Editorial

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2 pages, 181 KiB

Open AccessEditorial

Emerging Fungi and Diagnosis of Fungal Infections: Current Knowledge and New Developments

by Birgit Willinger

J. Fungi 2021, 7(4), 316; https://doi.org/10.3390/jof7040316 - 19 Apr 2021

Cited by 2 | Viewed by 1909

Abstract

I would like to thank all the authors contributing to this Special Issue [...] Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

Research

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13 pages, 1010 KiB

Open AccessArticle

Diagnostic Performance of (1→3)-β-D-Glucan Alone and in Combination with Aspergillus PCR and Galactomannan in Serum of Pediatric Patients after Allogeneic Hematopoietic Stem Cell Transplantation

by Jan Springer, Jürgen Held, Carlo Mengoli, Paul Gerhardt Schlegel, Florian Gamon, Johannes Träger, Oliver Kurzai, Hermann Einsele, Juergen Loeffler and Matthias Eyrich

J. Fungi 2021, 7(3), 238; https://doi.org/10.3390/jof7030238 - 22 Mar 2021

Cited by 6 | Viewed by 2300

Abstract

Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly [...] Read more.

Data on biomarker-assisted diagnosis of invasive aspergillosis (IA) in pediatric patients is scarce. Therefore, we conducted a cohort study over two years including 404 serum specimens of 26 pediatric patients after allogeneic hematopoietic stem cell transplantation (alloSCT). Sera were tested prospectively twice weekly for Aspergillus-specific DNA, galactomannan (GM), and retrospectively for (1→3)-β-D-glucan (BDG). Three probable IA and two possible invasive fungal disease (IFD) cases were identified using the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSGERC) 2019 consensus definitions. Sensitivity and specificity for diagnosis of probable IA and possible IFD was 80% (95% confidential interval (CI): 28–99%) and 55% (95% CI: 32–77%) for BDG, 40% (95% CI: 5–85%) and 100% (95% CI: 83–100%) for GM, and 60% (95% CI: 15–95%) and 95% (95% CI: 75–100%) for Aspergillus-specific real-time PCR. However, sensitivities have to be interpreted with great caution due to the limited number of IA cases. Interestingly, the low specificity of BDG was largely caused by false-positive BDG results that clustered around the date of alloSCT. The following strategies were able to increase BDG specificity: two consecutive positive BDG tests for diagnosis (specificity 80% (95% CI: 56–94%)); using an optimized cutoff value of 306 pg/mL (specificity 90% (95% CI: 68–99%)) and testing BDG only after the acute posttransplant phase. In summary, BDG can help to diagnose IA in pediatric alloSCT recipients. However, due to the poor specificity either an increased cutoff value should be utilized or BDG results should be confirmed by an alternative Aspergillus assay. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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9 pages, 862 KiB

Open AccessEditor’s ChoiceArticle

Validation of the SavvyCheck™ Vaginal Yeast Test for Screening Pregnant Women for Vulvovaginal Candidosis: A Prospective, Cross-Sectional Study

by Philipp Foessleitner, Herbert Kiss, Julia Deinsberger, Julia Ott, Lorenz Zierhut and Alex Farr

J. Fungi 2021, 7(3), 233; https://doi.org/10.3390/jof7030233 - 20 Mar 2021

Cited by 4 | Viewed by 2708

Abstract

Pregnant women have an increased risk of vulvovaginal candidosis. Recurrent candidosis is under debate as a contributor to preterm birth, and vertical transmission may cause diaper dermatitis and oral thrush in the newborn. Apart from cultural methods, the gold standard for diagnosing candidosis [...] Read more.

Pregnant women have an increased risk of vulvovaginal candidosis. Recurrent candidosis is under debate as a contributor to preterm birth, and vertical transmission may cause diaper dermatitis and oral thrush in the newborn. Apart from cultural methods, the gold standard for diagnosing candidosis is Gram staining, which is time-consuming and requires laboratory facilities. The objective of this prospective study was to validate a point-of-care vaginal yeast detection assay (SavvyCheck™ Vaginal Yeast Test) and to evaluate it in asymptomatic pregnant women. We enrolled 200 participants, 100 of whom had vulvovaginal candidosis according to Gram stain (study group) and 100 were healthy pregnant controls (control group). Of these, 22 participants (11%) had invalid test results. The point-of-care test of the remaining 85 and 93 study participants in the study and control groups, respectively, showed a sensitivity of 94.1%, specificity of 98.9%, positive predictive value of 90.3%, and negative predictive value of 99.4% when compared with Gram stain. In conclusion, we found a high correlation between the SavvyCheck™ Vaginal Yeast Test and Gram-stained smears during pregnancy. This suggests a potential role of this point-of-care test as a screening tool for asymptomatic pregnant women in early gestation. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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7 pages, 1284 KiB

Open AccessArticle

Do Candida albicans Isolates with Borderline Resistant Micafungin MICs Always Harbor FKS1 Hot Spot Mutations?

by Kathrin Spettel, Sonia Galazka, Richard Kriz, Iris Camp and Birgit Willinger

J. Fungi 2021, 7(2), 93; https://doi.org/10.3390/jof7020093 - 28 Jan 2021

Cited by 5 | Viewed by 1989

Abstract

Antifungal susceptibility testing is important in guiding patient therapy due to an increasing number of resistant Candida isolates. In the clinical strain collection of the Austrian resistance report (AURES), a high number of micafungin-resistant C. albicans isolates (18.2% 49/269) was detected in seven [...] Read more.

