The emergence of fungal pathogens and changes in the epidemiological landscape are prevalent issues in clinical mycology. Reports of resistance to antifungals have been reported. This review aims to evaluate molecular and nonmolecular mechanisms related to antifungal resistance. Mutations in the ERG genes and overexpression of the efflux pump (MDR1, CDR1 and CDR2 genes) were the most reported molecular mechanisms of resistance in clinical isolates, mainly related to Azoles. For echinocandins, a molecular mechanism described was mutation in the FSK genes. Furthermore, nonmolecular virulence factors contributed to therapeutic failure, such as biofilm formation and selective pressure due to previous exposure to antifungals. Thus, there are many public health challenges in treating fungal infections.

Background: Trichosporon spp. are opportunistic fungi, capable of causing infection, especially in critically ill individuals who often use broad-spectrum antibiotics, invasive devices, and have comorbidities. Objectives The aim of this study was to analyze individuals’ clinical characteristics, evaluate tolerance to biocides, as well as biofilm formation and efflux pump activity in isolates of Trichosporon asahii. Methods: Clinical isolates of T. asahii collected between 2020 and 2023 from both hospitalized and non-hospitalized individuals, of both sexes, regardless of age, were tested for tolerance to sodium hypochlorite, hydrogen peroxide, benzalkonium chloride, and ethyl alcohol. Efflux pump activity was also assessed using ethidium bromide, and biofilm formation was measured with the Safranin test. Clinical parameters such as outcomes, source, and length of hospitalization were analyzed through electronic medical records. Results: A total of 37 clinical isolates of T. asahii were identified. Thirty-three (83.8%) isolates were from hospitalized individuals, with 81.82% collected in ICUs, an average hospital stay of 35 days, and a mortality rate of 51.6%. The tested strains displayed the largest mean inhibition zone for 2% sodium hypochlorite, indicating lower tolerance. A high level of efflux pump expression was detected among clinical isolates. Biofilm formation was detected in 25/67.5% of the isolates. Conclusions: These findings highlight the clinical relevance of T. asahii, particularly in critically ill individuals, and underscore the pathogen’s ability to tolerate biocides, express efflux pumps, and form biofilms, all of which may contribute to its persistence and pathogenicity in hospital environments. Enhanced surveillance and effective microbial control measures are essential to mitigate the risks associated with T. asahii infections.

Candidiasis, caused by Candida spp. is an opportunistic infection with significant healthcare risks, worsened by trends in antifungal resistance. This study aimed to evaluate the antifungal susceptibility profile, investigate resistance mechanisms, assess efflux pump activity, and examine biocide tolerance in clinical Candida isolates. A total of 100 Candida isolates from hospitalized and outpatient individuals were analyzed for their antifungal susceptibility profile, molecular resistance mechanisms through PCR, efflux pump activity with the Cartwheel method, and biocide tolerance (sodium hypochlorite, hydrogen peroxide, and benzalkonium chloride), which was assessed by disk diffusion. A high prevalence of resistance (87%) to at least one antifungal was observed, with 47.12% of isolates showing simultaneous multiple resistance to three azole derivatives. The highest antifungal agent resistance was observed for fluconazole (n = 70) and the highest susceptibility for amphotericin B (n = 1). The most common mutation was in the ERG11 gene (n = 38/43.7%). Efflux pump activity was detected in both C. albicans and non-albicans Candida species. Biocide testing revealed a higher tolerance for sodium hypochlorite, with an inhibition zone ranging from 18.25 (4.40) to 34.0 (4.00). This study highlights significant antifungal resistance in Candida spp. particularly to azoles, stressing the need for improved infection control and novel therapeutic strategies.

Cutaneous Larva Migrans (CLM), also known as creeping eruption or ground itch, is a parasitic infection caused by larvae of the Ancylostoma braziliense and A. caninum species, which usually infect dogs and cats. CLM is considered a neglected disease that affects populations in developing countries located in tropical regions such as Brazil, India, and the Caribbean. Although the infection is more prevalent in areas with low economic and social development, sports activities on sand courts or beaches have led to infections among an economically privileged audience, including international travelers. Considering the current importance of CLM, this work describes an outbreak of the disease among residents of a high-end residential condominium located in the municipality of Lavras, Minas Gerais, Brazil. During the epidemiological investigation, five individuals with CLM were identified, and environmental risk factors for sand contamination were discovered. Preventive measures and controls for new cases were advised, as well as health education initiatives aimed at guiding the residents. The findings highlight the importance of CLM as a public health issue, even among populations with high socioeconomic status, and the need for increased awareness and control measures to prevent further outbreaks. This study adds to the growing body of evidence on the epidemiology of CLM and underscores the need for continued research to develop effective prevention and control strategies for neglected parasitic diseases.