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Trichophyton indotineae is an emerging dermatophyte responsible for widespread, chronic, and treatment-refractory dermatophytosis worldwide; however, data from China remain limited. This study aimed to characterize the clinical manifestations, antifungal resistance, and management challenges of T. indotineae infections in Chinese patients. Three patients with disseminated dermatophytosis were evaluated clinically. Fungal isolates were identified using multilocus sequence typing and phylogenetic analysis. Antifungal susceptibility testing and sequencing of the squalene epoxidase gene were performed to assess resistance. All patients presented with extensive dermatophytosis accompanied by severe pruritus, and two had a history of residence or work in Malaysia, suggesting imported infection. Elevated serum IgE levels were observed in two cases. Molecular analyses confirmed all isolates as T. indotineae. Antifungal susceptibility testing revealed reduced susceptibility to terbinafine, with two isolates harboring the SQLE F397L mutation and one carrying the F415C mutation. Clinically, all patients showed poor response to standard antifungal regimens. High-dose itraconazole achieved partial improvement; however, relapse occurred after treatment discontinuation in all cases. These findings indicate that T. indotineae infection is characterized by chronicity, extensive involvement, and difficulty in achieving sustained remission. Antifungal resistance, particularly terbinafine resistance, together with host-related factors, may contribute to disease persistence. This study highlights the importance of accurate species identification and resistance-guided therapy, and underscores the need for optimized management strategies for this emerging dermatophyte infection.
Candidozyma auris (formerly Candida auris) is an emerging yeast that causes bloodstream infections, especially in immunocompromised patients, and presents high resistance and virulence rates. To date, six clades have been established worldwide and the number of outbreaks caused by this microorganism has been increasing every year, causing concern in the medical community. Therefore, this study investigated the heterogeneity among clades of C. auris by evaluating the virulence profile and mechanism of infection using an in vivo model of Galleria mellonella. G. mellonella was infected with different clades (I, II, III and IV) of C. auris, C. albicans ATCC 5341 and C. parapsilosis ATCC 22019 for virulence and histopathologic evaluation. Aggregative strains of C. auris InP13 (I) and VEN C6 (IV) had a greater rate of melanization and larval mortality among the C. auris isolates, therefore, being the most aggressive strains. C. albicans caused the most melanization among all strains at the highest inoculum concentration (106 cells/mL). Histopathologic examination showed a greater number of granulomas in the lower and upper extremities of G. mellonella. The granulomas ranged from 0.07-0.11 nm in diameter. All strains showed biofilms adhering to larval tissue, which was more evident for InP13, VEN C6 and C. albicans. Infiltration of tissues by yeasts, pseudohyphae and chlamydospores (a resistance structure formed by C. albicans in stress environments) morphotypes were observed. The aggregative strains were more virulent and had a greater ability to form biofilms and granulomas, showing heterogeneity among the different C. auris clades.
This study investigated the treatment outcomes of 91 patients with chronic and recalcitrant dermatophytosis from 20 hospitals in Türkiye between June 2022 and March 2024, as well as the in vitro antifungal susceptibility and squalene epoxidase (SQLE) substitution profiles of the dermatophytes obtained from these patients. Molecular identification by sequencing 91 isolates, revealed 76 Trichophyton mentagrophytes ITS genotype VIII (TmVIII; also known as T. indotineae) isolates, 13 Trichophyton rubrum, one Trichophyton tonsurans, and one Microsporum canis. The Phe397Leu substitution predominated in the SQLE, and Tyr414His co-occurred in nine TmVIII isolates. Five novel substitutions were observed in TmVIII. Among 13 T. rubrum isolates, three showed different SQLE substitution patterns compared to the wild-type strain. EUCAST antifungal susceptibility testing revealed high minimum inhibitory concentrations (MICs) for terbinafine (TRB) (> 0.25 mg/L) and for fluconazole (FLZ) (≥ 16 mg/L), indicating resistance in most TmVIII isolates. Of the 91 patients, 83 responded to FLZ, itraconazole (ITZ), TRB, or voriconazole-based regimens. While adjunct therapy with FLZ and resveratrol (RES) led to improvement in 28/29 patients despite their high in vitro inhibition concentrations, ITZ and curcumin (CUR) therapy was successful in 3/3 patients. However, the in vitro efficiency of CUR could not be evaluated. These findings highlight the local occurrence of specific SQLE substitutions, underscore the importance of EUCAST MIC testing combined with SQLE sequencing for surveillance, and support further evaluation of RES and CUR as an adjunct in TRB-resistant TmVIII.