Antifungal susceptibility testing is important in guiding patient therapy due to an increasing number of resistant Candida isolates. In the clinical strain collection of the Austrian resistance report (AURES), a high number of micafungin-resistant C. albicans isolates (18.2% 49/269) was detected in seven different centres in Austria from 2011–2016. Most of these isolates showed a micafungin MIC value that was just above the clinical breakpoint (CB) established by EUCAST (0.016 mg/L). The aim of this study was to analyse whether C. albicans strains showing a micafungin MIC value of 1–2 dilutions above the CB (0.032 mg/L and 0.064 mg/L) are associated with mutations in FKS1 hotspot (HS) regions. 115 C. albicans candidemia strains showing a micafungin MIC one or two dilutions above the EUCAST CB (0.032 mg/L and 0.064 mg/L) were categorized as borderline resistant and screened for mutations in FKS1 HS1, HS2, and HS3 regions, which are known locations for the development of echinocandin resistance. For this purpose, we implemented targeted resequencing utilizing a next generation sequencing technology. No missense mutations could be detected in FKS1 HS1, HS2, and HS3 in any of the 115 isolates, which indicated that resistance conferred by alteration of FKS1 seems unlikely. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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14 pages, 582 KiB

Open AccessArticle

Filamentous Fungal Infections in a Tertiary Care Setting: Epidemiology and Clinical Outcome

by Miriam Van den Nest, Gernot Wagner, Martin Riesenhuber, Constantin Dolle, Elisabeth Presterl, Gerald Gartlehner, Deddo Moertl and Birgit Willinger

J. Fungi 2021, 7(1), 40; https://doi.org/10.3390/jof7010040 - 09 Jan 2021

Cited by 3 | Viewed by 3202

Abstract

Information on the distribution of filamentous fungal pathogens, which cause potential life-threatening invasive infections mostly in immunocompromised persons, is of great importance. The aim of this study was to evaluate the epidemiology and clinical outcome in patients with infections due to filamentous fungi [...] Read more.

Information on the distribution of filamentous fungal pathogens, which cause potential life-threatening invasive infections mostly in immunocompromised persons, is of great importance. The aim of this study was to evaluate the epidemiology and clinical outcome in patients with infections due to filamentous fungi at the University Hospital of Vienna, Austria. We conducted a retrospective observational study and consecutively included patients of any age with filamentous fungal infections between 2009 and 2017. The classification for probable and proven invasive filamentous fungal infections was based on the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC) criteria or the expert opinion of an experienced clinical mycologist. We included 129 patients (median age: 52 years; 47.3% female) with episodes of 101 proven and probable invasive and 35 localized filamentous fungal infections (16 sinus, 14 eye, one ear, and four deep cutaneous). Aspergillus fumigatus alone accounted for 50.3% of the fungi, which was followed by the Mucorales group (13.7%) and Fusarium spp. (8.5%). Diagnosis was mainly based on culture findings. The lung was the most frequent site of infection. The 30-day and 90-day overall mortality of invasive fungal infections was 30.2% and 42.7%, respectively. We observed a high all-cause mortality among patients with invasive filamentous fungal infections. Prospective data collection in a nationwide registry would be necessary to provide important information on surveillance to clinicians and other decision-makers. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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11 pages, 1702 KiB

Open AccessArticle

A Prospective Multicenter Cohort Surveillance Study of Invasive Aspergillosis in Patients with Hematologic Malignancies in Greece: Impact of the Revised EORTC/MSGERC 2020 Criteria

by Maria Siopi, Stamatis Karakatsanis, Christoforos Roumpakis, Konstantinos Korantanis, Helen Sambatakou, Nikolaos V. Sipsas, Panagiotis Tsirigotis, Maria Pagoni and Joseph Meletiadis

J. Fungi 2021, 7(1), 27; https://doi.org/10.3390/jof7010027 - 05 Jan 2021

Cited by 9 | Viewed by 3192

Abstract

Data concerning the incidence of invasive aspergillosis (IA) in high-risk patients in Greece are scarce, while the impact of the revised 2020 EORTC/MSGERC consensus criteria definitions on the reported incidence rate of IA remains unknown. A total of 93 adult hematology patients were [...] Read more.

Data concerning the incidence of invasive aspergillosis (IA) in high-risk patients in Greece are scarce, while the impact of the revised 2020 EORTC/MSGERC consensus criteria definitions on the reported incidence rate of IA remains unknown. A total of 93 adult hematology patients were screened for IA for six months in four tertiary care Greek hospitals. Serial serum specimens (n = 240) the sample was considered negative by PCR were collected twice-weekly and tested for galactomannan (GM) and Aspergillus DNA (PCR) detection. IA was defined according to both the 2008 EORTC/MSG and the 2020 EORTC/MSGERC consensus criteria. Based on the 2008 EORTC/MSG criteria, the incidence rates of probable and possible IA was 9/93 (10%) and 24/93 (26%), respectively, while no proven IA was documented. Acute myeloid leukemia was the most (67%) common underlying disease with most (82%) patients being on antifungal prophylaxis/treatment. Based on the new 2020 EORTC/MSGERC criteria, 2/9 (22%) of probable and 1/24 (4%) of possible cases should be reclassified as possible and probable, respectively. The episodes of probable IA were reduced by 33% when GM alone and 11% when GM + PCR were used as mycological criterion. The incidence rate of IA in hematology patients was 10%. Application of the 2020 EORTC/MSGERC updated criteria results in a reduction in the classification of probable IA particularly when PCR is not available. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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7 pages, 507 KiB

Open AccessCommunication

Comparison of Three Skin Sampling Methods and Two Media for Culturing Malassezia Yeast

by Abdourahim Abdillah, Saber Khelaifia, Didier Raoult, Fadi Bittar and Stéphane Ranque

J. Fungi 2020, 6(4), 350; https://doi.org/10.3390/jof6040350 - 09 Dec 2020

Cited by 9 | Viewed by 2681

Abstract

Malassezia is a lipid-dependent commensal yeast of the human skin. The different culture media and skin sampling methods used to grow these fastidious yeasts are a source of heterogeneity in culture-based epidemiological study results. This study aimed to compare the performances of three [...] Read more.

