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Systemic and Emerging Mycoses

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A special issue of Journal of Fungi (ISSN 2309-608X). This special issue belongs to the section "Fungal Evolution, Biodiversity and Systematics".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 47578

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Special Issue Editors

Prof. Dr. Carlos Pelleschi Taborda

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Guest Editor

Laboratory of Pathogenic Dimorphic Fungi, Departamento de Microbiologia, University of São Paulo, São Paulo, Brazil
Interests: medical mycology; parasite–host relationship; systemic and emerging mycoses
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Joshua Daniel Nosanchuk

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Guest Editor

Departments of Medicine (Division of Infectious Diseases) and Microbiology and Immunology, Albert Einstein College of Medicine, New York, NY, USA
Interests: medical mycology, parasite–host relationship, clinical mycology

Special Issue Information

Dear Colleagues,

The importance of systemic mycoses—either endemic or opportunistic—has increased in recent decades due to the growing number of patients undergoing medical procedures that lead to immunosuppression. Human interference in ecosystems and re-adaptation of wild animals into urbanized areas has modified the spectrum of the mycoses. The 1980s brought several social transformations: With the emergence of the first AIDS cases and better results of transplantation protocols, there was a marked increase in opportunistic mycosis all over the world. These changes led to constant updates in our understanding of the parasite–host relationship as well as new approaches in laboratory diagnosis. This Special Issue will focus on systemic emerging and reemerging mycoses. Studies covering the host–parasite relationship, epidemiological aspects, antifungal resistance, new antifungal drugs, clinical challenges, as well as new technologies for laboratorial diagnosis will be welcome.

Prof. Dr. Carlos Pelleschi Taborda
Prof. Dr. Joshua Daniel Nosanchuk
Guest Editors

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Keywords

systemic emerging and reemerging mycoses
epidemiology
antifungal resistance
new antifungal drugs
laboratorial diagnosis

Published Papers (13 papers)

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Research

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9 pages, 718 KiB

Open AccessArticle

Impact of the SARS-CoV-2 Pandemic in Candidaemia, Invasive Aspergillosis and Antifungal Consumption in a Tertiary Hospital

by Juan Vicente Mulet Bayona, Nuria Tormo Palop, Carme Salvador García, Begoña Fuster Escrivá, Mercedes Chanzá Aviñó, Pilar Ortega García and Concepción Gimeno Cardona

J. Fungi 2021, 7(6), 440; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7060440 - 31 May 2021

Cited by 33 | Viewed by 3073

Abstract

In addition to the increase in fungal infections that has been observed in the last few decades, it has been reported that severe clinical COVID-19 can increase the risk of invasive fungal infections. The main objective of this study was to evaluate if there had been an increase in candidaemia and invasive pulmonary aspergillosis (IPA) cases since the onset of the SARS-CoV-2 pandemic. Data were retrospectively collected from April 2019 to March 2021, from patients admitted to Consorcio Hospital General Universitario de Valencia (Spain). A total of 152 candidaemia cases (56 of which were due to Candida auris) and 108 possible IPA cases were detected. A great increase in candidaemia cases was produced during the first and the third epidemic waves of the SARS-CoV-2 pandemic (June 2020, and January 2021, respectively), while an increase in IPA cases was produced during the third wave. The 28-day mortality rates in patients affected by candidaemia and IPA increased in 2020 and 2021. C. auris has displaced the other Candida species, becoming the most isolated Candida species in blood cultures since the onset of the SARS-CoV-2 pandemic. Antifungal consumption increased in 2020 when compared to 2019, especially echinocandins, voriconazole and isavuconazole. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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21 pages, 5192 KiB

Open AccessArticle

Facile Bio-Fabrication of Ag-Cu-Co Trimetallic Nanoparticles and Its Fungicidal Activity against Candida auris

by Majid Rasool Kamli, Vartika Srivastava, Nahid H. Hajrah, Jamal S. M. Sabir, Khalid Rehman Hakeem, Aijaz Ahmad and Maqsood Ahmad Malik

