Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Background: Antifungal resistance (AFR) is a global public health problem with devastating effects, especially among immunocompromised individuals. Addressing AFR requires a One Health approach including Antifungal Stewardship (AFS). This study aimed to comprehensively review global studies published on fungal infections and AFR and to recommend solutions to address this growing problem. Materials and Methods: This was a narrative review that was conducted using published papers on fungal infections, AFR, and AFS between January 1961 and March 2024. The literature was searched using PubMed, Google Scholar, Web of Science, and EMBASE. Results: This found that there has been an increase in fungal infections globally, especially among immunocompromised patients. Due to this increase in fungal infections, there has been a proportionate increase in the use of antifungal agents to prevent and treat fungal infections. This increased use of antifungal agents has worsened the problem of AFR contributing to increased morbidity and mortality. Globally, fungal infections have contributed to 150 million infections annually and 1.7 million deaths per year. By the year 2023, over 3.8 million people died from fungal infections. Addressing AFR remains a challenge because the treatment of antifungal-resistant infections is difficult. Finally, the treatment of fungal infections is a global challenge exacerbated by the limited number of antifungal agents to treat invasive fungal infections. Conclusion: The results of this study indicated that fungal infections and AFR are prevalent across humans, animals, agriculture, and the environment. Addressing this problem requires the provision of solutions such as improving the awareness of AFR, conducting further research on the discovery of new antifungal agents, and implementing AFS programs. If this global problem is not addressed, the morbidity and mortality associated with AFR will continue to rise in the future.

Candidemia chronicles:Retrospective analysis of candidemia epidemiology,species distribution,and antifungal susceptibility patterns in Bahrain

BACKGROUND Invasive fungal infections,particularly candidemia,pose significant clinical challenges globally.Understanding local epidemiology,species distribution,and antifungal susceptibility patterns is crucial for effective management despite regional variations.AIM To investigate the epidemiology,species distribution,antifungal susceptibility patterns,and associated risk factors of candidemia among patients in Bahrain from 2021 to 2023.METHODS This retrospective study analyzed demographic data,Candida species distribution,antifungal susceptibility profiles,and risk factors among candidemia patients treated at a tertiary care hospital in Bahrain over three years.Data was collected from medical records and analyzed using descriptive statistics.RESULTS A total of 430 candidemia cases were identified.The mean age of patients was 65.7 years,with a mortality rate of 85.5%.Candida albicans(C.albicans)was the most common species,followed by Candida parapsilosis,Candida tropicalis(C.tropicalis),and emerging multidrug-resistant Candida auris(C.auris).Antifungal susceptibility varied across species,with declining susceptibility to azoles observed,particularly among C.albicans and C.tropicalis.Major risk factors included central venous catheters,broad-spectrum antibiotics,and surgical procedures.CONCLUSION This study highlights the substantial burden of candidemia among older adults in Bahrain,characterized by diverse Candida species.It also concerns levels of antifungal resistance,notably in C.auris.The findings underscore the importance of local epidemiological surveillance and tailored treatment strategies to improve outcomes and mitigate the spread of multidrug-resistant Candida species.Future research should focus on molecular resistance mechanisms and optimizing therapeutic approaches to address this growing public health concern.

Impact of Vegetation Restoration on Soil Fungal Community Structure in Karst Rocky Desertification Areas

