Bing J, Li S, Ji L
… +4 more, Du H, Shamoon NM, Nobile CJ, Huang G
Clin Microbiol Rev
· 2026 Jun · PMID 42017651
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SUMMARYThe emerging fungal pathogen (syn. ) has attracted considerable attention from the scientific, clinical, and public health communities due to its multidrug resistance, environmental persistence, and high transmis...SUMMARYThe emerging fungal pathogen (syn. ) has attracted considerable attention from the scientific, clinical, and public health communities due to its multidrug resistance, environmental persistence, and high transmissibility. Since its first description in Japan in 2009, has spread rapidly worldwide, with a marked acceleration following the coronavirus disease 2019 (COVID-19) pandemic. As of December 2025, 84,941 colonization or infection cases have been reported across 82 countries spanning 6 continents. In this review, we summarize the current knowledge of the biology and global epidemiology of . We first examine its taxonomy, proposed origins, and key biological, genetic, and phenotypic characteristics, with particular emphasis on factors underlying environmental persistence, transmission dynamics, antifungal resistance, and virulence. Drawing on published literature and publicly available surveillance data from national public health authorities worldwide, we provide an updated overview of the global epidemiological landscape and evolving transmission patterns of . Finally, we discuss potential strategies to mitigate the continued and escalating global spread of this emerging multidrug-resistant fungal pathogen.
Chancharoenthana W, Siripoon T, Kamolratanakul S
… +5 more, Luvira V, Phumratanaprapin W, Schultz MJ, Ronco C, Pitisuttithum P
Clin Microbiol Rev
· 2026 Jun · PMID 42007724
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SUMMARYLatent tuberculosis infection (LTBI) is common and preventable among patients with chronic kidney disease (CKD), where uremia and iatrogenic immunosuppression heighten reactivation risk. This narrative review synt...SUMMARYLatent tuberculosis infection (LTBI) is common and preventable among patients with chronic kidney disease (CKD), where uremia and iatrogenic immunosuppression heighten reactivation risk. This narrative review synthesizes evidence across pre-dialysis CKD, dialysis, and kidney transplantation to propose a pragmatic care pathway. In advanced CKD, the tuberculin skin test performs poorly, whereas interferon-γ release assays (IGRAs) are preferred. Screening should be risk-targeted in pre-dialysis CKD, systematic at dialysis initiation, and mandatory pre-transplant for candidates and living donors. Following a positive test, clinicians must exclude active tuberculosis via clinical assessment and chest imaging before starting preventive therapy. Short-course rifamycin-based regimens (4 months of daily rifampin [4R], 3 months of once‑weekly isoniazid plus rifapentine [3HP], or 3 months of daily isoniazid plus rifampin [3HR]) enhance completion rates compared with 9 months of daily isoniazid (9H). In transplant recipients, rifamycin interactions with calcineurin and Mammalian target of rapamycin (mTOR) inhibitors typically favor 9H; rifamycins demand expert multidisciplinary management with intensive therapeutic drug monitoring. Programmatic data from dialysis units show high completion with tolerable toxicity, affirming routine feasibility. We integrate IGRA-based screening at critical transitions with tailored regimen selection, pyridoxine coadministration for isoniazid, and structured safety monitoring. Priorities include validating novel antigen-based skin tests in CKD and developing implementation strategies to standardize renal care. We delineate setting-specific approaches for high- versus low-burden countries, addressing subclinical and incipient TB challenges in high-burden contexts. Adopting this framework can curb active TB progression, safeguard grafts, and enhance patient outcomes.
Pu P, Wang Y, Liu X
… +3 more, Pang Y, Qiang L, Wang W
Clin Microbiol Rev
· 2026 Jun · PMID 41995603
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SUMMARYThe skin microbiome, consisting of bacteria, fungi, viruses, and archaea, plays a crucial role in maintaining skin health by regulating immune responses, preserving barrier function, and influencing metabolic proc...SUMMARYThe skin microbiome, consisting of bacteria, fungi, viruses, and archaea, plays a crucial role in maintaining skin health by regulating immune responses, preserving barrier function, and influencing metabolic processes. Dysbiosis in the microbiome is linked to dermatological diseases such as atopic dermatitis (AD), psoriasis, and acne, with specific microbes, such as and , either promoting or protecting against disease. This review summarizes recent advances in understanding the composition and functions of the skin microbiome, its interaction with host immunity, and impact on skin health. We also discuss the implications of environmental and biological factors on microbiome stability and explore emerging therapeutic strategies targeting the skin microbiota. These insights highlight the potential of microbiome-based approaches for advancing dermatological treatment.