Malassezia is a lipid-dependent commensal yeast of the human skin. The different culture media and skin sampling methods used to grow these fastidious yeasts are a source of heterogeneity in culture-based epidemiological study results. This study aimed to compare the performances of three methods of skin sampling, and two culture media for the detection of Malassezia yeasts by culture from the human skin. Three skin sampling methods, namely sterile gauze, dry swab, and Transwab^TM with transport medium, were applied on 10 healthy volunteers at 5 distinct body sites. Each sample was further inoculated onto either the novel FastFung medium or the reference Dixon agar for the detection of Malassezia spp. by culture. At least one colony of Malassezia spp. grew on 93/300 (31%) of the cultures, corresponding to 150 samplings. The positive culture rate was 67%, 18%, and 15% (P < 10⁻³), for samples collected with sterile gauze, Transwab^TM, and dry swab, respectively. The positive culture rate was 62% and 38% (P < 0.003) by using the FastFung and the Dixon media, respectively. Our results showed that sterile gauze rubbing skin sampling followed by inoculation on FastFung medium should be implemented in the routine clinical laboratory procedure for Malassezia spp. cultivation. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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13 pages, 1856 KiB

Open AccessArticle

Human Pathogenic Candida Species Respond Distinctively to Lactic Acid Stress

by Isabella Zangl, Reinhard Beyer, Ildiko-Julia Pap, Joseph Strauss, Christoph Aspöck, Birgit Willinger and Christoph Schüller

J. Fungi 2020, 6(4), 348; https://doi.org/10.3390/jof6040348 - 08 Dec 2020

Cited by 2 | Viewed by 2611

Abstract

Several Candida species are opportunistic human fungal pathogens and thrive in various environmental niches in and on the human body. In this study we focus on the conditions of the vaginal tract, which is acidic, hypoxic, glucose-deprived, and contains lactic acid. We quantitatively [...] Read more.

Several Candida species are opportunistic human fungal pathogens and thrive in various environmental niches in and on the human body. In this study we focus on the conditions of the vaginal tract, which is acidic, hypoxic, glucose-deprived, and contains lactic acid. We quantitatively analyze the lactic acid tolerance in glucose-rich and glucose-deprived environment of five Candida species: Candidaalbicans, Candida glabrata, Candida parapsilosis, Candida krusei and Candida tropicalis. To characterize the phenotypic space, we analyzed 40–100 clinical isolates of each species. Each Candida species had a very distinct response pattern to lactic acid stress and characteristic phenotypic variability. C. glabrata and C. parapsilosis were best to withstand high concentrations of lactic acid with glucose as carbon source. A glucose-deprived environment induced lactic acid stress tolerance in all species. With lactate as carbon source the growth rate of C. krusei is even higher compared to glucose, whereas the other species grow slower. C. krusei may use lactic acid as carbon source in the vaginal tract. Stress resistance variability was highest among C. parapsilosis strains. In conclusion, each Candida spp. is adapted differently to cope with lactic acid stress and resistant to physiological concentrations. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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10 pages, 974 KiB

Open AccessArticle

Invasive Mold Infection of the Central Nervous System in Immunocompromised Children

by Luciana Porto, Se-Jong You, Andishe Attarbaschi, Gunnar Cario, Michaela Döring, Olga Moser, Urs Mücke, Fiona Poyer, Christian Temme, Sebastian Voigt, Andreas H. Groll, Melchior Lauten, Elke Hattingen and Thomas Lehrnbecher

J. Fungi 2020, 6(4), 226; https://doi.org/10.3390/jof6040226 - 16 Oct 2020

Cited by 5 | Viewed by 2234

Abstract

Background: Due to the difficulties in the definite diagnosis, data on brain imaging in pediatric patients with central nervous system (CNS)-invasive mold infection (IMD) are scarce. Our aim was to describe brain imaging abnormalities seen in immunocompromised children with CNS-IMD, and to analyze [...] Read more.

Background: Due to the difficulties in the definite diagnosis, data on brain imaging in pediatric patients with central nervous system (CNS)-invasive mold infection (IMD) are scarce. Our aim was to describe brain imaging abnormalities seen in immunocompromised children with CNS-IMD, and to analyze retrospectively whether specific imaging findings and sequences have a prognostic value. Methods: In a retrospective study of 19 pediatric patients with proven or probable CNS-IMD, magnetic resonance imaging (MRI)-findings were described and analyzed. The results were correlated with outcome, namely death, severe sequelae, or no neurological sequelae. Results: 11 children and 8 adolescents (11/8 with proven/probable CNS-IMD) were included. Seven of the patients died and 12/19 children survived (63%): seven without major neurological sequelae and five with major neurological sequelae. Multifocal ring enhancement and diffusion restriction were the most common brain MRI changes. Diffusion restriction was mostly seen at the core of the lesion. No patient with disease limited to one lobe died. Perivascular microbleeding seen on susceptibility weighted imaging (SWI) and/or gradient-echo/T2* images, as well as infarction, were associated with poor prognosis. Conclusions: The presence of infarction was related to poor outcome. As early microbleeding seems to be associated with poor prognosis, we suggest including SWI in routine diagnostic evaluation of immunocompromised children with suspected CNS-IMD. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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19 pages, 372 KiB

Open AccessCommunication

Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement

by Jeffrey D. Jenks, Jean-Pierre Gangneux, Ilan S. Schwartz, Ana Alastruey-Izquierdo, Katrien Lagrou, George R. Thompson III, Cornelia Lass-Flörl, Martin Hoenigl and European Confederation of Medical Mycology (ECMM) Council Investigators

J. Fungi 2020, 6(4), 216; https://doi.org/10.3390/jof6040216 - 11 Oct 2020

Cited by 28 | Viewed by 5967

Abstract

Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient [...] Read more.

Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient outcomes. In this review, we provide consensus recommendations on behalf of the European Confederation for Medical Mycology (ECMM) for the diagnosis of bIFI caused by invasive yeasts, molds, and endemic mycoses, to guide diagnostic efforts in patients receiving antifungals and support the design of future clinical trials in the field of clinical mycology. The cornerstone of lab-based diagnosis of breakthrough infections for yeast and endemic mycoses remain conventional culture, to accurately identify the causative pathogen and allow for antifungal susceptibility testing. The impact of non-culture-based methods are not well-studied for the definite diagnosis of breakthrough invasive yeast infections. Non-culture-based methods have an important role for the diagnosis of breakthrough invasive mold infections, in particular invasive aspergillosis, and a combination of testing involving conventional culture, antigen-based assays, and PCR-based assays should be considered. Multiple diagnostic modalities, including histopathology, culture, antibody, and/or antigen tests and occasionally PCR-based assays may be required to diagnose breakthrough endemic mycoses. A need exists for diagnostic tests that are effective, simple, cheap, and rapid to enable the diagnosis of bIFI in patients taking antifungals. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

20 pages, 6354 KiB

Open AccessFeature PaperArticle

Spread of Terbinafine-Resistant Trichophyton mentagrophytes Type VIII (India) in Germany–“The Tip of the Iceberg?”

by Pietro Nenoff, Shyam B. Verma, Andreas Ebert, Anke Süß, Eleni Fischer, Elke Auerswald, Stephanie Dessoi, Wencke Hofmann, Simone Schmidt, Kathrin Neubert, Regina Renner, Sirius Sohl, Uta Hradetzky, Ursula Krusche, Hans-Christian Wenzel, Annegret Staginnus, Jörg Schaller, Valentina Müller, Christiane Tauer, Matthias Gebhardt, Katja Schubert, Zaid Almustafa, Rudolf Stadler, Andrea Fuchs, Cassian Sitaru, Carsten Retzlaff, Cora Overbeck, Thomas Neumann, Anette Kerschnitzki, Stephan Krause, Martin Schaller, Birgit Walker, Thomas Walther, Lars Köhler, Manuela Albrecht, Ursula Willing, Michel Monod, Karine Salamin, Anke Burmester, Daniela Koch, Constanze Krüger and Silke Uhrlaß Show full author list Hide full author list

J. Fungi 2020, 6(4), 207; https://doi.org/10.3390/jof6040207 - 05 Oct 2020

Cited by 72 | Viewed by 8524

Abstract

Chronic recalcitrant dermatophytoses, due to Trichophyton (T.) mentagrophytes Type VIII are on the rise in India and are noteworthy for their predominance. It would not be wrong to assume that travel and migration would be responsible for the spread of T [...] Read more.

Chronic recalcitrant dermatophytoses, due to Trichophyton (T.) mentagrophytes Type VIII are on the rise in India and are noteworthy for their predominance. It would not be wrong to assume that travel and migration would be responsible for the spread of T. mentagrophytes Type VIII from India, with many strains resistant to terbinafine, to other parts of the world. From September 2016 until March 2020, a total of 29 strains of T. mentagrophytes Type VIII (India) were isolated. All patients were residents of Germany: 12 females, 15 males and the gender of the remaining two was not assignable. Patients originated from India (11), Pakistan (two), Bangladesh (one), Iraq (two), Bahrain (one), Libya (one) and other unspecified countries (10). At least two patients were German-born residents. Most samples (21) were collected in 2019 and 2020. All 29 T. mentagrophytes isolates were sequenced (internal transcribed spacer (ITS) and translation elongation factor 1-α gene (TEF1-α)). All were identified as genotype VIII (India) of T. mentagrophytes. In vitro resistance testing revealed 13/29 strains (45%) to be terbinafine-resistant with minimum inhibitory concentration (MIC) breakpoints ≥0.2 µg/mL. The remaining 16 strains (55%) were terbinafine-sensitive. Point mutation analysis revealed that 10/13 resistant strains exhibited Phe³⁹⁷Leu amino acid substitution of squalene epoxidase (SQLE), indicative for in vitro resistance to terbinafine. Two resistant strains showed combined Phe³⁹⁷Leu and Ala⁴⁴⁸Thr amino acid substitutions, and one strain a single Leu³⁹³Phe amino acid substitution. Out of 16 terbinafine-sensitive strains, in eight Ala⁴⁴⁸Thr, and in one Ala⁴⁴⁸Thr +, new Val⁴⁴⁴ Ile amino acid substitutions were detected. Resistance to both itraconazole and voriconazole was observed in three out of 13 analyzed strains. Treatment included topical ciclopirox olamine plus topical miconazole or sertaconazole. Oral itraconazole 200 mg twice daily for four to eight weeks was found to be adequate. Terbinafine-resistant T. mentagrophytes Type VIII are being increasingly isolated. In Germany, transmission of T. mentagrophytes Type VIII from the Indian subcontinent to Europe should be viewed as a significant public health issue. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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11 pages, 976 KiB

Open AccessArticle

German-Wide Analysis of the Prevalence and the Propagation Factors of the Zoonotic Dermatophyte Trichophyton benhamiae

by Max Berlin, Christiane Kupsch, Lea Ritter, Benjamin Stoelcker, Anton Heusinger and Yvonne Gräser

J. Fungi 2020, 6(3), 161; https://doi.org/10.3390/jof6030161 - 03 Sep 2020

Cited by 16 | Viewed by 3063

Abstract

For about 10 years, a new variant of the pathogen Trichophyton (T.) benhamiae has appeared in Germany, characterized by a previously unobserved culture phenotype with a strong yellow reverse. A few studies suggest that this new variety is now the most [...] Read more.