In this paper,managed forest(MF)and natural forest(NF)in the Huajiang Demonstration Zone of Guanling,Guizhou were selected as research objects,and cropland(CL)was taken as control.High-throughput sequencing technology was used to study the characteristics of fungal community composition and species diversity in the surface(0-10 cm)soil of each restoration measure,in order to reveal the dominant soil fungal groups and fungal community composition in karst rocky desertification areas,which was conducive to a more comprehensive understanding of the soil conditions of different vegetation restoration measures.Research has shown that vegetation restoration significantly affected the diversity of soil fungal community,with significant increases in Sob index,Ace index,and Chao index.The vegetation restoration has significantly changed the composition of fungal community.The dominant fungi in the CL topsoil are Sordariomycetes(62.28%),Dothideomycetes(12.34%),and Eurotiomycetes(9.12%);the dominant fungi in the MF soil are Sordariomycetes(45.05%),Dothideomycetes(14.74%),and Mortierellomycetes(10.40%);the dominant fungi in the NF soil are unclassified fungal community(26.38%),Sordariomycetes(19.78%),and Agaricomycetes(13.82%).Vegetation restoration has changed the key fungal groups in the soil.Sordariomycetes,Fusarium,and Setophoma are the key dominant fungal groups in CL soil;Dioszegia is key dominant fungal group in MF soil;c_unclassified_k_Fungi,p_unclassified_k_Fungi,o_unclassified_k_Fungi,f_unclassified_k_Fungi,g_unclassified_k_Fungi,Teichospora,and Diaporthe are key dominant fungal groups in NF soil.

Diverse responses of fungal functional groups to desertification in forest soils of Pinus densata on the Chinese Tibetan plateau

Rapid increase in desertification is an environ-mental concern,especially for the health and sustainabil-ity of ecosystems in changing climates.How ecosystems respond to such changes may be partially understood by studying interactions and performance of critically impor-tant groups such as soil fungi functional groups.This study investigated variations in diversities of three soil fungi functional guilds(saprotrophic,symbiotic,pathogenic)and influencing abiotic factors in a Pinus densata forest on the southeast Tibetan Plateau where desertification is intense.The results indicate desertification significantly decreased the proportion of dominant fungal guild-symbiotic fungi(mean relative abundance decreasing from 97.0%to 68.3%),in contrast to saprotrophic fungi(increasing from 2.7%to 25.7%)and pathogenic(from 0.3%to 5.9%).Soil pH had the most significant impact on fungal community structure and negatively correlated with symbiotic fungal richness,which was significantly lower in arid soils,and positively correlated with saprotrophic and pathogenic fungal alpha-diversity,which were abundant.Different community struc-tures and regulators of the three fungi communities were observed,with pH,total phosphorus and ammonium(NH_(4)^(+))as the main determinants.This study links the biotic and abi-otic components during desertification and the interactions between them,and may be used as indicators of ecosystem health and for amendments to mitigate the effects of a chang-ing climate.

Polyphenol from foxtail millet bran alleviates experimental colitis in mice by remodulating intestinal fungal community

Inflammatory bowel disease(IBD)is a chronic relapsing-remitting systemic disease of the gastrointestinal tract,characterized by an inflammatory process.Gut mycobiota community dysbiosis has been reported that is closely related to the development of IBD.Our previous findings indicated that polyphenol of the inner shell(BPIS)from foxtail millet bran could restore the gut microbiome and inhibit the progress of colorectal cancer(CRC).In the present study,we studied the anti-inflammatory potential of BPIS in the dextran sodium sulfate(DSS)-induced mouse colitis model.Data suggested that BPIS alleviated experimental colitis by restoring body weight,colonic length and protecting the epithelial architecture from damage by DSS.Moreover,we found that BPIS strengthened the gut barrier function and inhibited the activation of Wnt1/β-catenin pathway.Gene sequence analysis indicated that BPIS remodeled the overall structure of the gut mycobiota from colitis mice toward that of the normal counterparts,including 1 phylum and 9 genera.Interestingly,BPIS significantly increased the abundance of Aspergillus ruber.It further verified that BPIS significantly promoted the growth of A.ruber in vitro.Collectively,BPIS has great potential to develop into an effective against IBD drug.

Comparison of fungal vs bacterial infections in the medical intensive liver unit:Cause or corollary for high mortality?

BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver failure.AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial infections.METHODS From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial infections.We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts.Data was extracted through chart review.RESULTS All fungal infections were due to Candida species,and were most frequently blood isolates.Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,P<0.001).The majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,P<0.001),and dialysis due to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for End-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical significance.CONCLUSION Mortality was worse among patients with fungal infections,likely attributable to severe ACLF development.Prospective studies examining empiric antifungals in severe ACLF and associations between fungal infections and transplant outcomes are critical.