Beenken KE, Campbell MJ, Reyes-Pardo H
… +2 more, O'Brien CA, Smeltzer MS
Clin Microbiol Rev
· 2026 Jun · PMID 41989162
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Osteomyelitis refers to inflammation in the bone and is most often a consequence of bacterial infection. The most common cause, and the pathogen that causes the most severe form of infection, is is a common commensal of...Osteomyelitis refers to inflammation in the bone and is most often a consequence of bacterial infection. The most common cause, and the pathogen that causes the most severe form of infection, is is a common commensal of healthy humans, and this contributes to its predominance as a cause of osteomyelitis, but this does not account for the severity of bone infections or their therapeutic recalcitrance to conventional antibiotic therapy. Clinical characteristics of osteomyelitis implicated in this regard include cortical bone destruction resulting in a compromised local blood supply, formation of a biofilm, the ability to invade and survive inside osteoblasts, osteoclasts, and osteocytes, the formation of small-colony variants and persister cells, and invasion of the osteocyte lacuno-canalicular network. This review summarizes evidence implicating these features in the pathogenesis and therapeutic recalcitrance of osteomyelitis, and the attributes of that contribute to these features and define as the predominant orthopedic pathogen.
El-Kafrawy SA, Abbas AT, Abdel-Dayem UA
… +2 more, El-Kafrawy MS, Azhar EI
Clin Microbiol Rev
· 2026 Jun · PMID 41983631
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SUMMARYThe rising threat of emerging infectious diseases, especially zoonotic pathogens crossing species barriers, highlights the urgent global need for scalable, rapid-response passive immunotherapy platforms. Chicken e...SUMMARYThe rising threat of emerging infectious diseases, especially zoonotic pathogens crossing species barriers, highlights the urgent global need for scalable, rapid-response passive immunotherapy platforms. Chicken egg yolk-derived immunoglobulin Y (IgY) antibodies offer unique conceptual and practical advantages. This review critically evaluates IgY antibodies (IgY-Abs) as a One Health immunotherapeutic strategy with strong potential for mitigating zoonotic spillover risks. Drawing on insights from SARS-CoV-2, we highlight the advantages of IgY-Abs over traditional approaches in specific scenarios while emphasizing their role as a complementary rather than replacement platform within the broader passive immunotherapy landscape. We discuss key strategic considerations, regulatory challenges, and essential knowledge gaps. Finally, we propose a forward-looking research and development roadmap that emphasizes interdisciplinary collaboration, optimized production methods, targeted regulatory frameworks, and integrated One Health strategies to facilitate the rapid deployment of IgY-based countermeasures against WHO-priority zoonotic pathogens.
Clin Microbiol Rev
· 2026 Jun · PMID 41914741
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SUMMARYFungal infections are the leading cause of mortality among eukaryotic pathogens. They are responsible for approximately 150 million cases of severe illness and 3.8 million deaths annually. This global health threa...SUMMARYFungal infections are the leading cause of mortality among eukaryotic pathogens. They are responsible for approximately 150 million cases of severe illness and 3.8 million deaths annually. This global health threat is exacerbated by the limited arsenal of clinically approved antifungal drugs, particularly for the treatment of life-threatening invasive infections. The rise of multidrug-resistant fungal strains further underscores the urgent need for new classes of antifungals with novel mechanisms of action. In this context, the fungal coenzyme A (CoA) biosynthesis pathway has emerged as a promising therapeutic target due to its essential role in fungal physiology and key differences from its human counterpart. This review explores the critical role of CoA biosynthesis in fungal metabolism and highlights recent advances in the discovery and characterization of novel compounds targeting this pathway. Some of these emerging candidates act both as standalone inhibitors and as broad-spectrum potentiators of existing antifungals through their ability to enhance strain susceptibility and counteract mechanisms of drug detoxification and multidrug resistance. Collectively, these findings establish CoA metabolism as a compelling target for the next generation of antifungal therapies, offering a multipronged strategy to overcome the limitations of current treatment options and reduce fungal-related mortality.