For about 10 years, a new variant of the pathogen Trichophyton (T.) benhamiae has appeared in Germany, characterized by a previously unobserved culture phenotype with a strong yellow reverse. A few studies suggest that this new variety is now the most common zoophilic dermatophyte in Germany. The guinea pig is the main carrier. Exact prevalence measurements are not yet available. Thus, the aim of our ongoing study was to collect data on the frequency and geographic distribution of the pathogen and its phenotypes (white and yellow) in humans and guinea pigs throughout Germany. Our former studies have already shown that animals from large breeding farms are particularly heavily affected. In contrast to this, 21 small, private breedings were sampled and husbandry conditions recorded. This placed us in a position to identify propagation factors and to give recommendations for containment. For animals from private breedings, we detected T. benhamiae with a prevalence of 55.4%, which is a reduction of nearly 40% compared with animals from large breeding farms. As risk factors, we identified the type of husbandry and the contact to other breedings. Furthermore, certain animal races, like Rex guinea pigs and races with long hair in combination with curls were predestined for colonization with T. benhamiae due to their phenotypic coat characteristics. A prevalence for infections with T. benhamiae of 36.2% has been determined for symptomatic pet guinea pigs suspected of having dermatophytosis and is comparable to the study of Kraemer et al. showing a prevalence of 34.9% in 2009 in Germany. The prevalence in humans is stable with about 2–3% comparing the data of 2010–2013 and 2018 in Thuringia. The new type of T. benhamiae was by far the most frequent cause in all settings. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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10 pages, 860 KiB

Open AccessArticle

Dermatophytes and Dermatophytosis in Cluj-Napoca, Romania—A 4-Year Cross-Sectional Study

by Ioana Alina Colosi, Odile Cognet, Horațiu Alexandru Colosi, Marcela Sabou and Carmen Costache

J. Fungi 2020, 6(3), 154; https://doi.org/10.3390/jof6030154 - 28 Aug 2020

Cited by 12 | Viewed by 3097

Abstract

Dermatophytes are filamentous keratinophilic fungi which affect nails, skin, and hair. Their variable distribution in the world justifies local epidemiological studies. During recent decades, few studies have been published regarding the epidemiology and etiology of dermatophytosis in Romania. The aim of this study [...] Read more.

Dermatophytes are filamentous keratinophilic fungi which affect nails, skin, and hair. Their variable distribution in the world justifies local epidemiological studies. During recent decades, few studies have been published regarding the epidemiology and etiology of dermatophytosis in Romania. The aim of this study was to identify the dermatophytes isolated from superficial fungal infections. To the best of our knowledge, this is the first such study conducted in the area of North-Western Romania. Over the past four years, samples collected from outpatients with suggestive lesions for dermatophytoses (nails, skin, hair), who addressed several private practice dermatologists from Cluj-Napoca, Romania, were sent to a specialized laboratory and examined by microscopy and culture. A total of 350 samples from 322 patients were examined. One hundred samples (28.6%) collected from 90 patients (27.9%) were positive by direct microscopy and/or culture. Among the 63 positive cultures (18%), 44 dermatophytes (69.8%), 2 molds (3.2%), and 17 yeasts (27%) were isolated. The main dermatophyte species identified were Trichophyton rubrum (mostly from onychomycosis) and Microsporum canis (from tinea capitis and tinea corporis in children). Yeasts (Candida species) were isolated from nails, especially from women. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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10 pages, 366 KiB

Open AccessArticle

Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study

by Cornelia Lass-Flörl, Robert Krause, Birgit Willinger, Peter Starzengruber, Petra Decristoforo, Sabrina Neururer, Peter Kreidl and Maria Aigner

J. Fungi 2020, 6(2), 76; https://doi.org/10.3390/jof6020076 - 02 Jun 2020

Cited by 3 | Viewed by 2692

Abstract

This prospective noninterventional study evaluated whether antifungal susceptibility data (MIC) provided for Candida clinical isolates on the basis of recently established breakpoints are taken into account by clinicians to guide their treatment decision making process, and assessed the response in MIC- and non-MIC-based [...] Read more.

This prospective noninterventional study evaluated whether antifungal susceptibility data (MIC) provided for Candida clinical isolates on the basis of recently established breakpoints are taken into account by clinicians to guide their treatment decision making process, and assessed the response in MIC- and non-MIC-based treatment groups. During a six month period, the usage of systemic antifungals was recorded in detail and compared with mycological data (Candida species and MICs) in candidemia patients. Patients were assigned to a susceptible or resistant infection group based on European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints; treatment decisions were under the professional discretion of the treating physicians. 123 patients were evaluated with Candida albicans accounting for 59%, Candida glabrata for 19%, Candida parapsilosis for 15%, Candida tropicalis for 4% and Candida krusei for 3%. Antifungal treatment correlated with species and MICs in 80% (n = 99 patients), high MICs and species-dependent guideline recommendations were ignored in 20% (n = 24 patients); the overall outcome of candidemia cases in our study population was excellent, as by day 14, all patients were cleared from fungal blood stream infection (mean 5.6 days, range 2–12). The current variability in antifungal usage and the delay in initiating appropriate therapy indicate a need for antifungal stewardship to improve the management of invasive fungal infections. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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Review

Jump to: Editorial, Research

14 pages, 295 KiB

Open AccessReview

Recent Advances and Novel Approaches in Laboratory-Based Diagnostic Mycology

by Lewis P. White and Jessica S. Price

J. Fungi 2021, 7(1), 41; https://doi.org/10.3390/jof7010041 - 11 Jan 2021

Cited by 12 | Viewed by 3814

Abstract

What was once just culture and microscopy the field of diagnostic mycology has significantly advanced in recent years and continues to incorporate novel assays and strategies to meet the changes in clinical demand. The emergence of widespread resistance to antifungal therapy has led [...] Read more.

