Medical Mycology Update 16–23 March 2026
16–23 March 2026
Diagnostics, resistance, stewardship and clinically important signals
The first three weeks of March 2026 highlight several strong themes in medical mycology.
Candida resistance and surveillance remain especially prominent, with notable papers on
Candida auris, azole-resistant Candida parapsilosis, resistant Candida tropicalis,
candidemia trends, and antifungal susceptibility testing. There is also important new work on
fungal diagnostics, including improved sputum culture methods for Aspergillus,
galactomannan lateral flow testing, biomarker interpretation, panfungal PCR, and species-level diagnostic challenges.
Alongside these, several high-value reviews emphasise that diagnostic stewardship,
MIC interpretation, and decisions about when to stop antifungal therapy are becoming
increasingly central to practice.
Contents
1. Molecular diagnostics and biomarkers
False-positive beta-D-glucan remains a significant diagnostic pitfall
Fernández-Ruiz and colleagues examined false-positive results of the turbidimetric Wako beta-D-glucan assay in patients with bacteremia.
The study reinforces that bacterial bloodstream infection can confound fungal biomarker interpretation and that beta-D-glucan should not be read in isolation.
This is a highly practical paper for centres using beta-D-glucan in routine work-up.
PubMed: PMID 41273933
Beta-D-glucan performance may vary by Candida species
Kuhara and colleagues evaluated the sensitivity of the Wako beta-D-glucan assay in candidemia caused by Candida parapsilosis.
This is important because Candida parapsilosis has long been recognised as a species where biomarker performance may be less straightforward than in other forms of candidemia.
The paper is a useful reminder that assay interpretation may need to be organism-specific.
PubMed: PMID 41781580
Serum galactomannan and beta-D-glucan continue to be assessed in CAPA
Elnagar and colleagues assessed serum beta-D-glucan and galactomannan in severely ill COVID-19 patients with suspected COVID-associated pulmonary aspergillosis.
The paper adds to the still-evolving literature on how useful blood biomarkers are in critically ill viral pneumonia populations, where diagnostic uncertainty remains high.
PubMed: PMID 41365233
Real-time PCR detects circulating fungal DNA in a non-classical population
Pansu and colleagues reported real-time PCR detection of fungal translocation in patients with alcohol use disorder.
Although this is not a routine invasive fungal disease population, it is an interesting proof-of-concept study showing panfungal qPCR detection of circulating fungal DNA in blood.
It points toward broader future applications of fungal molecular testing beyond classical host groups.
PubMed: PMID 41839701
Microarray testing broadens dermatomycosis detection beyond routine culture
Gellrich and colleagues compared the EuroArray Dermatomycosis microarray with fungal culture for detecting dermatophytes, Candida species, and moulds in suspected dermatomycosis.
This paper reflects the wider move toward multiplex molecular approaches in fungal diagnosis, especially where culture is slow or insensitive.
PubMed: PMID 41842956
A frugal molecular assay for paracoccidioidomycosis points to more equitable diagnostics
Lorenzini Campos and colleagues described a miniaturized recombinase polymerase amplification assay for genus-level detection of Paracoccidioides in resource-limited endemic settings.
This is an important global-health diagnostics paper, showing how simpler molecular platforms may improve access to fungal diagnosis outside specialist centres.
PubMed: PMID 41855173
2. Aspergillus and mould diagnostics
High-volume sputum culture improves Aspergillus detection
van Haren and colleagues reported that high-volume culture improves diagnostic yield of Aspergillus species from sputum.
This is a particularly useful practical paper because it suggests that simple changes in specimen processing may improve sensitivity without requiring new technology.
It may be especially relevant in chronic pulmonary aspergillosis and in patients where bronchoscopy is not readily available.
PubMed: PMID 41860106
Galactomannan lateral flow testing may perform across different Aspergillus species
Loaiza-Oliva and colleagues assessed the diagnostic performance of the Sōna GM lateral flow assay in pulmonary infections caused by different Aspergillus species.
The study is notable because it extends interest beyond classic Aspergillus fumigatus-focused testing and supports the wider move toward rapid near-patient assays.
PubMed: PMID 41858119
Non-fumigatus Aspergillus-associated pulmonary disease remains a diagnostic challenge
Godet and colleagues highlighted non-fumigatus Aspergillus-associated pulmonary events as a diagnostic challenge.
This is important because cryptic or non-fumigatus species may be under-recognised in routine practice, and some may differ in antifungal susceptibility and clinical behaviour.
The paper reinforces the need for species-level identification in atypical or non-responding cases.
PubMed: PMID 41848336
Azole persistence may precede classical azole resistance in Aspergillus fumigatus
Delbaje and colleagues reported evidence that azole persistence and stress resistance can precede the in vivo evolution of azole resistance in Aspergillus fumigatus.