Lactobacillus species are essential for vaginal eubiosis; their depletion often leads to dysbiosis, increasing susceptibility to sexually transmitted infections (STIs). This study investigated the prevalence of Candida albicans colonization and its associated factors among HIV-negative adolescent girls and young women (AGYW) in South Africa. Furthermore, STIs associated with C. albicans colonization and Lactobacillus deficiency were investigated. Secondary data analysis was performed on 138 HIV-negative AGYW of Eastern Cape province, South Africa. Secondary data included cervico-vaginal detected C. albicans, Lactobacillus species (L. crispatus, L. gasseri or L. jensenii), bacterial vaginosis, human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, herpes simplex virus type 1/2 (HSV-1/2), and Mycoplasma genitalium, and behavioural questionnaires. Univariate and multivariate logistic regression were performed using GraphPad Prism Version 8.0.1.244. A proportion of 27.58% were positive for C. albicans, and 84.06% tested positive for at least one investigated STI (73.91% for HPV, 31.16% for C. trachomatis, 12.32% for N. gonorrhoeae, 10.87% for T. vaginalis, 7.25% for HSV-1/2, and 5.80% for M. genitalium). Frequent sexual intercourse (more than two times within the past 30 days) was associated with higher odds of C. albicans (OR: 1.84, 95% CI 1.85-3.80, p = 0.036), alcohol consumption (OR: 3.60, 95% CI 1.12-13.23, p = 0.038) and recent vaginal discharge syndrome (OR: 2.67, 95% CI 1.06-6.63, p = 0.005). Deficiency of Lactobacilli among C. albicans-positive AGYW was associated with increased odds of C. trachomatis positivity (OR: 4.37, 95% CI 1.05-17.05, p = 0.047). HIV-negative AGYW demonstrated a high burden of STIs, with C. albicans positivity associated with alcohol consumption, frequent sexual intercourse, and vaginal discharge syndrome. The absence of Lactobacilli was associated with increased odds of C. trachomatis positivity. Further research is recommended using longitudinal designs, larger sample sizes, and diverse populations to better understand these observations.
Microsporum canis is one of the most common zoophilic pathogenic fungi, and infections are typically managed using empirical antifungal therapy. The increasing incidence of M. canis infections has led to a growing demand for antifungal susceptibility assays in clinical settings, particularly in pediatric department, to guide drug selection and to monitor therapeutic responses in highly inflammatory cases. However, susceptibility testing methods rely heavily on sporulation capacity of M. canis, and more than half of the clinical isolates fail to produce sufficient microconidia in commonly-used media for reliable testing.In this study, we evaluated a novel a rice bran medium (RBM) for its ability to enhance microconidia production in clinical isolates of M. canis. RBM demonstrated a significantly greater sporulation-inducing effect than conventional media, including potato dextrose agar (PDA), Sabouraud dextrose agar (SDA), and oatmeal agar (OA), which are commonly used in clinical laboratories. Sporulation efficiency varied with RBM concentrations, with 4% RBM showing the highest efficacy. Under this concentration, abundant microconidia were consistently produced by testing clinical strains after 7-10 days of incubation at 30 ℃ across. These findings suggest that RBM represents a practical and effective alternative medium for promoting sporulation and facilitating antifungal susceptibility in clinical settings.
