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NEWSLETTER - March 2026
Welcome to the new LIFE Worldwide quarterly newsletter. We aim to bring you the latest developments in the world of Medical Mycology, including breaking news, diagnostic innovations and literature reviews. |
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Is voriconazole superior to itraconaazole in chronic pulmonary aspergillosis treatment? |
A recent Indian study has shown that there is no difference in the proportion of patients with chronic pulmonary aspergillosis (CPA) who experience a favourable response following treatment with either itraconazole or voriconazole. The study also found similar rates of relapse in chronic pulmonary aspergillosis across the two groups. However, significantly more adverse events were associated with voriconazole compared with itraconazole. Find more here. |
Fungal ball of the sinus – usually a benign long-term course without surgery
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An Israeli retrospective study has opined that upfront surgical intervention for asymptomatic fungal ball (FB) in elderly patients may not be mandatory. The authors suggested clinical and imaging follow-up as a reasonable plan. Of the 108,360 head CT scans evaluated in the study, a fungus ball was identified in the sinuses of 83 patients; only 5 (6%) of the 83 underwent endoscopic surgery, and none had open surgery. Follow-up scans were done in 49 patients at least 6 months later, and some as long as 11 years later (median 4 years). In 29 (59.2%), there was no change and in 5 (10.2%), there was a decreased opacity within the sinus. Increased opacity within the sinus was seen in 13 (26.5%), and increased opacity outside the sinus in 2 (4.1%). Find more here. |
Is the prognosis of patients with fungal keratitis better with natamycin 5% plus voriconazole 1% combined compared with natamycin monotherapy?
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A clinical trial conducted in India has reported that adjunctive topical voriconazole did not significantly improve clinical outcomes compared with natamycin 5% monotherapy. Di Zazzo and colleagues compared complete ulcer resolution with medical therapy and time to epithelial healing amongst 108 adults randomised 1:1 to receive either natamycin 5% plus voriconazole 1% (combination therapy) or natamycin 5% plus placebo (monotherapy): 79.2% of participants in the combination group had complete healing, compared with 76.1% in the monotherapy group (p = 0.7). The median time to epithelial healing was 38 days for combination therapy and 39 days for monotherapy (p=0.86). Better visual outcomes (p=0.048) and lower rates of corneal perforation were documented for non-Aspergillus (Fusarium) cases using natamycin monotherapy. Find more here. |
Albumin binding of fatty acids protects mammals from pulmonary mucormycosis.
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The immune defence against mucormycosis has long been assumed to be similar to that against other mould infections, but this is not the case. A remarkable piece of translational pathogenesis work coordinated by Georgios Chamilos at the University of Crete in Greece, convincingly demonstrates that circulating albumin bound to a multitude of unoxidized fatty acids in the body, is the major protection from infection by the ubiquitous Mucorales fungi. However, this pertains especially to pulmonary mucormycosis – whether it is also true for rhino-orbitocerebral or renal mucormycosis remains unclear. Pertinent findings included loss of inhibition of Rhizopus in vitro when fatty acids are removed but restored with the addition of oleic acid. In addition, fatty acids turn off at least 2 virulence determinants in Mucorales – CotH invasins and the mycotoxin mucoricin. Find more here. |
Should invasive pulmonary aspergillosis in patients with liver failure preclude liver transplant?
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A Chinese study has reported high mortality figures in patients with invasive pulmonary aspergillosis (IPA) post liver transplant, despite antifungal therapy in 67% of the cases. Mortality in patients with IPA compared with those without IPA was 38.1% vs 10.5% at 3 months (p = 0.049) and 42.9% vs 10.5% at 12 months (p = 0.026), respectively. However, in contrast with other studies that documented worse outcomes in non-transplant series (Gustot et al and Lahmer et al), IPA in patients on the transplant waiting list need not be a contraindication to transplantation, but the outcomes may be suboptimal compared with those being transplanted without IPA. Find more here. |
Isavuconazole, a suitable alternative for first-line treatment of invasive fungal disease in children
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The safe and effective use of isavuconazole in the treatment of invasive fungal disease (IFD) in the paediatric age group has been demonstrated in a Spanish multicentre study. Isavuconazole was used primarily as a second-line treatment in 64 patients (67%), mainly due to toxicity from previous antifungals (27/64 patients, 42%) and therapeutic failure (24/64 patients, 37%). The study also reported isavuconazole use as a first-line treatment in 31 patients (34%), mainly due to its favourable safety profile (18/31 patients, 58%) and less variable pharmacokinetics (11/31 patients, 35%). 60% favourable response was seen in 53 patients with proven/probable IFD, and of the twelve patients who received isavuconazole as prophylaxis, none developed breakthrough IFD. Find more here.