What was once just culture and microscopy the field of diagnostic mycology has significantly advanced in recent years and continues to incorporate novel assays and strategies to meet the changes in clinical demand. The emergence of widespread resistance to antifungal therapy has led to the development of a range of molecular tests that target mutations associated with phenotypic resistance, to complement classical susceptibility testing and initial applications of next-generation sequencing are being described. Lateral flow assays provide rapid results, with simplicity allowing the test to be performed outside specialist centres, potentially as point-of-care tests. Mycology has responded positively to an ever-diversifying patient population by rapidly identifying risk and developing diagnostic strategies to improve patient management. Nowadays, the diagnostic repertoire of the mycology laboratory employs classical, molecular and serological tests and should be keen to embrace diagnostic advancements that can improve diagnosis in this notoriously difficult field. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

17 pages, 2200 KiB

Open AccessReview

Scedosporium and Lomentospora Infections: Contemporary Microbiological Tools for the Diagnosis of Invasive Disease

by Sharon C.-A. Chen, Catriona L. Halliday, Martin Hoenigl, Oliver A. Cornely and Wieland Meyer

J. Fungi 2021, 7(1), 23; https://doi.org/10.3390/jof7010023 - 04 Jan 2021

Cited by 33 | Viewed by 6861

Abstract

Scedosporium/Lomentospora fungi are increasingly recognized pathogens. As these fungi are resistant to many antifungal agents, early diagnosis is essential for initiating targeted drug therapy. Here, we review the microbiological tools for the detection and diagnosis of invasive scedosporiosis and lomentosporiosis. Of [...] Read more.

Scedosporium/Lomentospora fungi are increasingly recognized pathogens. As these fungi are resistant to many antifungal agents, early diagnosis is essential for initiating targeted drug therapy. Here, we review the microbiological tools for the detection and diagnosis of invasive scedosporiosis and lomentosporiosis. Of over 10 species, Lomentospora prolificans, Scedosporium apiospermum, S. boydii and S. aurantiacum cause the majority of infections. Definitive diagnosis relies on one or more of visualization, isolation or detection of the fungus from clinical specimens by microscopy techniques, culture and molecular methods such as panfungal PCR or genus-/species-specific multiplex PCR. For isolation from respiratory tract specimens, selective media have shown improved isolation rates. Species identification is achieved by macroscopic and microscopic examination of colonies, but species should be confirmed by ITS with or without β-tubulin gene sequencing or other molecular methods. Matrix-assisted laser desorption ionization-time of flight mass spectrometry databases are improving but may need supplementation by in-house spectra for species identification. Reference broth microdilution methods is preferred for antifungal susceptibility testing. Next-generation sequencing technologies have good potential for characterization of these pathogens. Diagnosis of Scedosporium/Lomentospora infections relies on multiple approaches encompassing both phenotypic- and molecular-based methods. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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16 pages, 275 KiB

Open AccessReview

Update on Respiratory Fungal Infections in Cystic Fibrosis Lung Disease and after Lung Transplantation

by Sabine Renner, Edith Nachbaur, Peter Jaksch and Eleonora Dehlink

J. Fungi 2020, 6(4), 381; https://doi.org/10.3390/jof6040381 - 21 Dec 2020

Cited by 10 | Viewed by 2981

Abstract

Cystic fibrosis is the most common autosomal-recessive metabolic disease in the Western world. Impaired trans-membrane chloride transport via the cystic fibrosis transmembrane conductance regulator (CFTR) protein causes thickened body fluids. In the respiratory system, this leads to chronic suppurative cough and recurrent pulmonary [...] Read more.

Cystic fibrosis is the most common autosomal-recessive metabolic disease in the Western world. Impaired trans-membrane chloride transport via the cystic fibrosis transmembrane conductance regulator (CFTR) protein causes thickened body fluids. In the respiratory system, this leads to chronic suppurative cough and recurrent pulmonary infective exacerbations, resulting in progressive lung damage and respiratory failure. Whilst the impact of bacterial infections on CF lung disease has long been recognized, our understanding of pulmonary mycosis is less clear. The range and detection rates of fungal taxa isolated from CF airway samples are expanding, however, in the absence of consensus criteria and univocal treatment protocols for most respiratory fungal conditions, interpretation of laboratory reports and the decision to treat remain challenging. In this review, we give an overview on fungal airway infections in CF and CF-lung transplant recipients and focus on the most common fungal taxa detected in CF, Aspergillus fumigatus, Candida spp., Scedosporium apiospermum complex, Lomentospora species, and Exophiala dermatitidis, their clinical presentations, common treatments and prophylactic strategies, and clinical challenges from a physician’s point of view. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

15 pages, 3115 KiB

Open AccessReview

Advances in the In Vivo Molecular Imaging of Invasive Aspergillosis

by Matthias Gunzer, Christopher R. Thornton and Nicolas Beziere

J. Fungi 2020, 6(4), 338; https://doi.org/10.3390/jof6040338 - 04 Dec 2020

Cited by 12 | Viewed by 2961

Abstract

Invasive pulmonary aspergillosis (IPA) is a life-threatening infection of immunocompromised patients with Aspergillus fumigatus, a ubiquitous environmental mould. While there are numerous functioning antifungal therapies, their high cost, substantial side effects and fear of overt resistance development preclude permanent prophylactic medication of [...] Read more.

