Weekly fungal diagnostics research update: papers published 4–11 May 2026

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This week’s fungal diagnostics search identified new papers on sequencing-based diagnosis, fungal biomarkers, species identification, antifungal susceptibility testing, and candidemia surveillance. The strongest diagnostic themes were targeted next-generation sequencing, metagenomic next-generation sequencing on pathology samples, galactomannan biology, and clinical isolate identification.

This roundup combines results from the broad fungal diagnostics search and the focused diagnostic methods/performance search. Papers dated before 4 May 2026, and papers mainly focused on basic biology, drug mechanisms, industrial biotechnology or non-diagnostic host-response biology, have been excluded from the main highlight.

Key themes this week

  • Sequencing-based diagnostics: targeted next-generation sequencing and metagenomic next-generation sequencing continue to move into clinical infection diagnosis.
  • Fungal biomarkers: a review of galactomannan biology is directly relevant to invasive aspergillosis testing.
  • Species identification and susceptibility: new studies report Aspergillus and Candida species distribution and antifungal susceptibility patterns.
  • Candidemia surveillance: national and hospital-based data continue to show the importance of species-level identification and resistance monitoring.

Sequencing-based fungal diagnostics

Quantitative interpretation models for targeted next-generation sequencing in lower respiratory tract infections

Jing C, Ding Y, Zhou J, Wei J, Wang M, Yuan D, Peng L, Huang Y, Shi X, Wu X, Tao L, Qian Q, Sun W.
Respiratory Research. 2026 May 9. Online ahead of print.
doi: 10.1186/s12931-026-03690-7
PMID: 42106793

This multicentre prospective study evaluated quantitative interpretation models for targeted next-generation sequencing in lower respiratory tract infections. The PubMed summary reports that targeted next-generation sequencing showed enhanced pathogen detection, and that quantitative models demonstrated strong discriminatory performance, especially for bacterial pathogens. Conventional microbiological testing alone had reported sensitivity of 58.7% and specificity of 74.7%.

Why it matters: Sequencing tests can detect organisms that conventional methods may miss, but interpretation is difficult because detection does not always mean disease. Quantitative models may help distinguish colonisation, contamination and clinically significant infection. Although this paper is not solely fungal, the approach is relevant to fungal respiratory diagnostics, especially in complex lower respiratory tract infection.

Metagenomic next-generation sequencing for pathology-suspected fungal infections at rare anatomical sites

Xu X, Chen D, Luo N, Zhang W, Lou L.
Future Science OA. 2026 Dec;12(1):2669032. Epub 2026 May 8.
doi: 10.1080/20565623.2026.2669032
PMID: 42100992

This case series examined metagenomic next-generation sequencing using formalin-fixed paraffin-embedded tissue from 10 cases where histopathology suggested fungal infection at rare anatomical sites, including brain, cardiac valve and bone. Metagenomic next-generation sequencing detected fungal DNA in 8 of 10 cases and provided species-level identification, including organisms such as Cryptococcus, Candida, Fusarium, Rhizopus and Histoplasma.

Why it matters: Histopathology can show fungal elements but often cannot reliably identify the fungus to species level. Molecular testing on stored tissue may help resolve difficult cases, especially when culture is negative, unavailable or impossible because the tissue has already been fixed.

Fungal biomarkers and aspergillosis diagnostics

Structure and biosynthetic mechanisms of galactomannans in filamentous fungi

Oka T, Kadooka C, Tanaka Y, Hira D.
Biochimica et Biophysica Acta – General Subjects. 2026 May 7;1870(8):130960. Online ahead of print.
doi: 10.1016/j.bbagen.2026.130960
PMID: 42105885

This review describes the structure and biosynthesis of galactomannans in filamentous fungi. Galactomannan is an important fungal cell wall component and is clinically relevant because galactomannan detection is used as a biomarker in the diagnosis of invasive pulmonary aspergillosis.

Why it matters: Galactomannan testing is widely used in invasive aspergillosis diagnostics, but interpretation can be affected by host factors, specimen type, fungal biology, antifungal exposure and false positives. Better understanding of galactomannan structure and production helps explain why the test works, and why it has limitations.

Radiological manifestations of allergic bronchopulmonary aspergillosis in adult asthmatic patients

Wahab F, Hussain Babar T, Nadeem SF, Amin Z, Sarwar S, Ahmad S, Wahab A, Mukhtar S.
Monaldi Archives for Chest Disease. 2026 May 7. Online ahead of print.
doi: 10.4081/monaldi.2026.3648
PMID: 42099257

This study reports radiological findings in adult asthmatic patients with allergic bronchopulmonary aspergillosis. PubMed describes allergic bronchopulmonary aspergillosis as a hypersensitivity disease associated with exposure and immune response to Aspergillus.