Contribution to the Study of Fungal Strains Contaminating Peanut Pastes in Bangui (Central African Republic)

Introduction: Peanut pastes are food products resulting from artisanal or industrial processing, used in cooking in Africa in general and in Central African Republic in particular. These peanut pastes are often contaminated by molds and filamentous fungi involved in the degradation of hygienic and organoleptic or even toxicological quality. This study aims to determine the epidemiological profile of molds contaminating peanut pastes sold on the Central African market. Methodology: This was a cross-sectional study carried out from June to September 2023. Samples of peanut pastes sold on Central African market were taken and analyzed at the National Laboratory of Clinical Biology and Public Health using the conventional microbiology method according to ISO 7954 standards. The data obtained were collected in the ODK 2023.3.1 application and analyzed with the Epi Info 7 software. A multivariate analysis by logistic regression, Ficher’s exact test, and chi2 at the 5% threshold (p Penicillium sp.;11.25% of Mucor sp.;10.63% of Aspergillus terrei;3.13% of Aspergillus niger;1.25% of Aspergillus medullans;28.13% of Aspergillus flavus;2.50% of Aspergillus fumigatus. Peanut pastes stored beyond three days were more contaminated (94.19%). Conclusion: The results of this study made it possible to highlight strains of mold that impact the hygienic and organoleptic quality of peanut pastes sold at the Central African market. Most of the isolated strains were the Aspergillus flavus species which is recognized by its toxigenic effects. This species is much more incriminated in the contamination of foodstuffs with the production of the toxin which causes underlying pulmonary pathologies in humans.

Advances in Drug Treatment of Fungal Keratitis

Fungal keratitis is an important cause of corneal blindness in China, accounting for 45% of infectious keratitis. The main pathogenic bacteria include yeast, filamentous bacteria and nearly 100 kinds of fungi, which are difficult to diagnose, difficult to treat and poor prognosis. When the infected fungal strains have strong virulence and poor drug sensitivity, it is easy to prolong the disease. Once the fungal infection involves the whole limbus and reaches the whole layer of the cornea, it will be followed by intraocular tissue infection such as anterior chamber, lens and vitreous body. When the infection is difficult to control and the visual function is seriously damaged, the enucleation of eye contents has to be performed, which causes irreversible harm to the patient’s appearance and physical and mental health. Therefore, in order to gain greater hope for the vision of patients with fungal keratitis, In recent years, with the continuous progress of clinical medicine and microbiological diagnostics, the treatment methods of fungal keratitis have been constantly updated. This article will briefly review the new progress in drug and surgical treatment of fungal keratitis in recent years to provide patients with better visual prognosis. .

Prevalence of Bacterial and Fungal Infected Chronic Leg Ulcers at a Teaching Hospital in Ghana

Background: Chronic ulcers are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Chronic leg ulcers (CLUs) are susceptible to microbial infections and serious complications such as tissue necrosis and osteomyelitis, can result without the timely control of infections. Recent studies have also reported an increase in the association of fungal infections with chronic non-healing ulcers. Aim: To determine the prevalence of bacterial and fungal infections among patients reporting with chronic leg ulcers in participants without co-morbidities. Methods: A prospective cross-sectional study was conducted among patients with chronic leg ulcers at the National Reconstructive Plastic Surgery and Burns Centre, Korle-Bu Teaching Hospital (NRPS/BC-KBTH) and those who consented were enrolled. Characteristics of the wound as well as micro-organisms cultured from wound swabs were recorded. Results: A total of 50 participants were enrolled for the study with the mean (SD) age of 40.7 (10.7) years. Eighty percent of the participants presented with post traumatic leg ulcers with 80% being artisans and traders in the age group 31 - 50 years. There was no statistically significant association between sex and the organism cultured for post traumatic and cellulitis (p-value > 0.05). The prevalence of bacterial and fungal infection was 79.3% and 20.7% respectively. Pseudomonas species was the most isolated bacteria (61.5%) while Aspergillus niger was the most isolated fungi (41%). Conclusion: From this study, fungal infections should be included in managing chronic leg ulcers, especially among artisans, famers and gardeners even though there was a significantly higher burden of bacterial infections.