Despite important advancements in diagnostic modalities, routine use of therapeutic drug monitoring (TDM) and newer antifungal therapies, there is a paucity of contemporary data regarding clinical characteristics and outcomes of invasive aspergillosis (IA) in the United States. Single-center, retrospective cohort study of hospitalized patients between 2015 and 2020, who had active hematological malignancy (HM) or had undergone transplantation and cellular therapy (TCT) and had probable or proven IA. Sixty-two patients with probable or proven IA, including 21 HM and 41 TCT, were identified. Forty-four percent of the cases corresponded to breakthrough IA. Bronchoalveolar lavage galactomannan was ≥ 1 in 71% and ≥ 0.5 in 88%, while serum galactomannan was ≥ 0.5 in only 34%. Among assessable patients (n = 59), 90-day partial or complete response to antifungal therapy occurred in 39%. All-cause mortality for the entire cohort was 22% at 30 days and 46% at 90 days. IA attributable mortality was 18% at 30 days and 38% at 90 days. Achieving therapeutic antifungal serum levels was associated with a reduction in all-cause mortality, while prior clinically significant CMV infection (aOR 9.65, 95% CI 1.34-69.6; P = 0.025) and relapsed/refractory hematological disease (aOR 8.5, 95% CI 2.23, 32.4; P = 0.002) were associated with higher IA attributable mortality. Despite advancements in diagnosis and treatment, IA remains associated with poor outcomes in hematological patients in the contemporary era. Newer antifungals and improved strategies for monitoring and prevention of IA in these vulnerable patient populations are urgently needed.
The rapid expansion of zoonotic sporotrichosis in South America necessitates innovative surveillance strategies to identify natural ecological niches. Roadkill provides a unique, underutilized opportunity to monitor Sporothrix circulation within human-impacted landscapes. We conducted a molecular survey via a triplex probe quantitative real-time PCR (qPCR) assay targeting pathogenic Sporothrix species in 81 roadkilled vertebrates (mammals, birds, and reptiles) collected along highways BR-376 and PR-445 traversing the Atlantic Forest in Paraná, Brazil (2017-2023). Genomic DNA from visceral organs (heart, liver, lung, and spleen) was screened for fungal DNA. Sporothrix DNA was detected in 13.6% (11/81) of the samples. Sporothrix schenckii predominated, identified in wild mammals (Leopardus guttulus, Didelphis albiventris, and Lepus europaeus) and diverse birds (Colaptes melanochloros, Piaya cayana, and Selenidera maculirostris), indicating systemic exposure. Strikingly, S. brasiliensis was detected in avian hosts (Columbina picui, Crypturellus tataupa), challenging the thermal-exclusion hypothesis and implicating birds as potential aerial vectors. Furthermore, S. globosa was found in Dasyprocta spp. and was co-detected with S. brasiliensis in Columbina picui. Notably, a reptile (Oxyrhopus spp.) was positive for S. globosa and S. schenckii, expanding the known host spectrum, potentially via trophic transmission. Although distinguishing transient DNA carriage from active infection requires histopathological validation, these findings suggest that wildlife in fragmented corridors may function as reservoirs, biological amplifiers, or mechanical vectors rather than incidental hosts, reinforcing the blurring boundaries between sylvatic and synanthropic transmission cycles. In this context, integrating roadkill biosurveillance into a One Health framework is vital for tracking environmental pathogen loads and anticipating zoonotic spillover.
