Search Results (303)

(1) Background: Candida-positive cultures in pregnancy and the postpartum period are frequently identified in obstetric and gynecological practice. This study evaluated species distribution and associated maternal and obstetric variables in amniotic fluid, vaginal discharge, and lochial cultures. (2) Methods: A retrospective, single-center, cross-sectional comparative study was conducted at the “Cuza Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, including Candida-positive samples collected in 2024 (242 amniotic fluid, 2020 vaginal discharge, and 827 lochial isolates). Fungal identification was performed using Sabouraud and chromogenic media, with species-level identification in most cases and classification as Candida spp. when differentiation was not possible. (3) Results: Candida albicans predominated across all compartments (69.8%, 55.35%, and 66.9%, respectively), followed by non-albicans species, mainly Pichia kudriavzevii. Vaginal discharge cultures, obtained from both pregnant and non-pregnant women and analyzed after stratification by pregnancy status, showed multiple significant associations with maternal and obstetric variables; apparent associations with fetal variables were largely attributable to the inclusion of non-pregnant women and were not retained within the pregnant stratum. Amniotic fluid and lochial cultures demonstrated limited associations. Older maternal age was the only consistent independent correlate of non-albicans Candida isolation, whereas the remaining associated variables were compartment-specific. Multivariable models identified compartment-specific correlates of non-albicans Candida isolation but showed limited discriminatory performance, with low sensitivity in most strata. (4) Conclusions: Candida species distribution is compartment-dependent, with greater clinical heterogeneity in vaginal discharge and more limited patterns in amniotic fluid and lochia. These culture-positive findings support species-level identification for microbiological surveillance and provide perinatal microbiological context for future integrated maternal–neonatal studies; because antifungal susceptibility and neonatal outcomes were not assessed, no therapeutic or neonatal inferences can be drawn. Full article

Introduction: Candidemia is the most significant invasive fungal disease in critically ill patients. As a shift towards non-albicans Candida (NAC) species has been observed in recent years, differentiation among Candida species is essential for appropriate therapeutic management and improved prognosis. This study evaluated trends in the epidemiology of candidemia, species-specific characteristics, treatment practices, and mortality in a multidisciplinary Greek intensive care unit (ICU). Materials and Methods: In this single-center retrospective observational study, 90 ICU patients with candidemia were evaluated. Clinical characteristics, infection-related factors, treatment practices, and outcomes were compared according to isolated Candida species and patient survival. Results: C. parapsilosis accounted for the majority of isolates (33.7%; 41.9% fluconazole-resistant), followed by C. albicans (31.5%) and Candidozyma auris (23.9%). No significant differences in co-morbidities, origin of candidemia, or treatment-related factors were identified. However, NAC bloodstream infections occurred significantly later during ICU hospitalization, were associated with lower disease severity, and were preceded by nearly five-fold higher exposure to antifungal agents before candidemia onset. Overall, the ICU mortality rate was 53.3%. No significant differences were observed among species-specific mortality rates. Neither prompt initiation of antifungal therapy nor the antifungal class administered was associated with improved survival. Conclusions: NAC species predominated among candidemia episodes in critically ill patients, with C. parapsilosis emerging as the most frequent isolate and exhibiting substantial fluconazole resistance. Mortality remained high and did not differ significantly according to species. Treatment timing and antifungal class were not associated with outcome, highlighting the need for continued surveillance and optimized management strategies in the ICU. Full article