Why it matters: Allergic bronchopulmonary aspergillosis can be missed or delayed when symptoms are attributed to asthma alone. Imaging findings, alongside immunology and clinical history, remain important in recognising the condition and assessing airway damage.

Species identification and antifungal susceptibility

Species distribution and antifungal susceptibility patterns of clinical Aspergillus isolates from a tertiary care centre in India

Sudhaharan S, Pamidimukkala U, Vinod Kumar M, Verma N.
Indian Journal of Medical Microbiology. 2026 May 4;62:101135. Online ahead of print.
doi: 10.1016/j.ijmmb.2026.101135
PMID: 42092580

This study investigated the microbiological spectrum of clinical Aspergillus isolates and their antifungal susceptibility profiles at a tertiary care centre in India. The PubMed record notes that identification was performed using conventional techniques.

Why it matters: Species-level identification and antifungal susceptibility testing are increasingly important because different Aspergillus species can vary in antifungal susceptibility. Local surveillance can help inform diagnostic pathways, empirical treatment choices and awareness of resistant or less susceptible species.

Species distribution and antifungal susceptibility patterns of oral Candida colonisation and infection in beta-thalassemia major patients

Haghani I, Haseli Z, Yahyazadeh Z, Javidnia J, Abastabar M, Nazar E, Jalali H, Hedayati MT, Karami H, Davoodi L, Aghili SR, Moazeni M, Badali H, Nosratabadi M.
BMC Oral Health. 2026 May 6. Online ahead of print.
doi: 10.1186/s12903-026-08039-6
PMID: 42092857

This study collected oral swabs from 270 patients with beta-thalassemia major and assessed Candida colonisation and infection. Species identification used phenotypic characteristics, including CHROMagar Candida, and molecular testing by polymerase chain reaction. The most common species reported were Candida albicans, Pichia kudriavzevii and Nakaseomyces glabratus.

Why it matters: This is not an invasive fungal disease paper, but it is relevant to diagnostic practice because it combines phenotypic and molecular identification and highlights non-albicans Candida species, which may have different antifungal susceptibility patterns.

Antifungal susceptibility of genital yeast isolates in Auckland, 2016–2025

Morris AJ, McKinney WP, Roberts SA.
New Zealand Medical Journal. 2026 May 8;139(1634):103-110.
doi: 10.26635/6965.7444
PMID: 42096706

This study reports antifungal susceptibility testing of 1,307 initial genital yeast isolates from Auckland between 2016 and 2025. The most frequent isolates were Candida albicans, the Nakaseomyces glabratus complex and the Candida parapsilosis complex.

Why it matters: Although focused on genital yeast isolates, this study is relevant to diagnostic mycology because recurrent or persistent yeast infection increasingly requires accurate species identification and susceptibility testing, particularly when non-albicans species are involved.

Candidemia and cryptococcosis surveillance

National surveillance of candidemia in the Czech Republic

Lysková P, Dobiáš R, Bezdíček M, Hubka V, Sumerauerová P, Lžičařová D, Kocmanová I, Buchta V, Prošková I, Janouškovcová H, Olišarová P, Svobodová K, Hamal P, Mallátová N, Kadlečková Z, Kučerová J, Skružná M, Růžička F, Fridrichová M, Fáčková D, Hajná M, Kunzová J, Kubele J, Zemanová Z, Dlouhá M, Šemberová L, Balíková D, Eliášová G, Steinerová A, Prusík F, Filová R, Lásiková Š, Nikodýmová I, Pěkníková I, Kašperová E, Čurdová M, Tomášková H, Slepčanová H, Kolařík M.
Mycopathologia. 2026 May 4;191(3):50.
doi: 10.1007/s11046-026-01076-3
PMID: 42071049

This preliminary national surveillance study recorded 433 isolates from 408 candidemia bloodstream infection episodes in 398 patients in 2023. Candida albicans was the most frequent species, followed by Candida glabrata, Candida parapsilosis and Candida tropicalis.

Why it matters: Candidemia surveillance is essential for tracking species distribution and resistance trends. This has direct implications for laboratory identification, empirical treatment policies and antifungal stewardship.