J. Fungi 2021, 7(1), 62; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7010062 - 18 Jan 2021

Cited by 36 | Viewed by 3671

Abstract

Candida auris is an emergent multidrug-resistant pathogen that can lead to severe bloodstream infections associated with high mortality rates, especially in hospitalized individuals suffering from serious medical problems. As Candida auris is often multidrug-resistant, there is a persistent demand for new antimycotic drugs with novel antifungal action mechanisms. Here, we reported the facile, one-pot, one-step biosynthesis of biologically active Ag-Cu-Co trimetallic nanoparticles using the aqueous extract of Salvia officinalis rich in polyphenols and flavonoids. These medicinally important phytochemicals act as a reducing agent and stabilize/capping in the nanoparticles’ fabrication process. Fourier Transform-Infrared, Scanning electron microscopy, Transmission Electron Microscopy, Energy dispersive X-Ray, X-ray powder diffraction and Thermogravimetric analysis (TGA) measurements were used to classify the as-synthesized nanoparticles. Moreover, we evaluated the antifungal mechanism of as-synthesized nanoparticles against different clinical isolates of C. auris. The minimum inhibitory concentrations and minimum fungicidal concentrations ranged from 0.39–0.78 μg/mL and 0.78–1.56 μg/mL. Cell count and viability assay further validated the fungicidal potential of Ag-Cu-Co trimetallic nanoparticles. The comprehensive analysis showed that these trimetallic nanoparticles could induce apoptosis and G2/M phase cell cycle arrest in C. auris. Furthermore, Ag-Cu-Co trimetallic nanoparticles exhibit enhanced antimicrobial properties compared to their monometallic counterparts attributed to the synergistic effect of Ag, Cu and Co present in the as-synthesized nanoparticles. Therefore, the present study suggests that the Ag-Cu-Co trimetallic nanoparticles hold the capacity to be a lead for antifungal drug development against C. auris infections. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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21 pages, 1814 KiB

Open AccessArticle

Interacting with Hemoglobin: Paracoccidioides spp. Recruits hsp30 on Its Cell Surface for Enhanced Ability to Use This Iron Source

by Aparecido Ferreira de Souza, Mariana Vieira Tomazett, Kleber Santiago Freitas e Silva, Juliana Santana de Curcio, Christie Ataides Pereira, Lilian Cristiane Baeza, Juliano Domiraci Paccez, Relber Aguiar Gonçales, Fernando Rodrigues, Maristela Pereira and Célia Maria de Almeida Soares

J. Fungi 2021, 7(1), 21; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7010021 - 01 Jan 2021

Cited by 7 | Viewed by 2830

Abstract

Paracoccidioides spp. are thermally dimorphic fungi that cause paracoccidioidomycosis and can affect both immunocompetent and immunocompromised individuals. The infection can lead to moderate or severe illness and death. Paracoccidioides spp. undergo micronutrients deprivation within the host, including iron. To overcome such cellular stress, this genus of fungi responds in multiple ways, such as the utilization of hemoglobin. A glycosylphosphatidylinositol (GPI)-anchored fungal receptor, Rbt5, has the primary role of acquiring the essential nutrient iron from hemoglobin. Conversely, it is not clear if additional proteins participate in the process of using hemoglobin by the fungus. Therefore, in order to investigate changes in the proteomic level of P. lutzii cell wall, we deprived the fungus of iron and then treated those cells with hemoglobin. Deprived iron cells were used as control. Next, we performed cell wall fractionation and the obtained proteins were submitted to nanoUPLC-MS^E. Protein expression levels of the cell wall F1 fraction of cells exposed to hemoglobin were compared with the protein expression of the cell wall F1 fraction of iron-deprived cells. Our results showed that P. lutzii exposure to hemoglobin increased the level of adhesins expression by the fungus, according to the proteomic data. We confirmed that the exposure of the fungus to hemoglobin increased its ability to adhere to macrophages by flow cytometry. In addition, we found that HSP30 of P. lutzii is a novel hemoglobin-binding protein and a possible heme oxygenase. In order to investigate the importance of HSP30 in the Paracoccidioides genus, we developed a Paracoccidioides brasiliensis knockdown strain of HSP30 via Agrobacterium tumefaciens-mediated transformation and demonstrated that silencing this gene decreases the ability of P. brasiliensis to use hemoglobin as a nutrient source. Additional studies are needed to establish HSP30 as a virulence factor, which can support the development of new therapeutic and/or diagnostic approaches. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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16 pages, 2017 KiB

