Fungal Infections Research Articles

Comparative phytochemical profile and biological activity of three Terminalia species as alternative antimicrobial therapies

Ethnopharmacological relevanceMedicinal plants can help combat antibiotic resistance by providing novel, active molecules. Three plant species of the Terminalia genus are widely used in traditional medicine in the Mouhoun region for the treatment of cutaneous and respiratory diseases. Therefore, it is important to determine the ethnopharmacological potential of bark extracts from the trunks of these three Terminalia species. Aim of the studyThis study compared the phytochemical and biological activities of extracts from three Terminalia species to determine their ethnopharmacology. Materials and methodsThe medicinal properties of the extracts were assessed based on their ability to inhibit the growth of the following microorganisms: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans, Candida krusei, Candida glabrata, and Candida tropicalis. The significant interest in these medicinal plants among the local communities were elucidated by their antioxidant properties and phytochemical composition, along with the detection key bioactive compounds. Major phytochemical groups and phenolic compounds were determined using high-performance liquid chromatography with a diode array detector. These phytochemical findings were validated by evaluating the antioxidant capacity of the extracts using DPPH, FRAP, and ABTS assays. ResultsHydroethanolic, ethanolic, and hexane extracts from the bark of three Terminalia species inhibited the growth of both bacteria and fungi, as evidenced by their minimum inhibitory concentrations (MICs).The findings showed that Terminalia species were most effective against various tested bacteria and fungi, with MICs ranging from 0.1 to 6.25 mg/mL. Terminalia avicennioides, Terminalia macroptera, and Terminalia laxiflora extracts demonstrated 50 % inhibition of DPPH at concentrations ranging from 0.04 to 0.6 mg/mL. Phytochemical analysis revealed the presence of several families of chemical compounds, such as total phenolics and flavonoids. Phenolic compounds identified by HPLC in ethanolic extracts of T. avicennioides, such as isorhamnetin, quercetin, and ferulic acid, are recognised for their antimicrobial and antioxidant properties. ConclusionThese findings establish an ethnobotany for these three Terminalia species, with their chromatographic characteristics facilitating the identification of key molecules of interest. The ethanolic extract of T. avicennioides can be used in phytomedicinal formulations against bacterial (P. aeruginosa and S. aureus) and fungal (C. albicans and C. glabrata) infections, both of which are recurrently recorded in certain skin and respiratory tract diseases.

Clinical characteristics and decortication outcomes of bacterial, tuberculous and fungal pleural infection.

<sec><title>BACKGROUND</title>Pleural infection leading to empyema is a severe condition marked by accumulated infected fluid in the pleural space. Pneumonia with parapneumonic effusion is its most common precursor. The global incidence of pleural infections has increased significantly, with existing literature mainly focusing on bacterial empyema, leaving a gap in comparative analyses.</sec><sec><title>METHOD</title>A retrospective review was conducted on 561 cases of bacterial, tuberculous, and fungal empyema over a 10-year period. The study compared and analysed overall survival rates, 30-day mortality rates after surgery, and clinical characteristics.</sec><sec><title>RESULTS</title>The three empyema groups displayed distinct clinical characteristics. Fungal empyema had the worst overall survival compared to bacterial and tuberculous empyema, which had similar survival rates based on 30-day and 2-year mortality. Fungal empyema, advanced age, and high Charlson Comorbidity Index (CCI) score were independent predictors of poor prognosis.</sec><sec><title>CONCLUSION</title>Fungal empyema has the highest mortality rate post-decortication surgery. Advanced age and high CCI score are independent predictors of poor prognosis.</sec>.

Clearing the Air: Acute Invasive Fungal Rhinosinusitis in Hematologic Cancer Patients.

Air quality has been shown to impact the rates of fungal infection of the airway, causing diseases such as acute invasive fungal rhinosinusitis (AIFRS), particularly in immunocompromised patients. We theorize that patients with hematologic malignancies in units with aging air handling units (AHUs) have a higher attack rate of AIFRS. Retrospective chart review identified patients with hematologic malignancy and AIFRS in two distinct and equal time periods between 2013 and 2022, representing the presence of aging AHUs and new AHUs, respectively. Cubic feet per minute (CFM) air flows, AIFRS attack rates, and clinical data were compared between the two groups and statistical analyses performed. The older AHUs produce air flow of 27,610 CFM and the newer AHUs produce air flow of 80,000 CFM. There were 18 patients with air supplied by older AHUs and 7 patients with air supplied by new AHUs who developed AIFRS. There was a significantly higher AIFRS attack rate for patients supplied by the older AHUs compared with patients supplied by newer AHUs (p = 0.033). The patients supplied by the older AHUs tended to be younger. The white blood cell counts, absolute neutrophil counts, and the mean time to diagnosis did not differ between the two groups. To our knowledge, this is the first study to examine AIFRS in immunocompromised patients' inpatient environment. Further research should explore whether higher CFM AHUs can decrease this disease among our most vulnerable patients. 3 Laryngoscope, 134:4466-4470, 2024.