Invasive pulmonary aspergillosis (IPA) is a life-threatening infection of immunocompromised patients with Aspergillus fumigatus, a ubiquitous environmental mould. While there are numerous functioning antifungal therapies, their high cost, substantial side effects and fear of overt resistance development preclude permanent prophylactic medication of risk-patients. Hence, a fast and definitive diagnosis of IPA is desirable, to quickly identify those patients that really require aggressive antimycotic treatment and to follow the course of the therapeutic intervention. However, despite decades of research into this issue, such a diagnostic procedure is still not available. Here, we discuss the array of currently available methods for IPA detection and their limits. We then show that molecular imaging using positron emission tomography (PET) combined with morphological computed tomography or magnetic imaging is highly promising to become a future non-invasive approach for IPA diagnosis and therapy monitoring, albeit still requiring thorough validation and relying on further acceptance and dissemination of the approach. Thereby, our approach using the A. fumigatus-specific humanized monoclonal antibody hJF5 labelled with ⁶⁴Cu as PET-tracer has proven highly effective in pre-clinical models and hence bears high potential for human application. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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15 pages, 347 KiB

Open AccessReview

Epidemiology and Diagnostic Perspectives of Dermatophytoses

by Monise Fazolin Petrucelli, Mariana Heinzen de Abreu, Bruna Aline Michelotto Cantelli, Gabriela Gonzalez Segura, Felipe Garcia Nishimura, Tamires Aparecida Bitencourt, Mozart Marins and Ana Lúcia Fachin

J. Fungi 2020, 6(4), 310; https://doi.org/10.3390/jof6040310 - 23 Nov 2020

Cited by 40 | Viewed by 4616

Abstract

Dermatophytoses affect about 25% of the world population, and the filamentous fungus Trichophyton rubrum is the main causative agent of this group of diseases. Dermatomycoses are caused by pathogenic fungi that generally trigger superficial infections and that feed on keratinized substrates such as [...] Read more.

Dermatophytoses affect about 25% of the world population, and the filamentous fungus Trichophyton rubrum is the main causative agent of this group of diseases. Dermatomycoses are caused by pathogenic fungi that generally trigger superficial infections and that feed on keratinized substrates such as skin, hair, and nails. However, there are an increasing number of reports describing dermatophytes that invade deep layers such as the dermis and hypodermis and that can cause deep infections in diabetic and immunocompromised patients, as well as in individuals with immunodeficiency. Despite the high incidence and importance of dermatophytes in clinical mycology, the diagnosis of this type of infection is not always accurate. The conventional methods most commonly used for mycological diagnosis are based on the identification of microbiological and biochemical features. However, in view of the limitations of these conventional methods, molecular diagnostic techniques are increasingly being used because of their higher sensitivity, specificity and rapidity and have become more accessible. The most widely used molecular techniques are conventional PCR, quantitative PCR, multiplex PCR, nested, PCR, PCR-RFLP, and PCR-ELISA. Another promising technique for the identification of microorganisms is the analysis of protein profiles by MALDI-TOF MS. Molecular techniques are promising but it is necessary to improve the quality and availability of the information in genomic and proteomic databases in order to streamline the use of bioinformatics in the identification of dermatophytes of clinical interest. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

14 pages, 624 KiB

Open AccessReview

Vulvovaginal Candidosis: Current Concepts, Challenges and Perspectives

by Valentina Sustr, Philipp Foessleitner, Herbert Kiss and Alex Farr

J. Fungi 2020, 6(4), 267; https://doi.org/10.3390/jof6040267 - 07 Nov 2020

Cited by 34 | Viewed by 6954

Abstract

Vulvovaginal candidosis (VVC) is a frequently occurring infection of the lower female genital tract, mostly affecting immuno-competent women at childbearing age. Candida albicans is the most prevalent pathogenic yeast—apart from other non-albicans species—related to this fungal infection. Different virulence factors of C. [...] Read more.

Vulvovaginal candidosis (VVC) is a frequently occurring infection of the lower female genital tract, mostly affecting immuno-competent women at childbearing age. Candida albicans is the most prevalent pathogenic yeast—apart from other non-albicans species—related to this fungal infection. Different virulence factors of C. albicans have been identified, which increase the risk of developing VVC. To initiate treatment and positively influence the disease course, fast and reliable diagnosis is crucial. In this narrative review, we cover the existing state of understanding of the epidemiology, pathogenesis and diagnosis of VVC. However, treatment recommendations should follow current guidelines. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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20 pages, 389 KiB

Open AccessReview

Epidemiology and Diagnosis of Mucormycosis: An Update

by Anna Skiada, Ioannis Pavleas and Maria Drogari-Apiranthitou

J. Fungi 2020, 6(4), 265; https://doi.org/10.3390/jof6040265 - 02 Nov 2020

Cited by 328 | Viewed by 14128

Abstract

Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 [...] Read more.

Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. Τhe epidemiology of mucormycosis is evolving as new immunomodulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

20 pages, 2351 KiB

Open AccessReview

Consensus Multilocus Sequence Typing Scheme for Pneumocystis jirovecii

by Lana Pasic, Lidia Goterris, Mercedes Guerrero-Murillo, Laszlo Irinyi, Alex Kan, Carolina A. Ponce, Sergio L. Vargas, M. Teresa Martin-Gomez and Wieland Meyer

J. Fungi 2020, 6(4), 259; https://doi.org/10.3390/jof6040259 - 30 Oct 2020

Cited by 9 | Viewed by 3374

Abstract

Pneumocystis jirovecii is an opportunistic human pathogenic fungus causing severe pneumonia mainly in immunocompromised hosts. Multilocus sequence typing (MLST) remains the gold standard for genotyping of this unculturable fungus. However, the lack of a consensus scheme impedes a global comparison, large scale population [...] Read more.