Surgical management of fungal endophthalmitis resulting from fungal keratitis

AIM： To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis （EFE） secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS： The clinical records of 27 patients （27 eyes） with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS： There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% （12/27） of the eyes, followed by Aspergillus in 22% （6/27）. Posterior segment infection was involved in 78% （21127） of the patients. The corneal infection was larger than 3 mmx3 mm in 89% （24/ 27） of the patients, and 22% （6/27） of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes （81.5%） underwent penetrating keratoplasty （PKP）, and over half of them （545%） were operated within 3d from the onset of antifungal therapy. Fourteen eyes （52%） underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes （55.6%） underwent pars plana vitrectomy （PPV）. The rate of the eyes undergoing PPV as the initial surgical procedure was 60% （9/15）, lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes （16/27）, and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes （18.5%） were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil tamponade, two eyes received silicone oil removal, and the other one was eviscerated. CONCLUSION： Fusarium and Aspergillus are the dominant pathogens in EFE resulting from keratitis. Aggressive antifungal surgeries including multiple intravitreal injections, PKP and core vitrectomy （especially in the initial surgery） are helpful procedures to improve prognosis of severe EFE secondary to keratitis.

Effects of Fungal Elicitors on Cell Growth and Artemisinin Accumulation in Hairy Root Cultures of Artemisia annua

The artemisinin accumulation in the hairy root cultures of Artemisia annua L. was enhanced via a treatment of three fungal elicitors separately ( Verticillium dahliae Kleb., Rhizopus stolonifer (Ehrenb. ex Fr.) Vuill and Colletotrichum dematium (Pers.) Grove). Among these three elicitors, V. dahliae had the highest inducing efficiency, but none of them manifests any noticeable effects on the cell growth of the hairy root cultures. The artemisinin content of the hairy root cultures treated with V. dahliae elicitor was 1.12 mg/g DW, which was 45% higher than the control (0.77 mg/g DW). The results showed that elicitation was dependent on the elicitor concentration, the incubation period and the physiological stage at which the hairy root cultures were treated. In addition, the authors found that for V. dahliae , the optimum concentration was 0.4 mg carbohydrate per millilitre medium, the strongest response of A. annua hairy root cultures to the elicitation was at the late exponential growth stage, and the highest artemisinin content of the hairy root cultures was on the 4th day post treatment.

Effects of Acetochlor and Methamidophos on Fungal Communities in Black Soils

Using plate counting and ergosterol assay, single and joint effects of acetochlor and methamidophos on the dynamicsof soil fungal population and total fungal biomass in the black soil zone of Northeast China were investigated. The resultsdemonstrated that acetochlor at high concentration levels (150 and 250 mg kg-1) had an acute and mostly chronic toxicityon both the soil fungal population and total fungal biomass, but at a low concentration (50 mg kg-1) generally had astimulating effect that was stronger with total fungal biomass than with the soil fungal population. Methamidophos ata high concentration level (250 mg kg-1) alone and almost all of its combinations with various dosages of acetochlorincreased the soil fungal population, whereas at most sampling dates with 250 mg methamidophos kg-1 soil, total fungalbiomass increased, but in combination with acetochlor it was decreased in the early period of incubation and then increased28 days after incubation. Thus, through measuring the number of colony forming unit of the soil fungal population alongwith the total fungal biomass, a better understanding on effects of agrochemicals on soil fungi could be made.

Obstructing fungal cholangitis complicating metal biliary stent placement in pancreatic cancer

Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.