Construction of calcium zirconate nanoparticles confined on graphitic carbon nitride: An electrochemical detection of diethofencarb in food samples

A well-known fungicide designated diethofencarb (DFC) is used on crops to eradicate fungal infections and increase agricultural production. However, the National Food Safety Standard has established an overall maximum residual limit of 1 mg/kg for DFC, and excessive usage of this chemical has detrimental effects on the environment in real-time. In this work, an improved electrochemical sensor based on hydrothermally synthesized CaZrO3 is incorporated into a g-C3N4 sheet and developed to quickly and accurately screen DFC, a well-known carbamate fungicide. The electrochemical sensor that was successfully designed demonstrated good conductivity, high ion diffusion parameters, a high electro-active surface area, and a quick electron transport ratio when used for DFC detection. The structure, crystalline accuracy, and purity of the as-prepared CaZrO3@g-C3N4 were examined using various analytical and microscopic techniques. Additionally, the cyclic voltammetry technique examined the electrochemical investigations of the CaZrO3@g-C3N4 modified glassy carbon electrode (GCE). A robust synergistic interaction between the CaZrO3 and g-C3N4 makes large surface areas and improved DFC detection possible. The fabricated sensor exhibits a wide linear range of 0.01–230.04 μM, a low detection limit of 1.8 nM, and excellent stability according to the results of the DPV technique. Remarkably, our proposed sensor has proven to be feasible for real-time analysis and can distinguish DFC-spiked various food samples with a good recovery range.

P31 Navigating complex infections in systemic lupus erythematosus: a lupus flare complicated with neutropenic sepsis and a rare fungal infection by Magnusiomyces clavatus

P31 Navigating complex infections in systemic lupus erythematosus: a lupus flare complicated with neutropenic sepsis and a rare fungal infection by Magnusiomyces clavatus

Mucormycosis and COVID-19: Unraveling the Interplay of Fungal Infection in a Global Health Crisis: An Overview.

The healthcare system has been greatly affected by the COVID-19 pandemic, result-ing in an increase in secondary and co-infections among patients. Factors like pulmonary dam-age and weakened immune systems make patients more susceptible to fungal infections. Mu-cormycosis, an opportunistic fungal infection, prospers in environments with limited oxygen, and elevated glucose levels due to conditions such as diabetes and steroid use, as well as in acidic environments from metabolic acidosis and diabetic ketoacidosis, where it demonstrates heightened germination ability. Recognizing these complications is critical to minimize harm to patients. The insights gained from this review can improve our understanding of how fungal infections develop in connection to COVID-19, leading to better predictive algorithms, tailored care plans, enhanced antifungal treatments, quicker diagnostics, and improved management strategies.

Fungal disease incidence and prevalence in Iraq – Preliminary estimates

BackgroundThe surveillance of serious and superficial skin fungal infections in Iraq has not been conducted. Limited information exists on their incidence and prevalence. ObjectivesThis study aimed to analyze, compute and estimate the prevalence and burden of fungal infections, as no previous data is available and no studies has been attempted in Iraq. MethodsIn the present study the data were collected and reviewed from published data on epidemiology of fungal infections nationally, internationally, from unpublished postgraduate master and PhD theses, hospital records and private clinic records. External sources of data from other countries were used for diseases which lacked sufficient local data. ResultsWe estimated 985,628 annual serious infections comprising of 2.26 % of the total population. When including superficial fungal infections group of the skin, this rises to 2,075,113 infections at 4.76 % of the total population. The most common serious and skin infections were recurrent Candida vaginitis, fungal rhinosinusitis and tinea capitis comprising 61.5 %, 21.8 %, and 22.4 % of all infections although the total incidence of superficial fungal infections was also high at 1,071,485. Respiratory fungal disease is also common comprising 14.0 % of infections. We predicted the following annual burden per 100,000; oral candidiasis at 247.9, esophageal candidiasis at 6.04, candidemia at 5.0, Candida peritonitis at 0.75, recurrent Candida vaginitis at 5461, allergic bronchopulmonary aspergillosis at 35, severe asthma with fungal sensitisation at 46, invasive aspergillosis at 7.9, chronic pulmonary aspergillosis at 11.7, chronic fungal rhinosinusitis at 496, mucormycosis at 0.99, fungal keratitis at 14.0, and total dermatophytosis at 1631, the most severe being tinea capitis at 366. Many of these estimates were made with data sourced from other nations, so additional data from Iraq is required to validate or modify these estimates. ConclusionRecurrent Candida vaginitis, fungal rhinosinusitis, and tinea capitis are considered to be the most frequent fungal diseases present in Iraq.

