Management of invasive fungal infections (IFI) and subsequent treatment choices remain challenging for physicians in the ICU. Documented evidence shows increased practice of the inappropriate use of antifungal agents in the ICU. Continuous education of healthcare providers (HCPs) represents the cornerstone requirement for starting an antifungal stewardship program (AFS). This study aimed at evaluating knowledge gaps in systemic antifungal prescribing among physicians and clinical pharmacists in a critical care setting. A cross-sectional, multi-center, survey-based study was conducted in five tertiary hospitals located in Al-Ahsaa, Saudi Arabia between January and May 2021. A self-administered questionnaire was distributed among the targeted clinicians. A total of 63 clinicians were involved (65.5% ICU physicians and 34.5% clinical pharmacists). It was noted that a minority of the participating HCPs (3.2%) had overall good knowledge about antifungal prescribing, but the majority had either moderate (46%) or poor (50.8%) knowledge. The difference in overall knowledge scores between the ICU physicians and the clinical pharmacists (p = 0.925) was not significant. However, pharmacists showed better scores for the pharmacokinetics of antifungal therapy (p = 0.05). This study has revealed a significant gap in the knowledge and practice of clinicians as regards prescribing antifungal therapy in our area. Although the results cannot be generalized, the outcome of this study has exposed the need for a tailored training program essential for carrying out an AFS program.

Candida albicans is currently considered one of the most significant fungal pathogens in cetaceans and pinnipeds and the spread of antifungal-resistant strains pose significant threats to animal health and One Health concerns. Although C. albicans is the most commonly detected species, non-albicans Candida (NAC) species, including C. tropicalis, C. parapsilosis and Nakaseomyces glabratus and the multidrug-resistant C. auris, have been recognized in captive dolphins. This review examines the clinical patterns observed in marine mammal taxa: cetaceans are most commonly vulnerable to respiratory and disseminated mycoses owing to their distinct anatomical characteristics, whereas mucocutaneous infections are the common manifestation in pinnipeds. Localized mucocutaneous infections may progress to fatal systemic disease, with mortality rates approaching 100% in severe cases, despite therapeutic treatment. The most important predisposing factors are immunosuppression, long-term antibiotic treatment, environmental stress factors, and the deterioration of water quality. Diagnostic methods are based on cytology, histopathology, culture, and molecular methods, and treatment is mostly composed of systemic azole antifungals although with high levels of therapeutic failure. Recent results showed that there are high levels of azole resistance in the isolates of marine mammals that had no history of exposure to antifungal agents, which points to the role of aquatic environments as sources of resistance genes. The lack of knowledge remains particularly evident in species-specific pharmacokinetics and the development of evidence-based treatment guidelines. These infections also have broader implications for ecosystem health surveillance and the protection of endangered marine mammal populations. The current review highlights the One Health approach with marine mammals being at the core of ocean health surveillance and identifies the potential for zoonotic transmission.

The dramatic rise in global aquaculture has brought renewed focus on filamentous fungi impacting fish health and aquafeeds. The fungal genus Aspergillus has a Janus-like role in aquaculture. On the pathogenic side, opportunistic pathogens like A. flavus, A. niger and A. fumigatus cause outbreaks of aspergillosis, with granulomatous lesions and significant mortality, especially in fish with impaired immunity and/or poor environmental conditions. Toxigenic strains of A. flavus and A. parasiticus also contaminate aquafeeds with aflatoxins, some of the most toxic natural hepatotoxins and carcinogens, which have been shown to affect growth, immunity and aflatoxin residues in edible fish fillets. On the positive side, non-toxigenic strains of A. niger, A. oryzae and A. awamori are increasingly used as fungal probiotics, solid-state fermenters to upgrade plant protein feed supplements, and as sources of industrially useful hydrolytic enzymes, secondary metabolites and antifungal compounds. Synthesizing evidence from over 90 peer-reviewed studies, this narrative review elucidates how species, strain, and rearing context jointly determine whether Aspergillus behaves as a pathogen or as a functional additive. We highlight knowledge gaps, offer an interpretative model and suggest practical strategies to limit risks and leverage the biotechnological uses of Aspergillus for sustainable aquaculture. The novelty of this review lies in integrating, within a single finfish-focused framework, the three usually separate faces of Aspergillus—pathogen, aflatoxin producer, and functional feed additive—and in translating this dual nature into practical, strain-level guidance for aquaculture.