Background: Candidemia remains a significant public health challenge, with increasing resistance. Contemporary post-pandemic data from high-complexity Latin American hospitals are scarce. Methods: A retrospective study (2022–2023) was conducted in adults with candidemia at a high-complexity Colombian university hospital. Species identification and susceptibility were analyzed using VITEK^® 2 and Clinical and Laboratory Standards Institute (CLSI) criteria. Survival was estimated using Kaplan–Meier analysis. Results: Of 3483 blood cultures, 109 episodes were identified. The incidence was 1.13/1000 admissions (5.96/1000 in the Intensive care unit—ICU). Species other than Candida albicans predominated (61.5%), mainly C. tropicalis (22.9%) and C. parapsilosis (22.0%). Alarmingly, 28.6% of C. parapsilosis isolates were resistant to fluconazole. Consultation with an infectious diseases service was performed in 72.5% of cases, with a significantly higher rate among survivors (p < 0.05). Overall mortality was 52.3%, while 30-day mortality reached 42.2%. ICU patients had a cumulative mortality rate of 50% by day 30. Conclusions: Post-pandemic candidemia shows shifting species and high resistance. Key priorities include expert infectious disease consultation to optimize outcomes in non-neutropenic patients and strengthening laboratory capacity for identification and susceptibility testing to monitor rising resistance and guide effective institutional antifungal policies. Full article

In 2022, the World Health Organization (WHO) published the Fungal Priority Pathogens List (FPPL), yet its application has remained largely focused on human medicine, with limited consideration of animal hosts and veterinary diagnostics. This retrospective study aimed to characterise the occurrence of WHO critical- and high-priority yeasts in veterinary clinical submissions in Portugal within an explicit One Health framework. All yeast-positive submissions received by a Portuguese veterinary diagnostic laboratory between 2019 and 2026 were reviewed. Isolates were identified phenotypically, by an automated identification system and by MALDI-TOF mass spectrometry. Data on host species, sample type and year of submission were analysed using standard descriptive and inferential statistics. Among 2033 mycological submissions, 219 were yeast-positive. Out of these, 82 isolates (37.4%) corresponded to WHO critical- or high-priority taxa, most frequently Candida albicans, followed by Nakaseomyces glabratus, Cryptococcus neoformans var. neoformans, the Candida parapsilosis complex and Candida tropicalis. The remaining 137 isolates (62.6%) corresponded to non-WHO taxa, among which the most frequent were Papiliotrema laurentii and Debaryomyces hansenii (n = 21 each; 15.3%), followed by the Stephanoascus ciferrii complex (n = 15; 11.0%), Meyerozyma guilliermondii and Candida sake (n = 12 each; 8.8%), and Wickerhamomyces anomalus (n = 9; 6.6%). WHO-prioritised taxa were recovered predominantly from ornamental birds, as well as from dogs, cats and marine mammals. These findings demonstrate that FPPL-listed yeasts are regularly detected among yeast-positive veterinary diagnostic submissions and highlight ornamental birds as prominent hosts within this dataset. Full article

Fungal infections pose diagnostic challenges in both human and veterinary medicine, as traditional detection methods such as fungal culture are time-consuming, microscopy is operator-dependent, and molecular detection assays often require specialized instrumentation and trained personnel, which can limit their routine clinical application. This study developed a sandwich immunoassay to detect β-1,3- and β-1,6-glucans, two major components of the fungal cell wall, based on two catalytically inactive glucanase mutants, LamA_E175Q and Neg1_E321Q. The sandwich ELISA exhibited higher detection sensitivity than conventional ITS-based PCR for Saccharomyces cerevisiae and Candida albicans under the conditions of this study. Using pre-coated plates, the sample-processing and detection workflow can be completed in approximately 40 min. It effectively detected a wide range of fungal species, including yeasts (Saccharomyces cerevisiae, Candida albicans) and filamentous fungi such as dermatophytes and non-dermatophyte molds. In a preliminary clinical cohort, the assay identified β-glucan signals in all 21 samples confirmed positive for dermatophytes, while no signal was detected in 20 negative samples, suggesting potential clinical applicability. This dual-enzyme sandwich immunoassay provides a rapid and low-cost complementary tool for broad-spectrum fungal screening, which may help guide further confirmatory diagnostics and timely clinical decision-making. Full article