Open AccessArticle

Insights into the Multi-Azole Resistance Profile in Candida haemulonii Species Complex

by Laura Nunes Silva, Lívia de Souza Ramos, Simone Santiago Carvalho Oliveira, Lucas Barros Magalhães, Eamim Daidrê Squizani, Lívia Kmetzsch, Marilene Henning Vainstein, Marta Helena Branquinha and André Luis Souza dos Santos

J. Fungi 2020, 6(4), 215; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6040215 - 11 Oct 2020

Cited by 13 | Viewed by 2779

Abstract

The Candida haemulonii complex (C. duobushaemulonii, C. haemulonii, and C. haemulonii var. vulnera) is composed of emerging, opportunistic human fungal pathogens able to cause invasive infections with high rates of clinical treatment failure. This fungal complex typically demonstrates resistance to first-line antifungals, including fluconazole. In the present work, we have investigated the azole resistance mechanisms expressed in Brazilian clinical isolates forming the C. haemulonii complex. Initially, 12 isolates were subjected to an antifungal susceptibility test, and azole cross-resistance was detected in almost all isolates (91.7%). In order to understand the azole resistance mechanistic basis, the efflux pump activity was assessed by rhodamine-6G. The C. haemulonii complex exhibited a significantly higher rhodamine-6G efflux than the other non-albicans Candida species tested (C. tropicalis, C. krusei, and C. lusitaneae). Notably, the efflux pump inhibitors (Phe-Arg and FK506) reversed the fluconazole and voricolazole resistance phenotypes in the C. haemulonii species complex. Expression analysis indicated that the efflux pump (ChCDR1, ChCDR2, and ChMDR1) and ERG11 genes were not modulated by either fluconazole or voriconazole treatments. Further, ERG11 gene sequencing revealed several mutations, some of which culminated in amino acid polymorphisms, as previously reported in azole-resistant Candida spp. Collectively, these data point out the relevance of drug efflux pumps in mediating azole resistance in the C. haemulonii complex, and mutations in ERG11p may contribute to this resistance profile. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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12 pages, 7738 KiB

Open AccessArticle

In Vitro and In Vivo Inhibitory Activity of Limonene against Different Isolates of Candida spp.

by Julián E. Muñoz, Diego C. P. Rossi, Daniela L. Jabes, David Aciole Barbosa, Fernanda F. M. Cunha, Luiz R. Nunes, Denise C. Arruda and Carlos Pelleschi Taborda

J. Fungi 2020, 6(3), 183; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6030183 - 22 Sep 2020

Cited by 28 | Viewed by 4531

Abstract

Commensal yeast from the genus Candida is part of the healthy human microbiota. In some cases, Candida spp. dysbiosis can result in candidiasis, the symptoms of which may vary from mild localized rashes to severe disseminated infections. The most prevalent treatments against candidiasis involve fluconazole, itraconazole, miconazole, and caspofungin. Moreover, amphotericin B associated with prolonged azole administration is utilized to control severe cases. Currently, numerous guidelines recommend echinocandins to treat invasive candidiasis. However, resistance to these antifungal drugs has increased dramatically over recent years. Considering this situation, new therapeutic alternatives should be studied to control candidiasis, which has become a major medical concern. Limonene belongs to the group of terpene molecules, known for their pharmacological properties. In this study, we evaluated in vitro the limonene concentration capable of inhibiting the growth of yeast from the genus Candida susceptible or resistant to antifungal drugs and its capacity to induce fungal damage. In addition, intravaginal fungal infection assays using a murine model infected by Candida albicans were carried out and the fungal burden, histopathology, and scanning electron microscopy were evaluated. All of our results suggest that limonene may play a protective role against the infection process by yeast from the genus Candida. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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14 pages, 2622 KiB

Open AccessArticle

Intranasal Vaccine Using P10 Peptide Complexed within Chitosan Polymeric Nanoparticles as Experimental Therapy for Paracoccidioidomycosis in Murine Model

by Samuel Rodrigues Dos Santos Junior, Francenya Kelley Lopes da Silva, Lucas Santos Dias, Ana Camila Oliveira Souza, Marcelo Valdemir de Araujo, Leandro Buffoni Roque da Silva, Luiz R. Travassos, Andre Correa Amaral and Carlos P. Taborda