CARD9 deficiency is characterized by predisposing to increased susceptibility to fungal infections, particularly invasive fungi and dermatophytes. In recent years, the incidence of fungal infections in patients with CARD9 deficiency is on the rise, and the types of fungal pathogens have become increasingly diverse. In addition, most of CARD9 deficiency patients with fungal disease were prone to recurrence and resistant to antifungal agents, which pose significant challenges to treatment. To investigate the association between CARD9 mutations and fungal infections, we conducted a systematic analysis of published case reports involving 102 CARD9 deficient patients with fungal infections. In this study, the main fungal infections in these patients were candidiasis (34.3%), dermatophytosis (27.5%) and phaeohyphomycosis (23.5%). The main disease-causing fungi were Candida species (36.3%) and Trichophyton species (18.6%). 43 different genetic alterations in the CARD9 gene were identified and the three most frequent mutations were D274fsX60 (21.6%), Q289X (17.7%) and Q295X (12.8%). Our analysis revealed significant geographic variations in the frequency and distribution of CARD9 mutations. In addition, the Q289X and D274fsX60 were predisposed to dermatophytosis and phaeohyphomycosis, respectively. These findings enhance our understanding of the molecular mechanism underlying infection susceptibility in patients with CARD9 deficiency.
We aim to explore the factors that influence the varying prognostic outcomes of itraconazole treatment in patients with onychomycosis. A prediction model for treatment failure of onychomycosis to itraconazole was developed and validated. This study is a prospective, case-cohort study of observational cases. Patient information meeting the inclusion criteria will be grouped and compared based on their outcomes six months after treatment. A total of 437 patients were enrolled in our study, and the following factors were correlated with prognosis: patient ages, duration of illness, number of affected nails, fungal species, clinical classification, nail thickness, nail involvement, and bathing frequency. Based on these variables, we constructed a predictive model for treatment failure in onychomycosis. The accuracy and precision of the prediction model for itraconazole treatment failure in onychomycosis were 0.936 and 0.924. First, this study validated that multiple factors are associated with the prognosis of itraconazole pulse therapy for onychomycosis, suggesting that early treatment of the disease and attention to bathing habits can lead to better therapeutic outcomes. Second, based on the contribution of representative variables to the predictive power of the binary multivariate logistic regression model, it can help clinicians better understand the characteristics of patients with onychomycosis who experience treatment failure. These characteristics mainly include a longer disease duration, non-dermatophyte infections, multiple nail involvement, and significant psychological impact. Based on these features, it provides a reliable basis for determining the optimal treatment course of itraconazole pulse therapy for onychomycosis and whether additional treatment is needed.
Triazoles are widely used for treatment and prevention of invasive aspergillosis (IA) but can cause serious drug-drug interactions (DDIs) with chemotherapeutic (CT) and immunosuppressant (IS) agents via CYP3A4 inhibition. The frequency of triazole-CT or IS concurrent administration in hematologic malignancies (HM) patients newly admitted with IA is largely unknown. We studied US IQVIA claims including adults with ≥ 1 claim for an inpatient stay with a diagnosis code for IA from October 1, 2015-November 30, 2022 and evidence of systemic antifungal therapy for ≥ 3 days during the hospitalization. The cohort was limited to patients with ≥ 1 HM diagnosis code within 6 months prior to IA admission. Utilization of triazoles with CT and/or ISs known to have moderate-to-severe pharmacokinetic (PK) interactions was described. Triazoles, predominantly isavuconazole (61.0%) and voriconazole (53.6%), were administered in 97.2% of 317 patients with IA. Of these, 241 (78.2%) received an interacting CT and/or IS. Potentially interacting agents administered with a triazole included corticosteroids (70.8%), calcineurin or mammalian target of rapamycin (mTOR) inhibitors (25.0%) (84.4% tacrolimus), alkylating agents (14.0%) (76.7% cyclophosphamide), venetoclax (9.7%), anthracyclines (6.2%), and vincristine (5.8%). Concurrent administration of triazole with potential PK interactions with CT or IS agents occurred in most HM patients admitted for IA. Choosing alternative antifungals, therapeutic drug monitoring of triazoles or selective ISs, and dosage adjustment of CT/IS agents may mitigate the risk of adverse DDIs. New antifungal agents without serious DDIs with CT and/or IS agents are needed for treatment of IA to reduce the risk of serious adverse events.