Intestinal fungal overgrowth (IFO) is an increasingly recognized yet underexplored component of gut dysbiosis with potential implications for gastrointestinal and systemic disease. While bacterial microbiota have historically garnered research attention, recent advances in sequencing technologies have highlighted the importance of the gut mycobiome in maintaining intestinal homeostasis. Disruption of fungal–bacterial balance, particularly involving Candida albicans, C. tropicalis, and C. glabrata, may contribute to symptom generation through immune activation, epithelial barrier dysfunction, biofilm formation, and the production of toxic metabolites such as acetaldehyde and candidalysin. Emerging clinical evidence suggests that IFO is associated with persistent gastrointestinal symptoms, including bloating, abdominal discomfort, and altered bowel habits, particularly in patients who do not respond to conventional therapies targeting bacterial overgrowth. Furthermore, fungal dysbiosis involving Malassezia restricta and Saccharomyces cerevisiae has been associated with inflammatory bowel disease, metabolic disorders, and systemic immune dysregulation; however, the nature and directionality of these relationships remain incompletely understood. Despite increasing recognition, the diagnosis of IFO remains challenging due to a lack of standardized criteria and validated non-invasive tools. Therapeutic strategies, including antifungal agents such as fluconazole and nystatin, as well as microbiome-targeted interventions, show promise but require further validation. This review provides a comprehensive synthesis of current evidence regarding the epidemiology, pathophysiology, clinical manifestations, diagnostic challenges, and therapeutic implications of IFO, with particular emphasis on species-specific mechanisms. Recognition of the intestinal mycobiome as a potentially important component of gut health may provide new perspectives for understanding gastrointestinal disorders and inform future precision medicine approaches. Full article

Invasive candidiasis remains a major cause of morbidity and mortality worldwide, with increasing relevance of non-Candida albicans species, particularly Pichia kudriavzevii, which is associated with high mortality and intrinsic resistance to fluconazole. This study evaluated the effect of voriconazole (VRC) on P. kudriavzevii growth, biofilm formation, and metabolic activity under different nutritional conditions. Planktonic growth and biofilm development were analyzed in Sabouraud dextrose broth (SDB), RPMI-1640, and RPMI-1640 supplemented with glucose (20 g·L⁻¹). Antifungal activity was assessed by optical density (OD₅₇₀) and XTT reduction assays, and biofilm morphology was examined by light microscopy. Glucose consumption was also determined during growth. VRC showed dose-dependent inhibition in SDB, reducing growth and biofilm metabolic activity by up to 94% and 98%, respectively. In contrast, in RPMI-1640, inhibition was significantly lower (≤27% growth and ≤77% biofilm reduction). Glucose supplementation partially restored antifungal susceptibility and increased biofilm metabolic activity. Growth kinetics confirmed VRC-induced delays in proliferation and impaired glucose utilization. These results demonstrate that VRC activity against P. kudriavzevii is strongly dependent on environmental nutrient availability, particularly glucose, which modulates fungal metabolism, biofilm development, and antifungal susceptibility, highlighting the importance of standardized antifungal susceptibility testing conditions and the role of metabolic state in azole efficacy. Full article

Pediatric candidemia is a major cause of invasive fungal infections in hospitalized children, but long-term data on epidemiology, management, and mortality predictors remain limited. We conducted an 18-year retrospective cohort study of 465 pediatric candidemia episodes at a tertiary referral center in western Turkey between 2008 and 2025. The primary outcome was crude 30-day mortality; associated factors were assessed using univariable analyses, Kaplan–Meier estimates, and multivariable logistic regression. Non-albicans Candida species predominated, with Candida parapsilosis as the most frequent isolate (46%). Central venous catheters were present in 88.4% of episodes. Crude 30-day mortality was 10.8%. Reduced survival was observed among patients without catheter removal and among those with thrombocytopenia, severe neutropenia, or immunosuppressive therapy. Among 341 episodes classified as central line-associated bloodstream infections, crude 30-day mortality differed significantly by catheter removal timing. Mortality was 4.8% with catheter removal within 72 h versus 13.1% without early removal (p = 0.022). Using a 48 h threshold, mortality was 3.1% with removal within 48 h versus 12.3% without removal within 48 h (p = 0.029). In multivariable analysis, failure to remove the catheter was the strongest independent factor associated with mortality (adjusted odds ratio, 6.63; 95% confidence interval, 2.85–15.42; p < 0.001). Antifungal resistance patterns were not consistently associated with mortality. In this large pediatric candidemia cohort, 30-day mortality was mainly associated with host vulnerability and modifiable management factors, underscoring the importance of timely source control. Full article