Fungal infections following liver transplantation

With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are immune-compromised and have other chronic co-morbid conditions.Despite the recent advances in practice and improvement in diagnostic surveillance and treatment modalities,a major portion of these patients continue to be affected by post-transplant infections.Of these,fungal infections are particularly notorious given their vague and insidious onset and are very challenging to diagnose.This mini-review aims to discuss the incidence of fungal infections following liver transplantation,the different fungi involved,the risk factors,which predispose these patients to such infections,associated diagnostic challenges,and the role of prophylaxis.The population at risk is increasingly old and frail,suffering from various other co-morbid conditions,and needs special attention.To improve care and to decrease the burden of such infections,we need to identify the at-risk population with more robust clinical and diagnostic parameters.A more robust global consensus and stringent guidelines are needed to fight against resistant microbes and maintain the longevity of current antimicrobial therapies.

Endogenous fungal endophthalmitis:risk factors,clinical course,and visual outcome in 13 patients

AIM:To analyze the risk factors,ophthalmological features,treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis(EFE).METHODS:Data retrieved from the medical files included age at presentation to the uveitis clinic,gender,ocular symptoms and their duration before presentation,history of fever,eye affected,anatomical diagnosis and laboratory evidence of fungal infection.Medical therapy recorded included systemic antifungal therapy and its duration,use of intravitreal antifungal agents and use of oral/intravitreal steroids.Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected.RESULTS:Included were 13 patients(20 eyes,mean age 58 y).Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation.In one patient,there was no history of previous intervention.Diagnostic vitrectomy was performed in 16 eyes(80%)and vitreous cultures were positive in 10 of the vitrectomized eyes(62.5%).In only 4 patients(31%),blood cultures were positive.All patients received systemic antifungal therapy.Sixteen eyes(80%)received intravitreal antifungal agent with voriconazole being the most commonly used.Visual acuity(VA)improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last followup(P=0.03).A trend of greater visual improvement was noted in favor of eyes treated with oral steroids(±intravitreal dexamethasone)than eyes that were not treated with steroids.The most common complication was maculopathy.Twelve eyes(60%)showed no ocular complications.CONCLUSION:High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation.Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention.Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.

Untargeted metabolomics to evaluate antifungal mechanism:a study of Cophinforma mamane and Candida albicans interaction

Microbial interactions between filamentous fungi and yeast are still not fully understood.To evaluate a potential anti-fungal activity of a filamentous fungus while highlighting metabolomic changes,co-cultures between an endophytic strain of Cophinforma mamane(CM)and Candida albicans(CA)were performed.The liquid cultures were incubated under static conditions and metabolite alterations during the course were investigated by ultra-performance liquid chromatography-tandem mass spectrophotometry(UPLC-MS/MS).Results were analyzed using MS-DIAL,MS-FINDER,METLIN,Xcalibur,SciFinder,and MetaboAnalyst metabolomics platforms.The metabolites associated with catabolic processes,including the metabolism of branched-chain amino acids,carnitine,and phospholipids were upregulated both in the mono and co-cultures,indicating fungal adaptability to environmental stress.Several metab-olites,including C20 sphinganine 1-phosphate,myo-inositol,farnesol,gamma-undecalactone,folinic acid,palmitoleic acid,and MG(12:/0:0/0:0)were not produced by CA during co-culture with CM,demonstrating the antifungal mecha-nism of CM.Our results highlight the crucial roles of metabolomics studies to provide essential information regarding the antifungal mechanism of C.mamane against C.albicans,especially when the lost/undetected metabolites are involved in fungal survival and pathogenicity.

Effects of Six Kinds of Fungal Elicitors on Growth of Dendrobium hybrida cultivar ‘088' Tissue Culture Seedlings

To optimize the technique of rapid propagation of Dendrobium hybrida seedlings and to explore a hormone-free tissue culture method for D.hybrida,six kinds of mycorrhizal fungi which were isolated from the wild orchids were made into fungal elicitors.These fungal elicitors were added into the DE medium with concentrations of 40,60 and 80 ml/L,respectively.After a 90-d culturing,the effects of fungal elicitors on the growth of D.hybrida cultivar ‘088＇ tissue culture seedlings were studied.The results showed that treatment 13（T13） extremely significantly increased the fresh weight,but other treatment groups had no significant effects.In addition,T1,T5,T9,T11 and T13 extremely significantly influenced the contents of chlorophyll a and chlorophyll a ＋ b.However,T1 and T11 had extremely significantly effect on the content of chlorophyll b.Combining the effects on fresh weight and chlorophyll content,it could be concluded T13（40 ml/L of Y05） has promoting effects on the growth of D.hybrida tissue culture seedlings.