Clin Microbiol Rev
· 2026 Jun · PMID 41914740
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SUMMARYSince its first isolation in 1935, several thousand isolates have been collected and analyzed. These isolates belong to a diverse phylogeny consisting of five main clades and at least three cryptic clades. While...SUMMARYSince its first isolation in 1935, several thousand isolates have been collected and analyzed. These isolates belong to a diverse phylogeny consisting of five main clades and at least three cryptic clades. While clade 1 represents the largest and most diverse of the clades, clades 2 and 5 are the best studied, consisting of several strains attributed to the most severe clinical outcomes and increased rates of spread/recurrence. Strains belonging to clades 3 and 4 are typically minor constituents of infection (CDI) outbreaks but possess several distinctive genetic features (e.g., unique pathogenicity loci) that provide unique targets for clinical treatments. Much of the divergence between these clades is attributable to variation within the accessory genome. These factors, in turn, are often associated with mobile genetic elements (e.g., prophage, transposons, and plasmids). The transfer of these elements between strains is implicated in the acquisition and co-evolution of antibiotic resistance and virulence factors. The continued transfer of these elements between strains and their variation across the phylogeny emphasizes the need to include strains spanning multiple ribotypes/clades in phylogenetic and phenotypic studies.
Ni R, Liu Y, Armanni A
… +11 more, Ghisleni G, Fumagalli S, An Y, Li Y, Zhuang L, Ling Y, Li L, Ye Z, Bruno A, Zhang L, Gong W
Clin Microbiol Rev
· 2026 Jun · PMID 41910258
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SUMMARYOne quarter of the world's population carries latent tuberculosis infection (LTBI), an invisible reservoir that must be drained to end the global tuberculosis (TB) epidemic. This review charts the evolution of LTB...SUMMARYOne quarter of the world's population carries latent tuberculosis infection (LTBI), an invisible reservoir that must be drained to end the global tuberculosis (TB) epidemic. This review charts the evolution of LTBI diagnosis from the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) to a new molecular-intelligent paradigm. At the clinical level, we propose a CD4/age-stratified, resource-matched decision framework that delivers actionable screening and sequencing strategies for people living with HIV, children, the immunosuppressed, and pregnant women. At the biomarker level, we integrate host-derived analytes (CXCL1, CCL8, IP-10, CD38CD27⁻ T cells, and Fc-glycosylated antibodies) with pathogen-derived antigens (dormancy survival regulator [DosR], resuscitation-promoting factor [Rpf], heparin-binding hemagglutinin [HBHA], and PE/PPE) to create a three-tier index: single-analyte triage, multi-analyte confirmation, and dynamic treatment monitoring. At the technology level, we benchmark multi-omics-plus-AI models, single-molecule Simoa arrays, and microfluidic point-of-care testing (POCT) platforms for sensitivity, accessibility, and cost. High-quality cross-population validation, standardized thresholds, and resource-tiered deployment remain the principal translational bottlenecks. We call for integrated programs that combine key-population multicenter cohorts, explainable AI, and ASSURED criteria to propel LTBI management from the T-cell-sensitization era into the molecular-intelligent age. Achieving this vision within 5 years is technically feasible and will accelerate global elimination targets by enabling precision preventive therapy at an unprecedented scale.
