Medical Mycology

Medical mycology addresses fungal organisms that range from benign colonisers of skin and mucosa to agents of life-threatening invasive disease. Fungi inhabit diverse niches and include yeasts (for example Candida and Cryptococcus), moulds (notably Aspergillus and the Mucorales) and thermally dimorphic pathogens (such as Histoplasma and Coccidioides). In healthy hosts most fungi are held in check by intact mucosal barriers, neutrophils and cell-mediated immunity, whereas immunocompromised individuals—those with neutropenia, transplant recipients, advanced HIV/AIDS or on immunosuppressive therapies—are at particular risk of invasive mycoses. Clinical presentations range from superficial dermatophytoses and allergic syndromes to chronic pulmonary infection, bloodstream invasion and disseminated disease involving the central nervous system, bones or deep organs. Diagnosis relies on microscopy, fungal culture, antigen assays, molecular tests and antigen-antibody serology, while treatment is based on polyenes, azoles, echinocandins and adjunctive approaches. Rising antifungal resistance, emergence of multidrug-resistant species such as Candida auris and limitations of current therapies drive ongoing efforts to develop faster diagnostics, novel targets and improved antifungal agents.

Research from Nature Portfolio

Innovative use of matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry has shown that brief exposure of Candida glabrata isolates to echinocandins or azoles yields proteomic fingerprints distinguishing resistant from susceptible phenotypes within three hours, offering a rapid complement to traditional susceptibility testing. In parallel, the actin-binding natural product 19,20-epoxycytochalasin Q was found to disrupt hyphal development and biofilm formation in Candida albicans by fragmenting hyphae, inducing reactive oxygen species accumulation and downregulating key morphogenetic and cyclin-dependent kinase genes, revealing vulnerabilities in cytoskeletal control of pathogenesis.

Medical Mycology publication trend

The graph below shows the total number of articles in medical mycology across all publications each year (not limited to Nature Index journals).

Technical terms

Mycosis: Any disease caused by a fungal pathogen, encompassing superficial, allergic, chronic and invasive forms.

Antifungal susceptibility testing (AFST): In vitro methods (for example broth microdilution or MALDI-ToF MS) that determine fungal isolate sensitivity or resistance to antifungal agents.

Biofilm: A multicellular fungal community embedded in an extracellular matrix that adheres to surfaces and exhibits increased drug tolerance.

Hyphae: Filamentous, multicellular fungal structures that enable tissue invasion, branching networks and biofilm architecture.

MALDI-ToF mass spectrometry: A proteomic technique for rapid microbial identification and resistance profiling based on mass-to-charge signatures of cellular proteins.

References

1. Potential Use of MALDI-ToF Mass Spectrometry for Rapid Detection of Antifungal Resistance in the Human Pathogen Candida glabrata. Scientific Reports (2017).
2. Inhibition of cell cycle-dependent hyphal and biofilm formation by a novel cytochalasin 19,20‑epoxycytochalasin Q in Candida albicans. Scientific Reports (2023).
3. Evolutionary trends in antifungal resistance: a meta-analysis. Microbiology Spectrum (2024).
4. Calcineurin is required for Candida glabrata Pdr1 transcriptional activation. mBio (2023).
5. ABC Transporter Genes Show Upregulated Expression in Drug-Resistant Clinical Isolates of Candida auris: A Genome-Wide Characterization of ATP-Binding Cassette (ABC) Transporter Genes. Frontiers in Microbiology (2019).