This is one of the most interesting March papers because it suggests that treatment failure may occur before conventional resistance mutations are detectable.
It has clear implications for how we think about susceptibility, persistence, and early warning signals of emerging resistance.
PubMed: PMID 41837673
Tuberculosis-like presentations may conceal Aspergillus disease
Ebong and colleagues examined the positivity rate of Aspergillus species in patients with tuberculosis-like symptoms in Cameroon, along with antifungal resistance profiles.
This is clinically important in settings where chronic pulmonary aspergillosis or other forms of aspergillosis may be mistaken for tuberculosis.
The study reinforces the value of considering Aspergillus testing in TB mimic syndromes.
PubMed: PMID 41803790
Atypical aspergillosis remains easy to miss
Zahiri and colleagues described an unusual manifestation of aspergillosis involving soft tissue, supported by positive bronchoalveolar lavage galactomannan and biopsy confirmation.
Although a case report, it offers a useful reminder that Aspergillus disease can present beyond conventional radiological or anatomical expectations.
PubMed: PMID 41777483
Cerebral aspergillosis remains limited by slow and insensitive diagnostics
Soman and colleagues reviewed why there is still an urgent need for better management of cerebral aspergillosis, highlighting delayed recognition, long turnaround times, and limited sensitivity of available diagnostics.
The paper is more treatment-focused overall, but the diagnostic message is strong: current tools remain inadequate in one of the most severe forms of aspergillosis.
PubMed: PMID 41758247
Mortality gains in invasive aspergillosis may now be under threat
Maertens and colleagues reviewed 25 years of improvement in mortality in invasive aspergillosis in haematology patients and asked whether those gains are sustainable.
The discussion is relevant to diagnostics as well as therapy, because earlier recognition, better classification, and better test access have all contributed to progress.
Resistance pressures and changing host populations may now threaten that progress.
PubMed: PMID 41790511
ABPA remains under-recognised outside specialist respiratory practice
Chedal-Anglay and colleagues reviewed allergic bronchopulmonary aspergillosis from an internal medicine perspective.
The paper is a useful reminder that ABPA remains under-recognised outside respiratory and mycology specialist settings and continues to overlap diagnostically with asthma, eosinophilic disease, and other inflammatory lung conditions.
PubMed: PMID 41856838
3. Candida, Candida auris and candidemia surveillance
Candida auris biocide response raises infection-control concerns
Erganis and colleagues examined the biocide response of Candida auris.
This is important because it extends the resistance conversation beyond antifungal drugs to disinfection and outbreak control.
The findings reinforce the concern that standard cleaning measures may not always be sufficient in healthcare settings dealing with Candida auris.
PubMed: PMID 41853952
Multidrug resistance remains central to the Candida auris story
Santana and colleagues reviewed the multidrug resistance paradigm in Candida auris.
The paper provides a strong update on how resistance emerges and why it is so difficult to manage clinically and operationally.
It fits well with the wider March theme that Candida auris remains both a microbiology and a systems problem.
PubMed: PMID 41837697
Candida auris may not always be universally fluconazole-resistant
Kroustali and colleagues asked whether fluconazole can be used to treat non-resistant Candida auris infections, drawing on preclinical PK/PD data from a Galleria mellonella infection model.
This is an interesting stewardship paper because it challenges the reflex assumption that all Candida auris infections are fluconazole-untreatable.
While not a practice-changing clinical study, it introduces useful nuance.
PubMed: PMID 41856171
Predictors of resistant invasive Candida infection could support stewardship
Evans and colleagues identified predictors for the development of fluconazole-non-susceptible or echinocandin-non-susceptible invasive Candida infection across the Veterans Health Administration.
This is a clinically useful stewardship paper because it moves beyond descriptive resistance rates toward identifying patients at higher risk of resistant candidemia.
PubMed: PMID 41824413
Long-term candidemia surveillance continues to show shifting resistance patterns
Yazgan and Aygün reported a nine-year single-centre study of candidemia and antifungal resistance trends in Turkey.
Cong and colleagues similarly reported a 10-year observation from eastern China showing changes in species distribution and susceptibility among candidemia cases.
Together, these papers reinforce the importance of local epidemiology in guiding empirical therapy and stewardship.
PubMed: PMID 41794662
PubMed: PMID 41804483
Candida parapsilosis continues to emerge as a major resistance concern
García-Hernández and colleagues analysed azole-resistant Candida parapsilosis from burn patients in Mexico using genomic and phylogenetic approaches.
Vumbaca and colleagues also described a persistent azole-resistant Candida parapsilosis clone circulating in a tertiary hospital during the first COVID-19 wave.