Vulvovaginal candidiasis (VVC) is a common fungal infection among reproductive-age women and is increasingly challenged by the emergence of non-albicans Candida species and reduced azole susceptibility. This prospective cross-sectional study investigated 235 symptomatic reproductive-age women attending two healthcare facilities in Ho Chi Minh City, Vietnam, to determine VVC prevalence, Candida species distribution, pregnancy-associated patterns, antifungal susceptibility, and diagnostic performance. Vaginal swabs were cultured on Sabouraud Dextrose Agar and CHROMagar™ Candida, while species identification was confirmed by PCR-RFLP targeting the ITS region. Susceptibility to fluconazole and clotrimazole was assessed using the disk diffusion method. Candida spp. was detected in 55.7% of participants. C. albicans accounted for 50.3% of isolates, whereas non-albicans Candida species represented 49.7%, indicating a substantial species shift. VVC was more frequent among pregnant women, particularly in the third trimester. Most C. albicans, C. tropicalis, and C. parapsilosis isolates remained susceptible to azoles; however, C. glabrata showed markedly reduced susceptibility to fluconazole and clotrimazole. CHROMagar™ Candida reliably identified C. albicans but misclassified several non-albicans Candida isolates compared with PCR-RFLP. These findings highlight the need for routine species-level diagnosis, antifungal susceptibility testing, and strengthened VVC surveillance in reproductive and antenatal healthcare settings in Vietnam. Full article

Rising triple-negative breast cancer (TNBC) cases and Candida infection risks during chemotherapy demand novel therapies, with metal-oxide nanocomposites emerging as a promising solution. In this study, we synthesized Ag-ZnO and Cu-ZnO nanocomposites as established quantitative links between their physicochemical properties, ion release behaviour, and biological activity, evaluating antifungal effects against Candida albicans (ATCC 90028) and Saccharomyces cerevisiae (ATCC 9763), and their anticancer potential against MDA-MB-231 cells (ATCC HTB-26). The results revealed Ag (~13–19 nm) and Cu (~4–8 nm) nanoparticles dispersed in a ZnO matrix, with XPS confirming mixed Ag⁰/Ag(I)/Ag(III) and Cu(I)/Cu(II) speciation. Ag-ZnO NC exhibited strong antifungal activity (MIC = 25 mg L⁻¹) against both fungi, while Cu-ZnO NC was only effective (MIC = 100 mg L⁻¹) against S. cerevisiae. Aqueous release of Ag⁺ was ~2.6-fold higher than Cu²⁺. Ag-ZnO NC induced marked ROS generation (~6-fold higher than S. cerevisiae) and dehydrogenase inhibition (6.6- and ~20-fold, respectively). ATR-FTIR linked species-specific susceptibility to cell-wall architecture. SEM confirmed membrane destabilization and perforation. In MDA-MB-231, necrotic fractions reached ~9% and >40% for Ag-ZnO and Cu-ZnO, respectively. Both metal oxide nanocomposites (MONCs) act through ion release, revealing a selectivity window, especially for Ag-ZnO. Further studies on non-cancerous cells, ion-release kinetics, uptake and in vivo validation are essential to establish a therapeutic index. Full article