Caddy SL, van Dorp L, Swadling L
… +2 more, Wang-Koh YW, Houldcroft CJ
Clin Microbiol Rev
· 2026 Jun · PMID 41848320
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SUMMARYChildcare outside the home is a common experience for many children in high-income countries. It is associated with an increase in the incidence of infectious diseases-not just for the child but also for their par...SUMMARYChildcare outside the home is a common experience for many children in high-income countries. It is associated with an increase in the incidence of infectious diseases-not just for the child but also for their parents and other household members. In this review, we explore this phenomenon from multiple angles, combining age at first infection, maternal antibody dynamics, seroepidemiology, cohort studies, and outbreak reports to understand the relationship between the immune systems of children starting childcare and the pathogen milieu they encounter. We consider the interaction between the age at which many infants begin out-of-home childcare and the maturation of cellular and humoral immunity. We bring together data on what is "normal" for infections in the first years of life: the range and incidence of gastrointestinal, respiratory, and rash-forming illnesses that typically infect young children. We review evidence of the additional impact that childcare has on the transmission of these pathogens. The economic and personal impacts of these illnesses are considered, including our lived experiences. We ask whether there are effective interventions to reduce illness associated with childcare, as the UK adds chickenpox to the childhood vaccination schedule. Finally, we consider evidence suggesting a trade-off between infections earlier in life and when children start formal schooling. We conclude that the high burden of infection in young children is normal, linked to the immunobiology of infants and the transmission dynamics of individual pathogens, but the collective impact of these infections is underappreciated.
Angelini J, Ferin S, Martini L
… +3 more, Flammini S, Tascini C, Giuliano S
Clin Microbiol Rev
· 2026 Jun · PMID 41823404
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SUMMARYThe increasing incidence of invasive fungal infections caused by resistant species and molds presents a growing clinical challenge, particularly in immunocompromised patients. While echinocandins and azoles remai...SUMMARYThe increasing incidence of invasive fungal infections caused by resistant species and molds presents a growing clinical challenge, particularly in immunocompromised patients. While echinocandins and azoles remain the cornerstone of antifungal therapy, their use may be limited by increasing reports of resistance, tolerance, drug-drug interactions, and hepatotoxicity. Liposomal amphotericin B (L-AmB), a broad-spectrum antifungal agent with a more favorable safety profile than conventional amphotericin formulations, may offer a valuable alternative in selected high-risk scenarios. Despite its established role in treating infections such as cryptococcosis, mucormycosis, and leishmaniasis, the potential of L-AmB in other settings remains underutilized and underexplored. We discuss here the hypothetical utility of L-AmB in clinical situations where standard antifungal agents may be inadequate or contraindicated. These include candidemia due to resistant or tolerant strains, biofilm-related infections, infections in patients with hepatic vulnerability, and antifungal prophylaxis or treatment in hematologic patients at high risk for invasive fungal disease. In these contexts, L-AmB's fungicidal activity, lack of CYP450-mediated interactions, and reduced nephrotoxicity, compared to deoxycholate formulations, may be advantageous. Although definitive clinical evidence is limited, the insights offered here aim to stimulate reflection and support future research. Clinical judgment, guided by expert experience, may justify the selective use of L-AmB in challenging cases where therapeutic alternatives are restricted or risky.
Carbajal C, Owens F, Veeragoni D
… +5 more, Rodriguez M, Fernandez-Lima F, Nefzi A, Buch S, El-Hage N
Clin Microbiol Rev
· 2026 Jun · PMID 41817180
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SUMMARYThis review summarizes potential drug-drug interactions (DDIs) between long-acting antiretrovirals (LAAs) and opioids, focusing on pharmacodynamics (PD), pharmacokinetics (PK), and side effects related to absorpti...SUMMARYThis review summarizes potential drug-drug interactions (DDIs) between long-acting antiretrovirals (LAAs) and opioids, focusing on pharmacodynamics (PD), pharmacokinetics (PK), and side effects related to absorption, distribution, metabolism, and excretion (ADME). It also covers dysregulation in epigenetics and in the immune system. A comprehensive literature review was performed using PubMed and Google Scholar, along with data from the Liverpool HIV Drug Interactions Database, to evaluate pharmacokinetic interactions between LAA drugs, such as cabotegravir, rilpivirine, lenacapavir, and dapivirine, with opioids used in clinical settings, including morphine, tramadol, oxycodone, and codeine; medications for opioid use disorder (MOUD), such as methadone and buprenorphine; and the illicit opioids, including fentanyl and heroin. The review highlights key factors increasing DDI risk and discusses clinical considerations for managing preexposure prophylaxis (PrEP) or antiretroviral therapy (ART) in persons who use opioids. Lastly, it proposes research strategies for studying DDIs, including the use of animal models, physiologically based pharmacokinetic (PBPK) models, and clinical trials.