These papers highlight the increasingly important role of genomic surveillance in identifying resistant hospital lineages.
PubMed: PMID 41793231
PubMed: PMID 41840233
Candida tropicalis resistance and immune evasion traits warrant close surveillance
Jain and colleagues described a clade-specific Candida tropicalis lineage with azole resistance and immune evasion traits.
This is one of the stronger March genomic surveillance papers and underlines that resistance in Candida is not only about MICs but may also involve broader fitness and host interaction traits.
PubMed: PMID 41810942
Rare bloodstream yeasts remain clinically important
Buonafine and colleagues reported species distribution and antifungal susceptibility of rare Candida and related Saccharomycotina yeasts causing bloodstream infection across 28 medical centres.
This paper is valuable because rare yeasts are easily under-recognised, yet their susceptibility profiles can differ substantially from more familiar Candida species.
PubMed: PMID 41773913
Non-albicans Candida surveillance remains important
Chen and colleagues reported antifungal susceptibility and multilocus sequence typing of Pichia kudriavzevii (Candida krusei) from a tertiary hospital in Shanghai.
This is a useful surveillance paper on a species that remains clinically relevant because of its reduced fluconazole susceptibility and importance in invasive infection.
PubMed: PMID 41790340
Candidemia from a urinary tract source deserves closer attention
Díez-Vidal and colleagues reported a retrospective cohort study of candidemia attributed to a urinary tract source, covering risk factors, clinical features, treatment, and outcomes.
This is a useful clinical paper because urinary-source candidemia can be under-recognised and may have different management implications from other candidemia pathways.
PubMed: PMID 41860623
Alcoholism may be an under-recognised risk factor for candidemia
Kessel and colleagues described candidemia in adult patients with alcoholism in a retrospective Finnish cohort.
This contributes to a broader picture in which host risk may be shaped by underappreciated comorbidity and vulnerability patterns, rather than classical haematology-style risk groups alone.
PubMed: PMID 41861040
Candida and bacterial bloodstream isolates may co-vary in ICU populations
Hurley explored co-variation between bloodstream infections with Candida species and common bacterial pathogens across ICU patient cohorts.
This is an interesting systems-level paper that raises questions about co-infection ecology, risk clustering, and how fungal bloodstream infection sits within broader ICU microbiology patterns.
PubMed: PMID 41854346
Candida endocarditis remains a high-mortality syndrome requiring combined diagnostic approaches
Ben-Ami and colleagues reviewed Candida endocarditis, covering echocardiography, fungal biomarkers, molecular assays, therapy, and surgery.
Although not new primary data, this is one of the better March clinical reviews and worth highlighting because Candida endocarditis remains rare, difficult, and associated with substantial mortality.
PubMed: PMID 40490193
Ocular complications of candidemia remain diagnostically important
Permpalung and colleagues reviewed the diagnosis and management of Candida endophthalmitis and chorioretinitis.
This is particularly useful for clinicians considering when and how ocular involvement should be investigated in candidemia and how evolving diagnostics may complement traditional assessment.
PubMed: PMID 40441350
Onychomycosis still reflects wider antifungal susceptibility challenges
Lalchungnunga and colleagues revisited onychomycosis, its etiological agents, and antifungal susceptibility profiles.
Although this sits outside invasive fungal disease, it remains relevant to the wider resistance discussion and highlights that susceptibility challenges are not confined to deep-seated infection.
PubMed: PMID 41854354
4. Resistance, stewardship and laboratory practice
MICs are useful, but far from simple
Lass-Flörl and colleagues reviewed why MICs vary, why antifungal susceptibility testing methods diverge, and what MIC can miss.
This is one of the most useful papers for clinical laboratories this month because it explains, clearly and practically, why MIC interpretation is not always straightforward and why stewardship depends on more than a single number.
PubMed: PMID 41825586
Diagnostic stewardship in fungal disease is becoming a discipline in its own right
Steinbrink and colleagues reviewed fungal diagnostic stewardship in immunocompromised populations, with a focus on moulds and dimorphic fungi.
This is probably one of the most important papers in the March set because it moves the conversation beyond test availability to test selection, timing, overuse, underuse, and downstream decision-making.
PubMed: PMID 41677277
Stopping antifungal therapy safely is now a stewardship priority
Stemler and colleagues reviewed how to safely discontinue antifungal treatment in invasive pulmonary aspergillosis in haematology patients.
This is highly relevant to stewardship because stopping rules often remain poorly standardised, despite the toxicity, cost, and interaction burden of prolonged antifungal therapy.
PubMed: PMID 41796963
One Health and resistant fungi belong in the same conversation
Lackner and colleagues discussed One Health and resistant fungi, focusing on the tension between food security, environmental azole use, and patient survival.