The seemingly favourable outcomes (lower mortality rates) in the index study were despite the significant association observed between sequential organ failure assessment score, septic shock, and concomitant bacterial pneumonia with 30-day mortality. Similarly, prior hospitalization, sequential organ failure assessment score and septic shock were significantly associated with 90-day mortality, which paradoxically did not increase the risk of unfavourable prognosis as documented in previous studies. Find more here. |
Nosocomial transmission of Candida auris blocked in the Netherlands by infection control.
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A retrospective study from the Netherlands has reported a total of 26 isolates (cases) of C. auris, from first appearance in 2018 to 2025; two cases were invasive infections, while the remaining twenty-four cases were regarded as colonisation. The evidence is provided by the underlying data from whole genomic sequencing of isolates, available travel history, and information on contact tracing, which showed patients (cases) had recently travelled internationally, and all but one had been admitted to a foreign hospital. Frequent travel destinations included Greece, India, Turkey and South Africa, countries known to have a high prevalence of C. auris. All patients were admitted to single room isolation, and all but one remained there for the duration of their hospitalisation. The study clearly demonstrates the effectiveness of infection control practices and policies in preventing nosocomial transmission of infectious diseases. Find more here. |
Aspergillus IgG levels, a predictive tool for relapse in chronic pulmonary aspergillosis patients
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Tackling relapse in chronic pulmonary aspergillosis (CPA) may now be considered a surmountable challenge, as a recent study evidently demonstrates the presence of Aspergillus sensitisation and a higher Aspergillus-specific IgG titre at completion of antifungal treatment as predictors of relapse. In addition, as no significant association was found between relapse and underlying lung conditions such as chronic obstructive pulmonary disease or prior tuberculosis, the study also suggests the fungal burden in the airways as a more important determinant of CPA relapse than associated comorbidities or underlying disease conditions. Find more here. |
Recent cases indicate that both sporotrichosis and blastomycosis can be vector-borne diseases.
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While risk factors of invasive fungal infections (IFIs) remain a vital tool for a probable diagnosis, recent studies strongly suggest there could be other routes to the transmission of some IFIs. Fourteen cases of non-feline sporotrichosis linked with insect bites were identified in a systematic review spanning over four decades. The mechanism underlying this is seemingly unclear; whether they inoculate the infectious agent or merely facilitate its entry through the bite or sting. Further studies would be needed to ascertain whether this is a direct zoonotic transmission or an environmental exposure mediated by animal contact.
Liu and colleagues reported a Chinese-Canadian girl with primary cutaneous blastomycosis initially diagnosed with insect bite dermatitis. A poor response to treatment prompted a further investigation of the skin nodules, which showed spherical yeast cells with doubly refractile walls and single broad-based budding on microscopy but later identified by metagenomic next- generation sequencing (mNGS) as Blastomyces dermatitidis, and subsequently confirmed by fungal culture and ITS sequencing. |
A proven diagnosis of invasive mycosis relies on histopathology showing hyphae in tissue. A representative specimen, optimal staining and the experience of the microscopist are together all important.
Russell Goldman and colleagues retrospectively analysed the results from skin biopsies of 411 immunocompromised patients over 15 years performed at Brigham and Women’s Hospital, Boston, Massachusetts, USA. Fungal histochemical stains had moderate sensitivity: periodic acid Schiff stain with diastase (50%) and methenamine silver stain, (62%) compared to fungal culture, and a high specificity and strong negative predictive value. Gram stain had a low sensitivity for bacteria (34%), and Ziehl-Neelsen stain only 50%. Find more here. |
RECENT GUIDELINES added to LIFE
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LIFE Worldwide is a no-cost resource provided by the Fungal Infection Trust (UK), providing trusted up-to-date information on human fungal disease. Please pass this newsletter on to others who might be interested and encourage them to sign up for the next edition here: signup.ymlp.com/xgjyeqqegmguu |
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