Candida auris is a dangerous fungal pathogen that causes outbreaks in health care facilities, with infections associated with a high mortality rate. As conventional antifungal drugs have limited effects against the majority of clinical isolates, new and innovative therapies are urgently needed.

The glucocorticoid betamethasone (BM) is frequently employed in the clinical practice because of its anti-inflammatory and immunosuppressive properties. In this study, we investigated the effect of BM (1 and 2 mM) on the ability of Candida albicans to adhere to, invade and damage oral, intestinal or vaginal epithelial cells, as well as to elicit cytokine and chemokine release. BM at 2 mM concentration stimulated adherence of C. albicans to vaginal cells and facilitated the invasion of intestinal and vaginal epithelia without influencing the growth rate of invading C. albicans hyphae at any types of epithelia and BM concentrations tested. In addition, BM at 2 mM concentration also augmented C. albicans-initiated cell damage of oral and intestinal cells. Furthermore, BM exposure decreased IL-6 cytokine and IL-8 chemokine release from oral and vaginal epithelial cells and also IL-6 release from intestinal epithelium after infection with C. albicans. These observations suggest that high-dose applications of BM may predispose patients to various epithelial C. albicans infections.

Candida auris is a potential multidrug-resistant pathogen able to cause biofilm-associated outbreaks, where frequently indwelling devices are the source of infections. The number of effective therapies is limited; thus, new, even-combination-based strategies are needed. Therefore, the in vitro efficacy of caspofungin with posaconazole against FKS wild-type and mutant Candida auris isolates was determined. The interactions were assessed utilizing the fractional inhibitory concentration indices (FICIs), the Bliss model, and a LIVE/DEAD assay. Planktonic minimum inhibitory concentrations (pMICs) for the caspofungin–posaconazole combination showed a 4- to 256-fold and a 2- to 512-fold decrease compared to caspofungin and posaconazole alone, respectively. Sessile minimum inhibitory concentrations (sMICs) for caspofungin and posaconazole in combination showed an 8- to 128-fold and a 4- to 512-fold decrease, respectively. The combination showed synergy, especially against biofilms (FICIs were 0.033–0.375 and 0.091–0.5, and Bliss cumulative synergy volumes were 6.96 and 32.39 for echinocandin-susceptible and -resistant isolates, respectively). The caspofungin-exposed (4 mg/L) C. auris biofilms exhibited increased cell death in the presence of posaconazole (0.03 mg/L) compared to untreated, caspofungin-exposed and posaconazole-treated biofilms. Despite the favorable effect of caspofungin with posaconazole, in vivo studies are needed to confirm the therapeutic potential of this combination in C. auris-associated infections.

Trichophyton indotineae is associated with difficult-to-treat, often extensive dermatophytosis and resistance to the commonly used antifungal agents. Successful therapy often necessitates higher than usual doses of systemic therapy for prolonged periods. The spread of this species has gained much attention lately, as several European and other Western hemisphere countries have recently reported their first respective cases or increasing numbers of them. Until recently, this species was not described in Hungary. Here, we report a case caused by this species in a patient with a travel history to an endemic region. The isolate was identified preliminarily by MALDI-TOF mass spectrometry and confirmed by DNA sequencing; furthermore, it was subject to phenotypic antifungal susceptibility testing by broth microdilution to fluconazole, voriconazole, posaconazole, itraconazole, and terbinafine. According to the susceptibility results, the isolate was wild type to all tested agents, including terbinafine which was in line with the sequencing data, and with the uncommon excellent therapeutic response to topical allylamine treatment. This case also further confirms the applicability of the MSI-2 database for the rapid identification of T. indotineae in routine clinical microbiology laboratories as a cost-effective and simple method.