Candida species, particularly Candida albicans (C. albicans), are the leading cause of vulvovaginal candidosis (VVC) among women of reproductive age. In recent years, the epidemiology of VVC has shifted toward non-albicans Candida (NAC) species, accompanied by increasing antifungal resistance. This retrospective study evaluated the epidemiological profile of VVC and antifungal susceptibility patterns in Greece between 2020 and 2024 at a tertiary maternity and gynecological hospital. Species identification was performed using the VITEK^® 2 system, and antifungal susceptibility followed EUCAST guidelines. A total of 526 vaginal swab samples were analyzed, comprising C. albicans (57.9%) and NAC species (42.1%). The median age was 36.3 years (range: 18–92). Among NAC isolates, Nakaseomyces glabratus (26.4%) predominated, followed by Pichia kudriavzevii (7.6%), Candida parapsilosis (5.1%), and Candida tropicalis (3.0%). Resistance rates among C. albicans isolates increased from 9.3% in 2020 to 22.3% (fluconazole) and 20.9% (itraconazole) in 2024. Voriconazole resistance was not detected until 2023 and 2024, when rates rose to 3.2% and 15.2%. Fluconazole resistance was observed in C. parapsilosis (3.5%) and C. tropicalis (12.5%). Echinocandin resistance remained low overall, except for N. glabratus, which demonstrated a 13.8% resistance rate to caspofungin. These findings highlight the need for surveillance, improved diagnostics and antifungal stewardship. Full article

Digestive candidiasis is a major opportunistic infection among people living with HIV (PLHIV). In Gabon, data on antifungal resistance remain limited. This study aimed to characterise Candida colonisation and antifungal resistance according to anatomical site and species in Libreville. In this cross-sectional study, 108 PLHIV provided paired oral and stool samples. Candida spp. was identified using conventional phenotypic methods. Antifungal susceptibility to azoles and polyenes was assessed by disc diffusion following CLSI guidelines. Resistance burden was classified by drug class and by cumulative number of antifungal agents involved. Digestive colonisation was detected in 97 (89.8%) participants. Oral and intestinal colonisation rates were 78.7% and 66.7%, respectively, with dual-site involvement in 55.6%. Among resistant isolates, Candida albicans accounted for 55.2% (oral) and 48.9% (intestinal), while non-albicans Candida represented 29.8% and 44.4%, respectively. Multidrug resistance was significantly higher in intestinal than oral isolates (36.2% vs. 11.8%; OR = 4.99; 95% CI: 2.04–12.16; p < 0.01). Resistance was predominantly azole-driven, with complex cumulative resistance profiles in intestinal isolates. The intestinal tract showed resistance profiles consistent with a preferential accumulation of MDR Candida populations in PLHIV. Site-specific resistance patterns underscore the importance of targeted sampling and antifungal stewardship strategies in resource-limited settings. Full article

Background: Candida isolation is common in critically ill patients, but its clinical interpretation depends strongly on microbiological source, host factors, and clinical context. Bloodstream isolation, candiduria, respiratory tract isolation, surveillance cultures, catheter-tip cultures, and wound/skin cultures have different clinical implications. We aimed to evaluate clinical characteristics, microbiological sources, species distribution, antifungal treatment patterns, and outcomes among adult ICU patients with Candida-positive ICU cultures. Methods: This single-center retrospective observational cohort study was conducted in the medical intensive care unit of Marmara University Faculty of Medicine between 1 October 2022 and 5 September 2025. Adult ICU patients with at least one Candida-positive ICU culture were included. Non-Candida fungal isolates and duplicate patient-level records were excluded. The primary outcome was all-cause 28-day mortality. ICU mortality was defined as all-cause death during ICU stay. Source-stratified analyses and expanded multivariable logistic regression models were performed to evaluate factors associated with mortality. Results: A total of 349 adult ICU patients were included. Median age was 71 years [IQR, 62–82], and 185 patients were male (53.0%). Overall, 28-day mortality was 59.0% (206/349), and ICU mortality was 65.9% (230/349). Candida colonization was identified in 247 patients (70.8%), whereas Candida infection was identified in 102 patients (29.2%). The most common species were Candida albicans (48.4%), Candida glabrata (13.8%), and Candida auris (12.9%). The most frequent microbiological sources were urine (42.4%), lower respiratory tract samples (26.4%), and blood cultures (14.9%). Blood/sterile-site isolation was associated with higher ICU mortality than non-blood/non-sterile-site isolation (79.2% vs. 63.5%, p = 0.026), whereas the difference in 28-day mortality was not statistically significant (66.0% vs. 57.8%, p = 0.260). Antifungal treatment was more frequent among patients with blood/sterile-site isolation (94.3% vs. 16.9%, p < 0.001). In the expanded 28-day mortality model, lactate, NLR, and carbapenem exposure were independently associated with mortality. In the expanded ICU mortality model, lactate and CRRT/hemodialysis were independently associated with mortality. Candida score was not independently associated with either 28-day mortality or ICU mortality after broader adjustment. Conclusions:Candida-positive ICU cultures represent a heterogeneous clinical and microbiological spectrum. Source-specific interpretation is essential, particularly when distinguishing bloodstream or sterile-site isolation from non-sterile-site colonization. Candida score may reflect a higher-risk clinical phenotype, but it should not be interpreted as a stand-alone mortality prediction tool. Full article

