Background: Superficial candidiasis (SC) is widespread in humans worldwide. This study aimed to evaluate species distribution patterns and antifungal susceptibility through cluster analysis. Methods: A total of 180 Candida strains isolated from skin and nail samples of 1593 examined patients with suspected superficial fungal infection were identified by Matrix-assisted laser desorption in ionization-time of flight mass spectrometry (MALDI-TOF MS; Zybio EXS2600, China). Antifungal susceptibility was assessed using the commercial Integral System YEASTS Plus test (ISYPT; Liofilchem^®, Italy). Agglomerative hierarchical cluster analysis was used to analyze species distribution and susceptibility. Results: Candida parapsilosis (44.4%) and C. albicans (40%) were the most prevalent causative agents of SC. Cluster analysis established two defined clusters. Cluster 1 (121 isolates) showed a statistically significant difference compared to Cluster 2 (54 isolates) in species distribution (C. albicans was dominant in the first and C. parapsilosis in the second cluster) as well as in susceptibility to ECN (p ≤ 0.001), KCA (p = 0.030), CLO (p ≤ 0.001), MCZ (p ≤ 0.001), ITZ (p ≤ 0.001), and FLU (p ≤ 0.006). Conclusion: The fact that one-third of isolates exhibited low sensitivity to antifungals highlights the need for a new approach in SC treatment, emphasizing the importance of mycological analyses, including in vitro testing of antifungal effectiveness.

Exophiala endophthalmitis of exogenous origin is an exceptionally rare but severe ocular infection, characterized by diagnostic delays, limited therapeutic guidance, and frequently poor outcomes. Herein, we report one new case of an 80-year-old woman who presented with severe fungal keratitis progressing to endophthalmitis two years after an uncomplicated cataract surgery. The condition was initially misdiagnosed and treated with topical antibiotics and corticosteroids. By cultivation, microscopy, histopathological, and PCR analysis of the samples, Exophiala dermatitidis was identified as the causative agent. Despite targeted antifungal therapy with voriconazole, the disease rapidly progressed, resulting in corneal perforation and evisceration of the affected eye. The number of confirmed cases of this infection remains very limited. To address this gap, we conducted a structured review of all reported instances of exogenous Exophiala endophthalmitis, in which Exophiala dermatitidis emerged as the predominant causative species. Common predisposing factors included corneal barrier disruption, ocular surgery, diabetes mellitus, and corticosteroid use. Diagnostic confirmation was frequently delayed, and treatment outcomes varied. Amphotericin B-based regimens were associated with poor results, whereas voriconazole, particularly when combined with surgical intervention, demonstrated more favorable outcomes. Exogenous Exophiala endophthalmitis remains underrecognized, with limited evidence to guide management. This entity should be considered in postoperative or trauma-associated intraocular inflammation, and current evidence supports azole-based therapy combined with surgical intervention when indicated.