Degradative potential of laccase and manganese peroxidase to mycotoxins on infected maize grains by fungi with docking interaction studies

Fungal infection in agricultural grains is a global problem, particularly if it is accompanied by mycotoxin production. In this study, the degradation of mycotoxins by laccase and manganese peroxidase was investigated. Aspergillus flavus, Aspergillus fumigatus, and Fusarium graminearum were recorded in infected maize grains. Aflatoxin B1 (AF B1) was detected (from 3.38 to 2.60 ppm) on the infected samples by fungi compared to other detected aflatoxins. Trichothecene (T-2) toxin and deoxynivalenol (DON) were recorded with concentrations ranging from 0.464 to 0.184 ppm and 0.370 to 0.214 ppm, respectively. The addition of laccase and manganese peroxidase to the inoculated medium with A. flavus and F. graminearum individually degraded the produced AF B1, B2, G1, G2, T-2 toxin, and DON from 5.0, 1.33, 0.76, 0.61, 0.63, and 0.38 ppm to 2.77, 0.66, 0.37, 0.15, 0.45, and 0.38 ppm using laccase, to 3.08, 1.25, 0.61, 0.39, 0.55, and 0.36 ppm using manganese peroxidase. The computational technique (docking) demonstrated the laccase and manganese peroxidase activities on aflatoxin and DON degradation. Consequently, the results suggested that laccase (PDB ID: 1HFU) and manganese peroxidase (PDB ID: 1MNP) promise innovative activity toward aflatoxin degradation, while 1HFU has more effect than 1MNP on DON degradation.

CAF to the rescue! Potential and challenges of combination antifungal therapy for reducing morbidity and mortality in hospitalized patients with serious fungal infections

Abstract The global burden of invasive fungal disease (IFD) is substantial and escalating. Combination antifungal therapy (CAF) may improve patient outcomes by reducing development of resistance, improving drug penetration and rate of fungal clearance, and allowing for lower, less toxic antifungal drug doses; yet, increased cost, antagonism, drug-drug interactions, and toxicity are concerns. Clinical practice guidelines recommend antifungal monotherapy, rather than CAF, for most IFDs due to a lack of comparative randomized clinical trials. An examination of the existing body of CAF research should frame new hypotheses and determine priorities for future CAF clinical trials. We performed a systematic review of CAF clinical studies for invasive candidiasis, cryptococcosis, invasive aspergillosis, and mucormycosis. Additionally, we summarize findings from animal models of CAF and assess laboratory methods available to evaluate CAF efficacy. Future CAF trials should be prioritized according to animal models showing improved survival and observational clinical data supporting efficacy and safety.

Suspected nocardiosis in an immunosuppressed patient: a case report highlighting diagnostic challenges and management strategies

Nocardiosis is a rare but potentially fatal opportunistic infection caused by Nocardia species, predominantly affecting immunocompromised individuals. This case report details the clinical course, diagnostic workup, and management of a 63-year-old female with a history of renal transplantation. Initial investigations, including imaging studies, revealed multiple cavitary pulmonary nodules and a solitary brain lesion, raising concerns for disseminated infection. The diagnostic challenge was compounded by the broad differential diagnosis in this patient population, including fungal, mycobacterial, and other opportunistic infections. Empirical antimicrobial therapy was initiated, and subsequent microbiological confirmation of Nocardia asteroides from bronchoalveolar lavage specimens established the diagnosis. Despite initial therapeutic response, the patient developed worsening neurological symptoms indicative of CNS involvement, necessitating prolonged treatment with a combination of trimethoprim-sulfamethoxazole and imipenem. This report underscores the importance of early recognition, comprehensive diagnostic evaluation, and individualized therapeutic approaches in managing suspected nocardiosis in immunocompromised patients. Furthermore, it discusses the diagnostic pitfalls, highlights the need for a high index of suspicion, and reviews current therapeutic recommendations for both pulmonary and disseminated nocardiosis, providing a valuable reference for clinicians managing similar cases.