J. Fungi 2020, 6(3), 160; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6030160 - 02 Sep 2020

Cited by 13 | Viewed by 3003

Abstract

Paracoccidioidomycosis (PCM) is a granulomatous fungal disease caused by the dimorphic fungal species of Paracoccidioides, which mainly affects the lungs. Modern strategies for the treatment and/or prevention of PCM are based on a Th1-type immune response, which is important for controlling the disease. One of the most studied candidates for a vaccine is the P10 peptide, derived from the 43 kDa glycoprotein of Paracoccidioides brasiliensis. In order to improve its immune modulatory effect, the P10 peptide was associated with a chitosan-conjugated nanoparticle. The nanoparticles presented 220 nm medium size, poly dispersion index (PDI) below 0.5, zeta potential of +20 mV and encapsulation efficiency around 90%. The nanoparticles’ non-toxicity was verified by hemolytic test and cell viability using murine macrophages. The nanoparticles were stable and presented physicochemical characteristics desirable for biological applications, reducing the fungal load and the usual standard concentration of the peptide from 4 to 20 times. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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14 pages, 2669 KiB

Open AccessArticle

Pathogenicity Levels of Colombian Strains of Candida auris and Brazilian Strains of Candida haemulonii Species Complex in Both Murine and Galleria mellonella Experimental Models

by Julián E. Muñoz, Laura M. Ramirez, Lucas dos Santos Dias, Laura A. Rivas, Lívia S. Ramos, André L. S. Santos, Carlos P. Taborda and Claudia M. Parra-Giraldo

J. Fungi 2020, 6(3), 104; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6030104 - 10 Jul 2020

Cited by 18 | Viewed by 3910

Abstract

Candida auris and Candida haemulonii complex (C. haemulonii, C. haemulonii var. vulnera and C. duobushaemulonii) are phylogenetically related species that share some physiological features and habits. In the present study, we compared the virulence of these yeast species using two different experimental models: (i) Galleria mellonella larvae to evaluate the survival rate, fungal burden, histopathology and phagocytosis index and (ii) BALB/c mice to evaluate the survival. In addition, the fungal capacity to form biofilm over an inert surface was analyzed. Our results showed that in both experimental models, the animal survival rate was lower when infected with C. auris strains than the C. haemulonii species complex. The hemocytes of G. mellonella showed a significantly reduced ability to phagocytize the most virulent strains forming the C. haemulonii species complex. Interestingly, for C. auris, it was impossible to measure the phagocytosis index due to a general lysis of the hemocytes. Moreover, it was observed a greater capability of biofilm formation by C. auris compared to C. haemulonii species complex. In conclusion, we observed that C. auris and C. haemulonii complex have different levels of pathogenicity in the experimental models employed in the present study. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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Review

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26 pages, 1014 KiB

Open AccessReview

Epidemiology of Systemic Mycoses in the COVID-19 Pandemic

by María Guadalupe Frías-De-León, Rodolfo Pinto-Almazán, Rigoberto Hernández-Castro, Eduardo García-Salazar, Patricia Meza-Meneses, Carmen Rodríguez-Cerdeira, Roberto Arenas, Esther Conde-Cuevas, Gustavo Acosta-Altamirano and Erick Martínez-Herrera