This is an important broader resistance paper, especially for readers interested in the upstream ecological drivers of clinical antifungal resistance.
PubMed: PMID 41830442
Emerging mycoses remain under-recognised globally
Barac and colleagues reviewed emerging mycoses as a neglected global health issue, emphasising equitable access to diagnostics, antifungals, and surveillance.
This is broader than stewardship alone, but it fits well with the March theme that access and infrastructure remain as important as assay innovation.
PubMed: PMID 41839421
Hospital environments remain relevant to fungal exposure and surveillance
Pimentel and colleagues examined hospital indoor air as a reservoir of opportunistic filamentous fungi, with species diversity and antifungal susceptibility testing.
This is more environmental than some other papers in the set, but it has clear implications for exposure monitoring and hospital-risk awareness.
PubMed: PMID 41793475
Transplant populations remain central to fungal surveillance and stewardship
Douglas and Slavin reviewed invasive fungal disease in allogeneic haematopoietic cell transplantation, highlighting evolving risk factors, new therapeutic options, and the need for surveillance, diagnostics, and antifungal stewardship.
This is a strong context paper for high-risk host management.
PubMed: PMID 41766642
MALDI-TOF workflows for filamentous fungi continue to improve
Olaniyan and colleagues evaluated multiple extraction and inactivation methods for rapid identification of filamentous fungi using MALDI-TOF mass spectrometry.
This is a useful laboratory methods paper because filamentous fungi remain harder to handle in routine MALDI-TOF workflows than bacteria or yeasts, and improvements here may translate into faster specialist identification.
PubMed: PMID 41841722
5. Notable clinical and case-based signals
Trichosporon fungemia remains rare but serious in children
Steiner and colleagues reported a case series of Trichosporon fungemia in a tertiary paediatric hospital.
Although a small series, it is worth noting because Trichosporon asahii remains an important opportunistic yeast with high mortality in immunocompromised patients and with susceptibility patterns distinct from Candida.
PubMed: PMID 41800572
Rhino-orbito-cerebral mucormycosis remains a classic diagnostic emergency
Sharifi and colleagues reviewed rhino-orbito-cerebral mucormycosis in new-onset type 1 diabetes mellitus.
This is not a major diagnostics paper, but it is a useful clinical reminder of how rapidly mucormycosis can present in metabolically unstable hosts.
PubMed: PMID 41794396
Pulmonary cryptococcosis can still mimic metastatic disease
Uesugi and colleagues reported pulmonary cryptococcosis mimicking lung metastasis in a patient with pancreatic cancer.
This is a useful reminder that fungal infection continues to sit in the differential diagnosis of apparent malignant pulmonary lesions, especially in immunocompromised or complex hosts.
PubMed: PMID 41850830
Disseminated dermatophyte infection with vascular invasion remains unusual but important
Fujino and colleagues described disseminated trichophytosis with vascular invasion and multiple ulcers.
Although rare, this case report is worth noting because it highlights that dermatophytes are not always confined to superficial disease and can become deeply invasive in the right host context.
PubMed: PMID 41853986
Histoplasmosis can produce unusual hepatobiliary and portal presentations
Tippins and colleagues reported disseminated histoplasmosis presenting with an inflammatory hilar mass and cavernous transformation causing noncirrhotic portal hypertension.
This is a reminder that invasive fungal disease can occasionally present through hepatobiliary or vascular syndromes rather than straightforward respiratory findings.
PubMed: PMID 41847076
6. Key themes from 1–23 March 2026
- Candida resistance remains one of the dominant stories of the month. The March literature strongly emphasises Candida auris, resistant Candida parapsilosis, resistant Candida tropicalis, and broader candidemia surveillance.
- Stewardship is expanding beyond drug choice. The best March papers show stewardship now includes MIC interpretation, diagnostic strategy, risk prediction, and decisions about when antifungal therapy can safely be stopped.
- Biomarker interpretation is becoming more nuanced. Beta-D-glucan and galactomannan remain useful, but recent work continues to highlight false positives, species-specific limitations, and host-specific performance.
- Aspergillus diagnostics are increasingly focused on difficult real-world scenarios. These include TB-like presentations, cerebral aspergillosis, atypical disease, non-fumigatus species, and pre-resistance or persistence states in Aspergillus fumigatus.
- Surveillance is becoming more genomic and more system-aware. Hospital clones, regional resistance patterns, environmental pressures, and One Health framing are all becoming more prominent.
- Access still matters as much as innovation. Several papers reinforce that fungal disease outcomes are shaped not only by assay performance but also by laboratory capability, infrastructure, and equitable access to diagnostics and treatment.