Polysulfone (PSF) nanofiltration membranes incorporating oxidized multi-walled carbon nanotubes (o–MWCNTs) and terbium oxide (Tb₂O₃) nanoparticles were fabricated via the non-solvent-induced phase inversion technique. The effect of Tb₂O₃ loading (0, 1, 3, and 5% w/w) on membrane morphology, hydrophilicity, water permeability, dye rejection, and antibiofouling performance was systematically investigated. Membrane structure was characterized by FTIR spectroscopy, SEM, EDX, XRD, and water contact angle measurements. The results confirmed the successful incorporation of Tb₂O₃ within the membrane matrix, and morphological analysis revealed a relatively dense membrane structure without macrovoid formation. Filtration experiments conducted in a dead-end cell under pressures of 1–4 bar demonstrated a maximum water flux of 53 L m⁻² h⁻¹, with dye rejection exceeding 99.9% for both methylene blue (MB) and Congo red (CR) at 4 bar. Antibiofouling performance, evaluated by colony-forming unit analysis, revealed bacterial growth reductions of 59% against Gram-negative Escherichia coli and 89% against Gram-positive Candida albicans, attributed to the dark-active generation of reactive oxygen species by Tb₂O₃, eliminating the need for UV irradiation. These results demonstrate that the synergistic integration of o–MWCNTs and Tb₂O₃ effectively addresses the permeability-selectivity trade-off and mitigates biofouling limitations associated with pristine PSF membranes, thereby offering a promising multifunctional platform for sustainable industrial wastewater treatment. Full article

Background and Objectives: Candiduria is a common health problem especially among hospitalized patients. In the era of rising azole resistance, evidence from Saudi Arabia remains limited concerning Candida species. This study aimed to assess the prevalence and risk factors of Candida isolated from urine culture and to explore species distribution in relation to clinical characteristics. Materials and Methods: We retrospectively reviewed 188353 urine samples from 2013 to 2023. Using medical records, data on age, gender, hospitalization status, and urine sample type were collected. Identification of Candida species was performed by VITEK Mass Spectrometry (bioMerieux Inc.). Binary logistic regression analysis was used to identify predictors of candiduria. A p value below 0.05 at a 95% CI was considered statistically significant. Results: A total of 1667 urine samples with significant Candida growth were reported. It accounted for 0.88% of all organisms grown from urine culture and 30% of Candida grown from various body sites. Candida albicans was the most frequently identified species (n = 920, 55.2%), followed by C. tropicalis (n = 374, 22.4%), C. krusei (n = 80, 4.8%), C. glabrata (n = 78, 4.7%), and C. parapsilosis (n = 41, 2.5%). However, the rate was not stable throughout the years, and non-albicans Candida (NAC) was often the most prevalent. Female gender was the strongest predictor of candiduria (OR and AOR 1.81, 95% CI 1.46–2.25), whereas significantly lower odds were seen in elderly patients and in random urine specimens. The species distribution of NAC did not seem to change with age, gender, type of specimen, or hospitalization status. Conclusions: Among all Candida spp. isolated in the lab, 30 out of every 100 originated from urine culture, with a significant risk associated with females. The increasing prevalence of emerging Candida species in tertiary care settings can provide clinicians with valuable insights for the diagnosis and management of Candida UTI. Full article