Invasive yeast infections are associated with high mortality rates, particularly in immunocompromised patients. While most cases of fungaemia are caused by Candida species, rare yeast infections occasionally occur. Here, we present the first documented case of a Starmerella sorbosivorans (= Candida sorbosivorans, homotypic synonym) bloodstream infection in a 39 year-old man with chronic intestinal pseudo-obstruction requiring parenteral nutrition via a tunnelled central venous catheter. The patient presented with fever and was diagnosed with catheter-related bloodstream infection. Initial biochemical identification suggested S. magnoliae, but MALDI-TOF mass spectrometry (MS) failed to provide a definitive identification. Molecular phylogenetic analysis using multiple loci (18S rDNA, internal transcribed spacer [ITS] region, 26S rDNA-D1/D2, TEF1α, and RPB2), combined with proteomic analysis using MALDI-TOF MS, confirmed the isolate as S. sorbosivorans, despite a low ITS sequence similarity (91.3%) to the type strain. The patient was successfully treated with sequential administration of micafungin and liposomal amphotericin B, along with removal of the catheter. Antifungal susceptibility testing revealed low minimum inhibitory concentrations (MICs) for micafungin, amphotericin B, and voriconazole, but high MICs for fluconazole. Our findings emphasise the importance of multilocus sequence analysis for accurate species identification, especially in rare yeast infections caused by uncommon species such as S. sorbosivorans, for which conventional methods may be insufficient. However, to improve the applicability of MALDI-TOF MS in clinical settings, the reference library should be expanded to include rare and emerging yeast species.
Sporotrichosis is an implantation mycosis with a high incidence in Brazil. Diagnosing human sporotrichosis poses significant challenges, which can lead to increased morbidity and prolonged treatment duration. Direct examination of fresh biopsies using Blankophor represents a valuable tool for rapid diagnosis, offering high sensitivity.
Dermatophyte infections have evolved in both clinical presentation and etiological profiles, with chronic, recurrent, and widespread forms becoming increasingly prevalent and therapeutically challenging over the past decade. These infections are predominantly caused by Trichophyton indotineae (ITS genotype VIII), a member of the Trichophyton mentagrophytes complex. The virulence mechanisms of T. indotineae remain poorly understood. To elucidate potential pathogenic factors, we investigated hemolytic and co-hemolytic (CAMP-like) activities in dermatophytes associated with recalcitrant dermatophytosis. A total of 127 isolates (117 T. indotineae, 5 T. rubrum, 3 T. tonsurans, and 2 Microsporum canis) were examined using Columbia agar supplemented with 5% ovine (COA) or equine erythrocytes (CEA). Hemolysis was more consistently observed on COA (119 isolates) than on CEA (44 isolates) following 7-day incubation at 27 °C. Additional incubation at 36 °C up to 7 days was required to enhance hemolysis detection on CEA. Overall, 93.7% of isolates exhibited hemolytic activity, whereas only 3.1% demonstrated co-hemolytic activity. Among T. indotineae isolates, 97.4% were hemolytic. These findings underscore the importance of characterizing virulence traits in dermatophytes. Additional studies are needed to clarify the role of hemolysis in chronic and recalcitrant infections, with the goal of identifying novel therapeutic targets.