CRISPR-Cas9: A Cutting-edge Genome-editing Technology with Many Potential Applications

Unregulated human activities are responsible for climate change which is a major factor for the emergence of new infectious (bacterial, viral, fungus, and parasitic) and non-infectious diseases (genetic disorders, cancers, etc.). To tackle this situation, we must have better therapeutics, diagnostics, and vaccines for the treatment and prevention of emerging diseases in humans and animals. To address the aforementioned issues, CRISPR-Cas9, a revolutionary genome editing tool, can help us develop better therapeutics, diagnostics, and vaccines in a short time. In addition, it can be used to achieve food security by improving productivity, adaptability, and resilience traits in plants and animals. In nature, most bacteria and archaea have CRISPR as a part of their adaptive immune system that helps bacteria defend themselves from phages, viruses, and other foreign genetic elements. CRISPR-Cas9 is a highly effective, simple, and accurate genome editing tool compared to previous genome editing tools such as meganucleases, Zinc finger nucleases (ZFNs), and transcription activators like effector nucleases (TALENs). This review article discusses the different components and working of the CRISPR-Cas9 system, and how CRISPR-Cas9 plays a significant role in the development of next-generation therapeutics, diagnostics, vaccine platforms, and improved crops and livestock species for food security.

Clinical Recommendations for Managing Genitourinary Adverse Effects in Patients Treated with SGLT-2 Inhibitors: A Multidisciplinary Expert Consensus

Background: SGLT-2 inhibitors (SGLT-2is) are considered to be a first-line treatment for common conditions like type 2 diabetes, chronic kidney disease, and heart failure due to their proven ability to reduce cardiovascular and renal morbidity and mortality. Despite these benefits, SGLT-2is are associated with certain adverse effects (AEs), particularly genitourinary (GU) events, which can lead to treatment discontinuation in some patients. Preventing these AEs is essential for maintaining the cardiorenal benefits of SGLT-2is. Methods: A multidisciplinary panel of experts from various medical specialties reviewed the best available evidence on GU AEs associated with SGLT-2i therapy. The panel focused on the prevention and management of genital mycotic infections, urinary tract infections, and lower urinary tract symptoms in both the general population and high-risk groups, such as renal and cardiac transplant recipients. Results: The panel found that permanent discontinuation of SGLT-2is results in a rapid loss of cardiorenal benefits. Preventive strategies, including identifying high-risk patients before initiating therapy, are critical for minimizing GU AEs. Clinical trials show that most GU infections linked to SGLT-2i therapy are mild to moderate in severity and typically respond to standard antimicrobial treatment, without the need for discontinuation. Conclusions: Routine discontinuation of SGLT-2is due to GU AEs is not recommended. Therapy should be resumed as soon as possible, unless severe or persistent conditions contraindicate their use, in order to preserve the significant benefits of SGLT-2is in reducing cardiovascular and renal events

Feline sporotrichosis: occurrence in the Metropolitan Region of the municipality of Recife and anatomical distribution of lesions on cats’ body

Sporotrichosis is a fungal infection of worldwide importance caused by a saprophyte fungus of the genus Sporothrix. The objective of this study was to report the occurrence of feline sporotrichosis in the Metropolitan Region of the city of Recife and the anatomical distribution of lesions on the bodies of cats. Stray cats (n=100) with suggestive sporotrichosis lesions were examined. Material from the lesion was collected from all patients using an imprint and/or sterile swab for cytology. The material was placed on a glass slide and stained using rapid panoptic staining. Data on the localization of each skin lesion were recorded, and cigar-shaped yeast structures were searched at the microscopical examination. A heat map graphically represented the anatomical distribution of each lesion. In 70% (70/100) of samples were visualized fungal structure compatible with Sporothrix spp. There was a predominance of positive males (?2=6.691; p=0.0097). Skin lesions related to Sporothrix spp. infections were unevenly distributed throughout the animal's body. Based on the interpolation of data, the chance for detecting lesions was higher on the nose, anterior paw, and ears than on other body sites (H=40.0043; p=0.0000). Because of the high positivity in these cats, measures of health vigilance are imperative to reduce the risk of animal and human infection.