Incidence and characteristics of candidemia in hospitalised patients with advanced HIV in Kinshasa

Walo C, Kisaka P, Mikobi Maleshila JC, Mwenemboka G, Kutomisa F, Fuka R, Ntabugi N, Mulanga J, Nzembomba A, Dicko A, Tshimungu A, Kasenda C, Mucinya G, Gordillo Gomez F, Burton R, Garcia-Vello P, Comelli A.
AIDS Research and Therapy. 2026 May 6. Online ahead of print.
doi: 10.1186/s12981-026-00890-5
PMID: 42092975

This retrospective study at a Médecins Sans Frontières-supported hospital in Kinshasa described candidemia among hospitalised patients with advanced HIV disease. Among 3,974 admissions, 46 candidemia cases were identified.

Why it matters: Candidemia diagnosis depends on laboratory access, blood culture capacity and clinical suspicion. Studies from different healthcare settings are important because the burden of invasive fungal disease is often underestimated where diagnostic resources are limited.

Epidemiology and outcomes of cryptococcal infections in liver transplant recipients

Sigler R, Hanigan C, Rahman A, Ratnayake I, Akella P, Carlini L, Gorsline C, Mackenzie E, Eid A, Shoemaker D, Taylor R, Waller S.
Transplant Infectious Disease. 2026 May 6. Online ahead of print.
doi: 10.1111/tid.70231
PMID: 42093238

This retrospective cohort study examined cryptococcal infections in liver transplant recipients at a US academic centre. The PubMed summary notes that solid organ transplant recipients represent an important group among immunocompromised patients with cryptococcosis.

Why it matters: Cryptococcosis requires timely diagnosis in transplant patients, where symptoms may be non-specific and disease can be severe. Epidemiological studies can help define risk groups and prompt earlier diagnostic testing.

Diagnostic case reports and unusual presentations

Cryptococcal meningitis in a patient with VEXAS syndrome

Lin MC, Day T, Lammerink S, Ali SB.
BMC Rheumatology. 2026 May 9. Online ahead of print.
doi: 10.1186/s41927-026-00648-6
PMID: 42106884

This case report describes cryptococcal meningitis in a patient with VEXAS syndrome. The patient initially presented with confusion, fever, inflammatory markers and worsening cytopenia, creating a differential diagnosis that included inflammatory disease flare and intercurrent infection.

Why it matters: This case highlights a common diagnostic challenge: invasive fungal infection can mimic inflammatory or autoimmune disease activity, especially in patients receiving immunosuppression or with complex inflammatory syndromes.

Fungal interface keratitis following superficial anterior lamellar keratectomy

Chowdhury T, Rana V.
BMC Ophthalmology. 2026 May 9. Online ahead of print.
doi: 10.1186/s12886-026-04856-z
PMID: 42106691

This case report describes fungal interface keratitis following superficial anterior lamellar keratectomy for limbal dermoids. Microbiological analysis of graft and host bed samples showed fungal filaments, and culture confirmed Aspergillus niger.

Why it matters: Ocular fungal infections require prompt microbiological diagnosis because delayed identification can threaten vision. The report also illustrates the value of combining microscopy, culture and targeted antifungal therapy.

Papers noted but not included as main diagnostic highlights

The following papers appeared in the search results but were not included as main highlights because they were mainly focused on virulence, host response, drug mechanisms, biotechnology or therapeutic mechanisms rather than clinical fungal diagnostics:

  • Montoya C et al. Beyond roughness: Lateral surface architecture drives Candida albicans virulence on denture polymers.
  • Qian Y et al. Cigarette smoke-induced caspase-12 nuclear translocation compromises oral mucosal defense via RIP2 and NF-κB signaling.
  • Engelbert K et al. Understanding pellet population heterogeneity of Aspergillus niger in stirred tank and rocking motion bioreactors.
  • Motamedi M et al. Symptomatic candiduria in neonates, infants, and pediatric patients admitted to ICUs.
  • Tipping WJ et al. Label-Free Visualization of the Antifungal Polyene Drug, Nystatin, in Biological Membranes Using Raman Microscopy.
  • Yuan Y et al. A Keratinocyte-Mast Cell NF-κB2/CXCL2/IL-6 Amplification Loop Enhances Cutaneous Antifungal Defense Against C. albicans.
  • Yang Z et al. Drug-resistant clinical Candida responded to 5-aminolevulinic acid photodynamic therapy in vitro via enhanced ROS release.
  • Kriti D et al. Chromosome-scale genome assembly and characterization of Saccharomycopsis schoenii.

Summary

The most diagnostically important papers this week are the targeted next-generation sequencing study for lower respiratory tract infections, the metagenomic next-generation sequencing case series using fixed pathology samples, the galactomannan review, and the clinical Aspergillus isolate identification and susceptibility study. Together, these papers reflect continuing movement toward more precise fungal diagnostics, while also underlining the need for careful clinical interpretation of advanced molecular tests.