Fungal arthritis:A challenging clinical entity

There has been an increasing incidence of fungal infections in recent years.Rarely joints are also affected by fungal infections.Mainly,these infections develop in prosthetic joints,but sometimes native joints are also involved.Candida infections are mostly reported,but patients may also develop infections secondary to non-Candida fungi,especially Aspergillus.Diagnosis and management of these infections is challenging and may involve multiple surgical interventions and prolonged antifungal therapy.Despite this,these infections are associated with high morbidity and mortality.This review described the clinical features,risk factors,and therapeutic interventions required to manage fungal arthritis.

Intracranial Fungal Infections: Overview from Two Large Tertiary Hospital in Upper Egypt and Literature Review

Purpose: Fungal infections of the central nervous system (CNS) are potentially lethal conditions with high morbidity and mortality. In this review, we summarise the most common clinical manifestations, diagnostic methods, and treatment strategies for intracranial fungal infection at two tertiary care teaching hospitals. Material and methods: Prospective hospital study is carried out at Department of Neurosurgery;Assiut and Suhaj University Hospitals between January2010 to January 2018 (Minimum 12-months follow-up). Radiographs and hospital data of 74 patients with proven intracranial fungal infections were gathered and analyzed. There were no exclusion criteria: age, gender, clinical presentations, immunity status, radiological findings, laboratory, and microbiological data, types of management and outcome. In surgically treated patients, diagnosis was confirmed by pathologic evaluation. Gathered data were coded and entered into a computer and analyzed using SPSS version 22. Results: The greatest number of the patients had 40 to 60 years old (49;66%) and the mean age was 44 years. There was an overwhelming male patient’s ranged preponderance 66%;49 cases. Sixty-three patients (85%) were immunosuppressed;11 cases (15%) were immunocompetent. The most common causes of immunosuppression were diabetes 27 patients;43%, on chemotherapeutic agents 19 patients;31%, on corticosteroid 16 patients;25% and AIDS in one patient;1%. Five different fungal types were identified but Cryptococcus spp. was the most common cause of CNS fungal infection, occurring in 39 patients (53%). This was followed by Candida spp. in 14 patients (19%), Aspergillus in 11 patients (15%), Blastomyces in 7 patients (9%) and Coccidiosis in 3 patients (4%). Headache was the most common presenting symptom, occurring in 33 patients (45%). Other relatively common symptoms were nausea or vomiting 11 patients (15%), fever 10 patients;(13%), seizures 9 patients (12%), acute mental status changes 8 patients;(11%) and stroke like Symptoms 3patients (4%). Different surgical procedures were done. Stereotactic biopsy is in 19 patients (deep;located in an eloquent region of the brain or multiple small lesion) or excision in 38 patients (cortical, relatively accessible regions of the brain), and CSF shunting in 17 patients. All patients received parenteral and, in some cases, oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 52.7% (39 deaths). An additional 8 surviving patients exhibited permanent morbidity due to neurological deficits and seizure disorders. Conclusion: This prospective population study demonstrates an insight into the intracranial fungal infection and management. CNS fungal infections have increased in frequency, particularly in immunocompromised patients;most infections are caused by Cryptococcus spp. Diabetes was the most common cause of immunosuppression and headache was the most common symptom at presentation. CNS fungal infection is still associated with a high mortality and morbidity. Prompt diagnosis;early and appropriate medical and surgical management are fundamental to optimize the outcome.

Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective

Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients,not even the antifungals used for the prophylaxis,neither optimal treatment. We reviewed,in order to focus the epidemiology,characteristics,and,considering the high mortality rate of SFP,the use of optimal empirical antifungal therapy the current literature.