Epidermal growth factor receptor signaling governs the host inflammatory response to invasive aspergillosis.

The epidermal growth factor receptor (EGFR) has been identified as an epithelial cell receptor for Mucorales fungi and Candida albicans. Blocking EGFR with small molecule inhibitors reduces disease severity in mouse models of mucormycosis and oropharyngeal candidiasis. In contrast, cases of invasive aspergillosis have been reported in cancer patients who were treated with EGFR inhibitors, suggesting that EGFR signaling may play a protective role in the host defense against this infection. Here, we analyzed transcriptomic data from the lungs of mice with invasive aspergillosis and found evidence that Aspergillus fumigatus infection activates multiple genes that are predicted to function in the EGFR signaling pathway. We also found that A. fumigatus infection activates EGFR in both a human small-airway epithelial (HSAE) cell line and in the lungs of immunosuppressed mice. EGFR signaling in HSAE cells is required for maximal endocytosis of A. fumigatus and for fungal-induced proinflammatory cytokine and chemokine production. In a corticosteroid immunosuppressed mouse model of invasive pulmonary aspergillosis, inhibition of EGFR with gefitinib decreased whole-lung cytokine and chemokine levels and reduced accumulation of phagocytes in the lung, leading to a decrease in fungal killing, an increase in pulmonary fungal burden, and accelerated mortality. Thus, EGFR signaling is required for pulmonary epithelial cells to orchestrate the host innate immune defense against invasive aspergillosis in immunosuppressed hosts.IMPORTANCEWhen A. fumigatus infects the lungs, it invades epithelial cells that line the airways. During this process, the fungus interacts with epithelial cell receptors. This interaction stimulates epithelial cells to endocytose the fungus. It also induces these cells to secrete proinflammatory cytokines and chemokines that recruit phagocytes to the site of infection where they can kill the fungus. Here, we show that in small-airway epithelial cells, the EGFR acts as a sensor for A. fumigatus that triggers the production of chemokines in response to fungal infection. In corticosteroid-immunosuppressed mice, blocking EGFR with the kinase inhibitor gefitinib reduces chemokine production in the lungs. This leads to decreased accumulation of neutrophils and dendritic cells in the lungs, reduced A. fumigatus killing, and increased mortality. These results provide a potential explanation as to why some cancer patients who are treated with EGFR inhibitors develop invasive aspergillosis.

Spectrum and Antifungal Drug Resistance among Fungal Pathogens Isolated from Prison Inmates in Nairobi, Kenya

Background The emergence of antifungal resistance in fungal pathogens highlights the need for local epidemiological data to guide empirical therapy in clinical settings. Fungal research and anti-fungal drug resistance studies are limited in developing countries; hence, there is a need for burden estimation in low- and middle-income countries. This study aimed to determine the spectrum of fungal pathogens and the anti-fungal resistance profile of fungal pathogens isolated from the respiratory and urinary tracts of prison inmates in Nairobi, Kenya. Methods A cross-sectional study was conducted in which sputum and urine samples were obtained from inmates presenting with symptoms of respiratory and urogenital infections at a prison outpatient clinic. One hundred and sixty-two samples were collected and subjected to fungal investigation using standard protocols. Susceptibility to fluconazole, itraconazole, and voriconazole was assessed using standard broth microdilution. Clinical and sociodemographic data were obtained using a structured questionnaire. Results From the 162, 94 samples were positive for fungal pathogens, with an overall prevalence of 58%. Seventeen (18%) of the isolated fungi were Aspergillus fumigatus, Aspergillus flavus and Histoplasma. There was a statistically significant difference between fungal pathogens isolated from the respiratory and urogenital tracts in both sexes (p&lt;0.05). Antifungal susceptibility testing against itraconazole showed 2 of Aspergillus flavus and Aspergillus fumigatus were resistant. Conclusion Mycological agents are significant causes of respiratory and UTI infections among prison inmates, which could be attributed to prison conditions and misdiagnosis as bacterial infections. This highlights the need for specific control measures to reduce exposure to fungal infections in prisons and in the general population.