Blastomycosis is an invasive dimorphic fungal infection capable of causing severe disseminated disease in immunocompromised hosts. Although traditionally endemic to North America, increasing molecular evidence suggests a broader geographic distribution. Iran is not considered endemic, and no prior species-level confirmed cases of Blastomyces percursus have been reported. We report a 31-year-old liver transplant recipient who developed progressive diffuse papulopustular and verrucous necrotic cutaneous lesions 17 months after transplantation. Initial diagnostic evaluation was inconclusive. Detection of fungal DNA consistent with Aspergillus species in skin biopsy specimens prompted initiation of voriconazole therapy; however, the clinical course progressed despite treatment. The patient subsequently developed severe weight loss, high-level cytomegalovirus (CMV) viremia, pulmonary nodules, and mucosal involvement. Initial fungal culture suggested Pseudallescheria boydii, but re-evaluation at a reference mycology laboratory raised suspicion for blastomycosis. Definitive species identification was achieved by amplification and Sanger sequencing of the internal transcribed spacer (ITS1-5.8S-ITS2) region. The 520-bp sequence demonstrated 99.6-100% identity with reference Blastomyces percursus strains, and phylogenetic analysis confirmed clustering within the B. percursus clade. Despite targeted antifungal therapy with liposomal amphotericin B and antiviral treatment for CMV disease, the infection progressed to disseminated involvement with central nervous system manifestations, resulting in a fatal outcome. This case highlights the diagnostic complexity of invasive fungal infections in non-endemic regions and emphasizes the importance of early molecular identification in immunocompromised patients presenting with atypical cutaneous and systemic fungal disease.
Although Scedosporium species may cause severe infections in immunocompromised patients, little is known about their pathogenic mechanisms. The thioredoxin reductases (TrxRs) of Scedosporium apiospermum are thought to play an important role in protecting the fungus against oxidative stress. The genes that encode these proteins are part of biosynthetic gene clusters (BGCs) which ensure the synthesis of non-ribosomal peptides. Due to the discrepancies between chemical studies and bioinformatic predictions regarding the product of the BGC comprising the TrxR-encoding gene SAPIO_CDS1830, a large-scale study of almost 300 fungal genomes was undertaken to search for BGCs that could potentially synthesize homodipeptides. Phylogenetic analysis of the amino acid sequence of the adenylation domain of a large number of non-ribosomal peptide synthases confirmed the assembly of two phenylalanine molecules. Synteny analysis clearly showed that this BGC ensures the synthesis of some aranotin-related hybrid compounds, called boydins. This BGC comprised 15 genes, including one encoding a polyketide synthase, which allows the synthesis of the polyketide chain attached to the dipeptide skeleton. The orthologues of all members of this BGC were also identified in all available Scedosporium genomes, as well as in other Sordariomycetes and even in some phylogenetically distant molds living as endophytes or plants pathogens, or on decaying wood. These secondary metabolites, which may therefore not be specific to the Scedosporium genus, could play a role in evasion of the fungus to the oxidative stress, as suggested by the overexpression of several members of this BGC in response to oxidative stress.
A 43-year-old man with myelodysplastic syndrome underwent umbilical cord blood transplantation (CBT). On day 4 post-transplantation, he developed right periorbital pain and oculomotor nerve palsy. Brain MRI revealed fluid accumulation in the sphenoid sinus and mucosal thickening in the right maxillary sinus. Given the extraordinarily early onset and neurological involvement, fungal meningitis, including mucormycosis, was suspected, and empirical high-dose liposomal amphotericin B (10 mg/kg/day) was initiated. Nasal discharge culture yielded Rhizomucor species, later identified as Rhizomucor miehei by polymerase chain reaction (PCR). Despite aggressive antifungal therapy, the patient's neurological condition deteriorated, and he died on day 49. Autopsy confirmed extensive rhino-cerebral mucormycosis with angioinvasion, and Mucorales DNA was detected in brain tissue by quantitative PCR. To our knowledge, this represents the first reported case of R. miehei infection occurring within days after transplantation, preceding neutrophil engraftment. This case highlights the importance of recognizing mucormycosis even in the immediate post-transplant period and underscores the limitations of antifungal therapy in the absence of surgical debridement.
Emergomyces (Ajellomycetaceae, Onygenales) is a genus of dimorphic fungal pathogens that cause severe, opportunistic infections around the world. We used long-read nanopore sequencing to generate de novo genome assemblies followed by comparative analyses for the type-strains of Emergomyces africanus, Emergomyces canadensis, Emergomyces crescens, Emergomyces europaeus, Emergomyces orientalis, Emergomyces pasteurianus, and Emergomyces soli. The average Emergomyces genome was found to be 32,965,087 bp in size (range 28,687,700-35,863,369 bp) with GC%-contents of 42.01-45.72%. Average Nucleotide Identity analysis of the seven type-strain genomes with the publicly available Emergomyces and Blastomyces genomes was performed, showing values of 85-100% similarity between genomes and 85-91% between the twelve species tested. Furthermore, we formally validate the species descriptions for Emergomyces crescens and Emergomyces soli.