J. Fungi 2021, 7(7), 556; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7070556 - 13 Jul 2021

Cited by 22 | Viewed by 5015

Abstract

The physiopathologic characteristics of COVID-19 (high levels of inflammatory cytokines and T-cell reduction) promote fungal colonization and infection, which can go unnoticed because the symptoms in both diseases are very similar. The objective of this work was to study the current epidemiology of systemic mycosis in COVID-19 times. A literature search on the subject (January 2020–February 2021) was performed in PubMed, Embase, Cochrane Library, and LILACS without language restrictions. Demographic data, etiological agent, risk factors, diagnostic methods, antifungal treatment, and fatality rate were considered. Eighty nine publications were found on co-infection by COVID-19 and pneumocystosis, candidiasis, aspergillosis, mucormycosis, coccidioidomycosis, or histoplasmosis. In general, the co-infections occurred in males over the age of 40 with immunosuppression caused by various conditions. Several species were identified in candidiasis and aspergillosis co-infections. For diagnosis, diverse methods were used, from microbiological to molecular. Most patients received antifungals; however, the fatality rates were 11–100%. The latter may result because the clinical picture is usually attributed exclusively to SARS-CoV-2, preventing a clinical suspicion for mycosis. Diagnostic tests also have limitations beginning with sampling. Therefore, in the remainder of the pandemic, these diagnostic limitations must be overcome to achieve a better patient prognosis. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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28 pages, 2620 KiB

Open AccessReview

Updates in Paracoccidioides Biology and Genetic Advances in Fungus Manipulation

by Alison Felipe Alencar Chaves, Marina Valente Navarro, Yasmin Nascimento de Barros, Rafael Souza Silva, Patricia Xander and Wagner Luiz Batista

J. Fungi 2021, 7(2), 116; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7020116 - 04 Feb 2021

Cited by 11 | Viewed by 3747

Abstract

The dimorphic fungi of the Paracoccidioides genus are the causative agents of paracoccidioidomycosis (PCM). This disease is endemic in Latin America and primarily affects workers in rural areas. PCM is considered a neglected disease, despite being a disabling disease that has a notable impact on the public health system. Paracoccidioides spp. are thermally dimorphic fungi that present infective mycelia at 25 °C and differentiate into pathogenic yeast forms at 37 °C. This transition involves a series of morphological, structural, and metabolic changes which are essential for their survival inside hosts. As a pathogen, the fungus is subjected to several varieties of stress conditions, including the host immune response, which involves the production of reactive nitrogen and oxygen species, thermal stress due to temperature changes during the transition, pH alterations within phagolysosomes, and hypoxia inside granulomas. Over the years, studies focusing on understanding the establishment and development of PCM have been conducted with several limitations due to the low effectiveness of strategies for the genetic manipulation of Paracoccidioides spp. This review describes the most relevant biological features of Paracoccidioides spp., including aspects of the phylogeny, ecology, stress response, infection, and evasion mechanisms of the fungus. We also discuss the genetic aspects and difficulties of fungal manipulation, and, finally, describe the advances in molecular biology that may be employed in molecular research on this fungus in the future. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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14 pages, 1870 KiB

Open AccessReview

Replicative Aging in Pathogenic Fungi

by Somanon Bhattacharya, Tejas Bouklas and Bettina C. Fries

J. Fungi 2021, 7(1), 6; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7010006 - 25 Dec 2020

Cited by 12 | Viewed by 4129

Abstract

Candida albicans, Candida auris, Candida glabrata, and Cryptococcus neoformans are pathogenic yeasts which can cause systemic infections in immune-compromised as well as immune-competent individuals. These yeasts undergo replicative aging analogous to a process first described in the nonpathogenic yeast Saccharomyces cerevisiae. The hallmark of replicative aging is the asymmetric cell division of mother yeast cells that leads to the production of a phenotypically distinct daughter cell. Several techniques to study aging that have been pioneered in S. cerevisiae have been adapted to study aging in other pathogenic yeasts. The studies indicate that aging is relevant for virulence in pathogenic fungi. As the mother yeast cell progressively ages, every ensuing asymmetric cell division leads to striking phenotypic changes, which results in increased antifungal and antiphagocytic resistance. This review summarizes the various techniques that are used to study replicative aging in pathogenic fungi along with their limitations. Additionally, the review summarizes some key phenotypic variations that have been identified and are associated with changes in virulence or resistance and thus promote persistence of older cells. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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12 pages, 290 KiB

Open AccessReview

Coccidioidomycosis: Changing Concepts and Knowledge Gaps

by Neil M. Ampel

J. Fungi 2020, 6(4), 354; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6040354 - 10 Dec 2020

Cited by 11 | Viewed by 2586

Abstract

Although first described more than 120 years ago, much remains unknown about coccidioidomycosis. In this review, new information that has led to changing concepts will be reviewed and remaining gaps in our knowledge will be discussed. In particular, new ideas regarding ecology and [...] Read more.