Yeast-contaminated water as a potential emerging health concern: a review

Invasive fungal infections pose a serious risk to human health; therefore, it is important to study the dissemination and proliferation of pathogenic fungal species in the environment. This could prove useful in preventing infections in susceptible individuals, such as those who are immune-compromised or suppressed. Pathogenic yeasts belonging to the genera Candida, Cryptococcus and Rhodotorula are commonly found in various water sources that are used for daily activities and are included in the World Health Organization fungal priority pathogens list, further warranting investigation into the possibility that infections may occur through contact with yeast-contaminated water. In addition, the close association between antifungal pollutants and yeast in water may induce acquired antifungal resistance development, further complicating the effective treatment of these infections. Thus, investigating the presence and antifungal susceptibility of yeast found in water and identifying ways to monitor potential fungal pathogens may prove useful in combating invasive fungal infections. This review deals with the occurrence and infection risks posed by pathogenic yeasts in water as well as the possibility of these yeasts acquiring antifungal resistance due to the simultaneous presence of antifungal compounds from medical and agricultural runoff.

Superficial Dermatomycosis in Primary Care in the Ecuadorian Andean Region: Clinical Presentation and Therapeutic Approaches

Dermatomycosis encompasses a spectrum of fungal infections caused by filamentous fungi, predominantly dermatophytes, affecting humans and animals. This article presents various cases of dermatomycosis along with their respective treatments.

Clinically Cure with Oral Fluconazole of a Wide Spread Tinea Corporis in Immunocompromised Patient

Tinea Corporis is a commonly superficial fungal infection that mainly affects the skin either immunocompetent or immunocompromised host. Widespread Tinea corporis has been rarely reported. We report an extensive superficial fungal infection with a successful clinical cure with oral Fluconazole. A 38-year- old male presented generalized acuate and annular elevated erythematous scaly border with central clearing distribute on the trunk, both hand and leg. The blood test was confirmed positive for human immunodeficiency virus. KOH preparation was requested which was shown a positive result. The diagnosis was widespread tinea corporis. He was misdiagnosed and received inappropriate treatment with various topical steroid and systemic antihistamine and steroid for several months without any improvement. We emphasized the necessary mycological intervention that enables fast and provides the correct diagnosis and thus medical care. Furthermore, in extensive skin lesions immunocompromised comorbidity should be requested. Mycology detection such as fungal culture and PCR were important tools diagnoses to detect agent-causal, however, it was costly and required a period of time. KOH preparation is one of the in-office methods effective and fast in assisting in an appropriate diagnosis.

Crushed posaconazole delayed-release tablets for antifungal prophylaxis and treatment in children.

Therapeutic drug monitoring (TDM) is recommended for posaconazole to achieve target concentrations of ≥0.7 mg/L and ≥1.0 mg/L for prophylaxis and treatment of invasive fungal infection (IFI), respectively. However, target attainment is challenging with the oral suspension, particularly in children. Here, we describe our experience using crushed delayed-release tablet (DRT) in a paediatric cohort, with a focus on TDM. We undertook a retrospective audit of crushed posaconazole DRT administration via enteral feeding tubes (EFTs) for patients aged ≤18 years over 18 months at The Royal Children's Hospital Melbourne who had at least one trough concentration measured at steady state. Details of patient demographics, posaconazole dosing, monitoring and adverse effects were recorded. Twelve patients with a median age of 9 years (range 2 to 14) received posaconazole DRT via EFT for prophylaxis (n = 8) or treatment (n = 4). All children achieved target concentration, with a median dose of 7 mg/kg/day (range 5 to 11) for prophylaxis and 13 mg/kg/day (range 9 to 20) for treatment. The median time to reach therapeutic levels was 7 days (range 5 to 14) for prophylaxis and 20 days (range 15 to 35) for treatment. One child had blockage of their EFT, which was attributed to posaconazole. No other adverse effects were observed. Crushed posaconazole DRT administered via EFT may be used as a method of attaining therapeutic posaconazole concentrations in children for antifungal prophylaxis and treatment.

Understanding the clinical and environmental drivers of antifungal resistance in the One Health context.

Antifungal drugs have had a tremendous impact on human health and the yields of crops. However, in recent years, due to usage both in a health setting and in agriculture, there has been a rapid emergence of antifungal drug resistance that has outpaced novel compound discovery. It is now globally recognized that new strategies to tackle fungal infection are urgently needed, with such approaches requiring the cooperation of both sectors and the development of robust antifungal stewardship rationales. In this review, we examine the current antifungal regimes in clinical and agricultural settings, focusing on two pathogens of importance, Candida auris and Aspergillus fumigatus, examining their drivers of antifungal resistance, the impact of dual-use azoles and the impact agricultural practices have on driving the emergence of resistance. Finally, we postulate that a One Health approach could offer a viable alternative to prolonging the efficacy of current antifungal agents.