Candidozyma auris (syn. Candida auris) is an emerging multidrug-resistant yeast of growing clinical and environmental concern. Despite its increasing detection in healthcare settings worldwide, environmental evidence remains scarce. This study presents the first molecular detection of C. auris DNA in surface waters of Türkiye, within the Ramsar-protected Gediz Delta, as part of the national One Health Surveillance Framework. A total of 80 surface-water samples were collected from five wetland ecosystems Tuz Lake, Kulu Lake, Göksu Delta (Akgöl and Paradeniz Lagoons), Kızılırmak Delta, and Gediz Delta. Physicochemical parameters; temperature, pH, and salinity were recorded in situ using a multi parameter sensor. Environmental DNA was extracted from 2 L of 0.22 µm Sterivex-filtered water and analyzed via qPCR using C. auris-specific (CauF/CauR) and Candida-genus (CauRelF/CauRelR) primer sets. Yeast isolation was performed on CHROMagar™ Candida Plus, and identification was achieved by MALDI-TOF MS. C. auris DNA was detected in one sample (1.25%), specifically from the Gediz Delta (Sample No. 5651, 38.523° N, 26.892° E), with Ct values 33.8-37.2 confirmed by sequencing. Broader Candida genus signals were observed in 24% of samples. Culture-based analyses yielded no viable C. auris, but 15 yeast isolates were identified, mainly Pichia kudriavzevii (Candida krusei), C. albicans, and Nakaseomyces glabratus (Candida glabrata). The culture-negative yet qPCR-positive finding indicates that C. auris DNA likely persists in aquatic environments as non-viable or residual material. This finding provides early molecular evidence of environmental dissemination and underscores the need for viability assays, culture-based isolation, and metagenomic monitoring integrated within One Health surveillance programmes.
Urinary-source candidemia is an uncommon but clinically relevant form of invasive candidiasis, often underrecognized and poorly characterized in the literature. Retrospective single-center study of adult patients with candidemia attributed to a urinary source between 2019 and 2023. Eligible cases were identified using predefined attribution criteria, requiring microbiologically confirmed Candida spp. bloodstream infection with significant candiduria by the same species, in the absence of an alternative clinically plausible source. Among 526 positive blood cultures, 26 fulfilled the predefined criteria for urinary tract source attribution. The median age was 74 years. Most patients had a nephro-urological history, with frequent chronic kidney disease (15, 57.7%), obstructive uropathy (19, 73.1%), indwelling urinary devices (21, 80.8%) and recent urological procedures (19, 73.1%). Type 2 diabetes was present in 50% of patients (13), most receiving SGLT2 inhibitors. The majority presented with fever (23, 88.5%), and sepsis was frequent (14, 53.8%). Urinary symptoms were present in only half of the patients (14, 53.8%). Candida albicans was the most frequent isolate (13, 50%); followed by Candida glabrata (8, 30.8%) and Candida parapsilosis (5, 19.2%), both showing high rates of elevated fluconazole MICs. Empirical therapy was often discordant with final susceptibility. Combination antifungal therapy was used in 26.9% (7). Attributable mortality was 23.1% (6 deaths). Independent predictors of mortality included type 2 diabetes, Barthel Index < 50, therapeutic failure and septic shock. Candidemia with a presumed urinary tract source primarily affects frail patients with urological comorbidities, often presents with non-specific symptoms and is associated with significant morbidity and mortality. Combination antifungal therapy may be beneficial in selected cases. Early recognition and individualized management are essential to improve outcomes.