Blacksell SD, Le KK, Dhawan S
… +8 more, Wuthiekanun V, Limmathurotsukul D, Dunachie SJ, Norton R, Meumann E, Currie BJ, Day NPJ, Dance DAB
Clin Microbiol Rev
· 2026 Jun · PMID 41810995
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SUMMARY and present significant biosafety challenges due to their high pathogenicity, environmental resilience, intrinsic antimicrobial resistance, and potential use as bioterrorism agents. This review examines key aspe...SUMMARY and present significant biosafety challenges due to their high pathogenicity, environmental resilience, intrinsic antimicrobial resistance, and potential use as bioterrorism agents. This review examines key aspects of laboratory management and infection control for these organisms, focusing on inconsistencies in biosafety protocols and risk classifications across regions. We synthesize current evidence on biocontainment requirements, disinfection strategies, and personal protective equipment (PPE), with particular emphasis on sustainable practices for laboratories in low-resource settings. Although laboratory-acquired infections are rare, their potential severity underscores the importance of stringent safety measures. Critical gaps remain in our understanding of infectious dose, the effectiveness of post-exposure prophylaxis (PEP), and the development of risk assessment frameworks. We advocate for harmonized global biosafety standards and targeted research on transmission dynamics and inactivation protocols. These priorities are essential to enhance laboratory safety, especially in endemic areas, and to inform coherent international policy on containment and management.
Elsener TA, Dillon J-AR, Shafer WM
… +1 more, Tang CM
Clin Microbiol Rev
· 2026 Jun · PMID 41805170
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SUMMARYGonococcal disease is a serious threat to reproductive health, with cases and antimicrobial resistance steadily increasing. Currently, the β-lactam antibiotic ceftriaxone is the mainstay of treatment, while doxycy...SUMMARYGonococcal disease is a serious threat to reproductive health, with cases and antimicrobial resistance steadily increasing. Currently, the β-lactam antibiotic ceftriaxone is the mainstay of treatment, while doxycycline post-exposure prophylaxis (DoxyPEP) is being implemented to reduce bacterial sexually transmitted infections. , the causative agent of gonorrhoea, can harbor two resistance plasmids, p and pConj, which confer resistance to penicillin and tetracycline/doxycycline, respectively. Additionally, over 90% of isolates carry a small plasmid, pCryp, whose function remains unclear. Of concern, p-encoded β-lactamases only differ from extended-spectrum β-lactamases by one or two amino acid changes. DoxyPEP is completely ineffective against isolates carrying pConj expressing -mediated resistance has increased in the gonococcus following introduction of DoxyPEP and is widespread in low- and middle-income countries. Therefore, plasmids pose a significant risk to the successful management of gonococcal infection. Here, we review current knowledge of the epidemiology and biology of gonococcal plasmids. We describe the hierarchy of acquisition and dependencies between plasmids in and their subsequent evolution, transfer dynamics, fitness costs, and benefits to provide a better understanding of the implications of the plasmids on public health interventions for controlling and treating gonococcal infection.
Ghai RR, Benedict K, Chiller TM
… +8 more, Chow NA, Hennessee IP, Jones S, Lockhart SR, Lyman M, Smith DJ, Toda M, Gold JAW
Clin Microbiol Rev
· 2026 Jun · PMID 41784366
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SUMMARYChronic diseases, defined as conditions that persist for 1 or more years and require ongoing medical attention or impede daily life, represent an urgent public health challenge in the United States. In the last de...SUMMARYChronic diseases, defined as conditions that persist for 1 or more years and require ongoing medical attention or impede daily life, represent an urgent public health challenge in the United States. In the last decade, fungal infections have garnered increased attention from public health officials and the media owing to the rapid and global rise of severe and antifungal-resistant infections. It is well-established that certain chronic diseases can increase the risk of invasive fungal infections. However, the inverse relationship-how fungal infections contribute to the development or exacerbation of chronic diseases-is less well studied. In this review, we summarize the current literature on the role of fungal infections in the development of chronic diseases, discussing pathophysiologic mechanisms and examining how chronic conditions can arise from the direct effects and sequelae of fungal infections. In addition, we discuss how the toxic effects of antifungal therapies can also contribute to the development of chronic disease states. Overall, our review highlights the significant yet underexplored role of fungal infections in the burden of chronic disease and emphasizes the need for further research, improved surveillance, increased public and healthcare awareness, and better access to diagnostics and treatments to address this issue.
