = 0.037), gamma-glutamyl transferase (GGT; R = 0.35, p = 0.0055) and alkaline phosphatase (R = 0.36, p = 0.0052), and with the circulating M65 fragment of cytokeratin 18 (CK18-M65; R = 0.51, p = 0.0012), a marker of hepatocyte death. In addition, patients with alcohol use disorder in the upper quartile had significantly higher liver stiffness (p = 0.0022). Serum CaMp65p was significantly higher in patients with fibrosis stage F2–F4 as compared with patients with no or minimal fibrosis F0–F1 (p = 0.0082). The area under the curve (AUC) for detecting F2–F4 fibrosis was 0.70. Elevated serum CaMp65p levels are associated not only with more severe hepatic injury, but also with liver fibrosis in patients with alcohol use disorder. Therefore, CaMp65p may serve as a non-invasive biomarker for fibrosis assessment in patients with alcohol use disorder. Full article