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

Other

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9 pages, 12160 KiB

Open AccessCase Report

Acute Pulmonary Histoplasmosis Following COVID-19: Novel Laboratorial Methods Aiding Diagnosis

by Priscila Marques de Macedo, Andrea D’Ávila Freitas, Thiago Prudente Bártholo, Andrea Reis Bernardes-Engemann, Marcos de Abreu Almeida, Fernando Almeida-Silva, Rosely Maria Zancopé-Oliveira and Rodrigo Almeida-Paes

J. Fungi 2021, 7(5), 346; https://0-doi-org.brum.beds.ac.uk/10.3390/jof7050346 - 28 Apr 2021

Cited by 24 | Viewed by 2697

Abstract

The acute form of histoplasmosis usually occurs after the exposition of more than one individual to a common environmental source harboring Histoplasma capsulatum. Here, we present two cases of acute pulmonary histoplasmosis seen within two weeks at a reference center for infectious diseases at Rio de Janeiro, Brazil. The patients did not present a common epidemiologic history for histoplasmosis, however both presented COVID-19 before the onset of histoplasmosis symptoms. Due to the difficulties in the diagnosis of acute histoplasmosis, novel laboratory methods such as Western Blot and PCR were included in the investigation of these cases. Both patients presented negative cultures for H. capsulatum and negative urinary galactomannan. However, they presented H and M bands in the Western blot as well as a positive H. capsulatum DNA detection in sputum. These results were available approximately 36 h after sample collection, fastening the beginning of treatment of one patient. Both patients progressed well with itraconazole treatment. These cases suggest that COVID-19 may facilitate the development of acute pulmonary histoplasmosis and, therefore, clinicians must be aware of this differential diagnosis in patients from endemic areas with fever and coughing after recovery from COVID-19. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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7 pages, 1740 KiB

Open AccessCase Report

Fatal Case of Fungemia by Wickerhamomyces anomalus in a Pediatric Patient Diagnosed in a Teaching Hospital from Brazil

by Vitor Rodrigues Dutra, Leonardo Francisco Silva, Adriana Nazaré Miziara Oliveira, Emília Freitas Beirigo, Vanessa Mello Arthur, Raíssa Bernardes da Silva, Thatiana Bragine Ferreira, Leonardo Andrade-Silva, Marcos Vinícius Silva, Fernanda Machado Fonseca, Mario León Silva-Vergara and Kennio Ferreira-Paim

J. Fungi 2020, 6(3), 147; https://0-doi-org.brum.beds.ac.uk/10.3390/jof6030147 - 25 Aug 2020

Cited by 12 | Viewed by 3610

Abstract

In recent decades, emerging fungal infections have changed the clinical mycology scenario as a consequence of the advances in medical diagnostics and therapeutic procedures, long hospitalization times, and the growing number of individuals with debilitating chronic diseases and impaired immune systems. This report presents a 19 months old Brazilian female patient who developed a severe fungal sepsis by an uncommon yeast. She was admitted at the intensive care unit with severe pneumonia, bronchopulmonary dysplasia, and weight-for-age z score of less than −2. She remained more than 30 days in the intensive care unit where she had a femoral venous catheter placement, enteral nutrition, broad-spectrum antibiotic therapy, and prophylaxis with fluconazole. Moreover, pericardiocentesis was performed due to cardiac tamponade. She had a previous history of prematurity, cardiac surgery due to patent ductus arteriosus, and a long period of hospital stay. Despite the antifungal prophylaxis, two yeast isolates were recovered from blood and then identified by classical mycological methods and internal transcribed spacer (ITS) sequencing as Wickerhamomyces anomalus. Both isolates exhibited susceptibility to amphotericin B, ketoconazole, itraconazole, voriconazole, and fluconazole. Her clinical state worsened, presenting anasarca, epistaxis, and hemorrhagic suffusions in the mouth, sclera, oliguria, and bradycardia. Two days after the first positive culture, she presented a gradual reduction of the white blood cells count, with severe leukopenia and neutropenia. She died five days after. Full article

(This article belongs to the Special Issue Systemic and Emerging Mycoses)

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