Roque-Borda CA, Zhang Q, de la Torre BG
… +3 more, Albericio F, Perdigão J, Pavan FR
Clin Microbiol Rev
· 2026 Jun · PMID 41778900
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SUMMARYMultidrug-resistant (MDR) bacterial infections continue to outpace therapeutic innovation, undermining the efficacy of conventional antibiotics and exposing the limitations of the current drug pipeline. In this re...SUMMARYMultidrug-resistant (MDR) bacterial infections continue to outpace therapeutic innovation, undermining the efficacy of conventional antibiotics and exposing the limitations of the current drug pipeline. In this review, we critically examine the translational viability of peptide-based antimicrobials and siderophore conjugates-two classes of therapeutics often promoted as next-generation solutions against MDR pathogens. Rather than reiterating their mechanistic promise, we dissect the structural assumptions that underpin their design and expose the clinical blind spots that have hindered their success. While peptides offer membrane disruption, intracellular targeting, and, in some cases, selective bacterial killing, their efficacy remains context-dependent and is frequently compromised by host-driven proteolysis, poor bioavailability, and limited tissue penetration. Similarly, siderophore-based conjugates exploit iron uptake systems for targeted delivery, yet depend on bacterial receptors that are variably expressed, easily suppressed, or genetically lost during infection. The failure of cefiderocol in specific clinical settings exemplifies the vulnerability of "Trojan horse" approaches to metabolic plasticity and ecological interference. This review highlights the need for a paradigm shift-from broad biochemical optimism to receptor-aware, pathogen-stratified, and pharmacologically grounded strategies. Reframing these modalities within their biological and clinical constraints offers a more realistic foundation for the development of actionable peptide- and siderophore-based therapies against resistant bacterial infections.
Zhazykhbayeva D, Kosherova Z, Turdalina B
… +3 more, Almazan J, Aljofan M, Semenova Y
Clin Microbiol Rev
· 2026 Jun · PMID 41778862
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SUMMARYAntimicrobial resistance (AMR) is a public health threat that requires a coordinated and multi-sectoral approach. AMR is largely underexplored in Central Asia, a region shaped by the Soviet legacy. This narrative...SUMMARYAntimicrobial resistance (AMR) is a public health threat that requires a coordinated and multi-sectoral approach. AMR is largely underexplored in Central Asia, a region shaped by the Soviet legacy. This narrative review aimed to synthesize evidence on the AMR landscape from articles published in five countries: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. A structured search of peer-reviewed and gray literature was conducted, covering AMR prevalence, consumption patterns, knowledge, awareness, practices, stewardship interventions, and AMR governance. Key findings revealed that all five countries in the region have retained the rigidly centralized public health system, which was formerly known as the Sanitary Epidemiological Service during the Soviet era. This has led to fragmented surveillance and poor AMR monitoring. Up to 70% of spp. were resistant to third-generation cephalosporins, and up to 58% of species exhibited macrolide resistance. Consumption of Watch group antibiotics ranged from 53% to 68%, with a broad preference for injectables. Self-medication was found to be common, with rates ranging between 26% and 40% among the general public. High levels of patient demand coincided with medical errors, affecting up to 80% of antibiotic prescriptions. Only a limited number of antimicrobial stewardship studies were found, highlighting the insufficient integration of stewardship practices into routine healthcare delivery. Central Asian countries continue to face significant challenges because of the persistence of poor surveillance, high antibiotic consumption, and inadequate implementation of AMS because of long-standing legacies and systemic weaknesses. Addressing these gaps demands structural reforms, integrated surveillance systems, targeted education, and robust stewardship programs as urgent priorities.