Pneumocystis jirovecii is an opportunistic human pathogenic fungus causing severe pneumonia mainly in immunocompromised hosts. Multilocus sequence typing (MLST) remains the gold standard for genotyping of this unculturable fungus. However, the lack of a consensus scheme impedes a global comparison, large scale population studies and the development of a global MLST database. To overcome this problem this study compared all genetic regions (19 loci) currently used in 31 different published Pneumocystis MLST schemes. The most diverse/commonly used eight loci, β-TUB, CYB, DHPS, ITS1, ITS1/2, mt26S and SOD, were further assess for their ability to be successfully amplified and sequenced, and for their discriminatory power. The most successful loci were tested to identify genetically related and unrelated cases. A new consensus MLST scheme consisting of four genetically independent loci: β-TUB, CYB, mt26S and SOD, is herein proposed for standardised P. jirovecii typing, successfully amplifying low and high fungal burden specimens, showing adequate discriminatory power, and correctly identifying suspected related and unrelated isolates. The new consensus MLST scheme, if accepted, will for the first time provide a powerful tool to investigate outbreak settings and undertake global epidemiological studies shedding light on the spread of this important human fungal pathogen. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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13 pages, 618 KiB

Open AccessReview

A One Health Perspective to Recognize Fusarium as Important in Clinical Practice

by Valeri Sáenz, Carlos Alvarez-Moreno, Patrice Le Pape, Silvia Restrepo, Josep Guarro and Adriana Marcela Celis Ramírez

J. Fungi 2020, 6(4), 235; https://doi.org/10.3390/jof6040235 - 20 Oct 2020

Cited by 29 | Viewed by 4647

Abstract

Any strategy that proposes solutions to health-related problems recognizes that people, animals, and the environment are interconnected. Fusarium is an example of this interaction because it is capable of infecting plants, animals, and humans. This review provides information on various aspects of these [...] Read more.

Any strategy that proposes solutions to health-related problems recognizes that people, animals, and the environment are interconnected. Fusarium is an example of this interaction because it is capable of infecting plants, animals, and humans. This review provides information on various aspects of these relations and proposes how to approach fusariosis with a One Health methodology (a multidisciplinary, and multisectoral approach that can address urgent, ongoing, or potential health threats to humans, animals, and the environment). Here, we give a framework to understand infection pathogenesis, through the epidemiological triad, and explain how the broad utilization of fungicides in agriculture may play a role in the treatment of human fusariosis. We assess how plumbing systems and hospital environments might play a role as a reservoir for animal and human infections. We explain the role of antifungal resistance mechanisms in both humans and agriculture. Our review emphasizes the importance of developing interdisciplinary research studies where aquatic animals, plants, and human disease interactions can be explored through coordination and collaborative actions. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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11 pages, 1212 KiB

Open AccessReview

The Medical Relevance of Fusarium spp.

by Herbert Hof

J. Fungi 2020, 6(3), 117; https://doi.org/10.3390/jof6030117 - 24 Jul 2020

Cited by 23 | Viewed by 5105

Abstract

The most important medical relevance of Fusarium spp. is based on their phytopathogenic property, contributing to hunger and undernutrition in the world. A few Fusarium spp., such as F. oxysporum and F. solani, are opportunistic pathogens and can induce local infections, i.e., [...] Read more.

The most important medical relevance of Fusarium spp. is based on their phytopathogenic property, contributing to hunger and undernutrition in the world. A few Fusarium spp., such as F. oxysporum and F. solani, are opportunistic pathogens and can induce local infections, i.e., of nails, skin, eye, and nasal sinuses, as well as occasionally, severe, systemic infections, especially in immunocompromised patients. These clinical diseases are rather difficult to cure by antimycotics, whereby the azoles, such as voriconazole, and liposomal amphotericin B give relatively the best results. There are at least two sources of infection, namely the environment and the gut mycobiome of a patient. A marked impact on human health has the ability of some Fusarium spp. to produce several mycotoxins, for example, the highly active trichothecenes. These mycotoxins may act either as pathogenicity factors, which means that they damage the host and hamper its defense, or as virulence factors, enhancing the aggressiveness of the fungi. Acute intoxications are rare, but chronic exposition by food items is a definite health risk, although in an individual case, it remains difficult to describe the role of mycotoxins for inducing disease. Mycotoxins taken up either by food or produced in the gut may possibly induce an imbalance of the intestinal microbiome. A particular aspect is the utilization of F. venetatum to produce cholesterol-free, protein-rich food items. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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14 pages, 587 KiB

Open AccessReview

Molecular Methods for the Diagnosis of Invasive Candidiasis

by Iris Camp, Kathrin Spettel and Birgit Willinger

J. Fungi 2020, 6(3), 101; https://doi.org/10.3390/jof6030101 - 06 Jul 2020

Cited by 25 | Viewed by 4982

Abstract

Invasive infections caused by members of the genus Candida are on the rise. Especially patients in intensive care units, immunocompromised patients, and those recovering from abdominal surgery are at risk for the development of candidemia or deep-seated candidiasis. Rapid initiation of appropriate antifungal [...] Read more.

Invasive infections caused by members of the genus Candida are on the rise. Especially patients in intensive care units, immunocompromised patients, and those recovering from abdominal surgery are at risk for the development of candidemia or deep-seated candidiasis. Rapid initiation of appropriate antifungal therapy can increase survival rates significantly. In the past, most of these infections were caused by C. albicans, a species that typically is very susceptible to antifungals. However, in recent years a shift towards infections caused by non-albicans species displaying various susceptibly patterns has been observed and the prompt diagnosis of the underlying species has become an essential factor determining the therapeutic outcome. The gold standard for diagnosing invasive candidiasis is blood culture, even though its sensitivity is low and the time required for species identification usually exceeds 48 h. To overcome these issues, blood culture can be combined with other methods, and a large number of tests have been developed for this purpose. The aim of this review was to give an overview on strengths and limitations of currently available molecular methods for the diagnosis of invasive candidiasis. Full article

(This article belongs to the Special Issue Epidemiology, Diagnosis of Fungal Infections)

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