Steinbrink JM, Friedman DZ, Thompson GR
… +5 more, Kauffman CA, Alexander BD, Hanson K, Imlay H, Mycoses Study Group Education & Research Consortium (MSGERC)
Clin Microbiol Rev
· 2026 Mar · PMID 41677277
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SUMMARYInvasive fungal diseases cause severe illness and death in immunocompromised patients. Antifungal use is increasingly common, as is fungal diagnostic testing. However, these efforts have not been guided by traditi...SUMMARYInvasive fungal diseases cause severe illness and death in immunocompromised patients. Antifungal use is increasingly common, as is fungal diagnostic testing. However, these efforts have not been guided by traditional stewardship efforts akin to those used for bacterial infections. Fungal diagnostic stewardship can have a significant impact on the care of vulnerable patients, including decreasing unnecessary testing while increasing appropriate testing and improving testing strategies to reduce diagnostic errors. In this review, we discuss the most frequently used fungal diagnostic assays for molds and dimorphic fungal infections, their diagnostic performance for these organisms in immunocompromised hosts, and strategies to improve diagnostic stewardship and ultimately patient outcomes.
Chiu C-Y, Hicklen RS, Ostrosky-Zeichner L
… +6 more, Sheth SA, Tan C, Weinberg JS, Chiller T, Walsh TJ, Kontoyiannis DP
Clin Microbiol Rev
· 2026 Mar · PMID 41665346
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SUMMARYIatrogenic central nervous system mold infections (ICNSMIs) are rare and occur as sporadic complications of neurosurgical procedures or device insertions. However, recent outbreaks have been reported in outpatient...SUMMARYIatrogenic central nervous system mold infections (ICNSMIs) are rare and occur as sporadic complications of neurosurgical procedures or device insertions. However, recent outbreaks have been reported in outpatient settings, following epidural injections with contaminated medicines. We conducted a comprehensive literature review of studies published without date restrictions through July 2025 on ICNSMIs. We identified 905 cases of such infections, with 4% occurring in non-outbreak settings and 96% associated with five documented outbreaks. In both non-outbreak and outbreak settings, infections were more common after spinal/epidural injections, with contaminated medicines or supplies being the primary source. Due to their angioinvasive tendencies, ICNSMI caused by and species had a higher frequency of stroke/intracranial hemorrhage ( = 0.011), aneurysm formation ( = 0.012), and resulted in higher mortality compared with ICNSMI caused by other molds ( < 0.001). ICNSMI, as a result of catheter-associated fungemia, was very rare (only one case). Strategies to identify ICNSMI in exposed individuals during an outbreak have included (i) symptom-driven lumbar puncture, (ii) screening lumbar puncture regardless of symptoms, and (iii) screening brain MRI regardless of symptoms. Measurement of (1→3)-β-D-glucan in cerebrospinal fluid was a valuable tool to diagnose ICNSMI preemptively. Outcomes of ICNSMI following neurosurgical procedures were poor (90-day mortality of 35%) and depended on the route of inoculation, mold species, timing of diagnosis, and prompt initiation of appropriate antifungal therapy in combination with source control. Patients with ICNSMI often suffered long-term neurologic sequelae, even with the most optimal management strategies.
Clin Microbiol Rev
· 2026 Mar · PMID 41627026
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SUMMARYParatransgenesis employs insect-associated bacteria to deliver antipathogen effectors and is an emergent complementary strategy for vector control. This review synthesizes current evidence for species as paratran...SUMMARYParatransgenesis employs insect-associated bacteria to deliver antipathogen effectors and is an emergent complementary strategy for vector control. This review synthesizes current evidence for species as paratransgenic vehicles, combining mechanistic insights into effector molecules (e.g., scorpine, MP2, multi-fusion constructs, and the naturally secreted antimalarial lipase AmLip), with comparative evidence on colonization, transmission, and efficacy. strains (e.g., AS1, Su_YN1) demonstrate rapid dissemination in laboratory populations and potent reductions in development (reported oocyst inhibition in laboratory studies ranging from ~60% to >90% for specific effectors). We critically examine biosafety, genetic stability, and ecological factors and propose a minimum evidence package and translational roadmap comprising multigeneration stability assays, horizontal gene transfer monitoring, non-target impact assessments, and community and regulatory engagement to responsibly advance Serratia-based paratransgenesis toward field evaluation. This comparative framing integrates -focused detail with the broader paratransgenesis literature to clarify both its promise and remaining knowledge gaps.