Introduction: A group of approximately 15 Candida species are frequently found to be responsible for human invasive candidiasis, an infection that appears in patients with prolonged hospitalization, particularly in Intensive Care Units, and in immunosuppressed individuals. Given the considerable burden if not rapidly treated, clinicians face diagnostic challenges in distinguishing infection. The objective of this narrative review is to summarize the clinically applicable biomarkers used for invasive candidiasis and to evaluate their performance and create a diagnostic algorithm for clinical practice. Methods: This narrative review was conducted by searching PubMed and Scopus for studies published between 1990 and 2025, using keywords related to invasive candidiasis and non-culture diagnostic biomarkers. Clinical guidelines and consensus documents from major infectious diseases societies were additionally reviewed to supplement. Results: Blood cultures, which are considered the “gold standard” for diagnosis, face important fallouts caused by the limited sensitivity of 50%. Polymerase Chain Reaction assays can identify Candida species at an early stage when compared to blood cultures, demonstrating high specificity that ranges between 91% and 98, due to their high cost, and the limitations regarding only the identification of certain species, their widespread use remains limited. Non-culture serological tests such as mannan, anti-mannan and 1-3-β-D-glucan can detect fungal cell wall components or antibodies directed towards them. These tests have the advantage of being performed directly from blood samples. Reported sensitivity and specificity are 83% and 86% for mannan/anti-mannan, and 73% and 80% for 1-3-β-D-glucan, respectively. They are used for early detection of candidemia in high-risk patients, including immunocompromised individuals. Conclusions: Our report suggests that the traditional “gold standard” for diagnosing invasive candidiasis can be improved by integrating and combining novel biomarkers in the diagnostic pathways, and, thus, potentially reducing the time spent for diagnosing and facilitating early treatment access.

Background: Candidemia remains a major cause of morbidity and mortality among hospitalized patients. The emergence of Candidozyma auris has added further complexity due to its persistence in healthcare settings and its high rates of antifungal resistance. Comparative real-world data between Candidozyma auris and Candida spp. candidemia remain limited. Methods: We conducted a retrospective cohort study that included adult patients with candidemia, admitted to a tertiary infectious diseases hospital in Romania between August 2018 and August 2025. Risk factors, including medical history, previous hospitalizations, clinical characteristics, laboratory parameters, antifungal susceptibility patterns, treatment, and outcomes, were compared in patients with Candidozyma auris- and Candida spp.-positive blood cultures. Overall survival and prognostic factors were evaluated using univariable and multivariable Cox-proportional hazards models. Results: Sixty-one patients with candidemia were included; out of them, 24 (39.3%) had Candidozyma auris-positive blood cultures. Candidozyma auris infections, which emerged later during the study period, occurred after a significantly longer period of hospitalization compared with Candida spp. candidemia (median 52.5 vs. 20 days, p < 0.001). Azole resistance was almost universal among Candidozyma auris isolates (95.8%), whereas Candida species displayed significantly lower resistance rates and a broader susceptibility spectrum (p < 0.001). Inflammatory markers were comparable between groups; however, Candidozyma auris candidemia was associated with lower neutrophil counts and lower neutrophil-to-lymphocyte ratios at diagnosis (p = 0.020). Persistent candidemia at day 7 occurred more frequently in Candidozyma auris infections (6 vs. 2 patients; p = 0.05) and was universally fatal. Overall, in-hospital mortality was high (70.5%) and did not differ between Candidozyma auris and Candida spp. candidemia. In multivariable analysis, thrombocytopenia < 100,000/μL was independently associated with mortality (HR 2.34, 95% C.I. 1.20–4.56; p = 0.012). Conclusions: In this 7-year study at a Romanian tertiary center, Candidozyma auris emerged as a major healthcare-associated pathogen affecting patients with significantly prolonged hospitalization (median 52.5 days). Despite near-universal azole resistance (95.8%), mortality was exceptionally high (70.5%) and was comparable between groups, with pathogen type not independently associated with outcome after multivariable adjustment. Moderate thrombocytopenia (<100,000/μL) and persistent candidemia identified patients at particularly high risk of death, underscoring the need for early risk stratification, optimized antifungal management, and enhanced diagnostic vigilance, both in intensive care and general wards.

Fungal endocarditis, despite being a rare diagnosis, has a higher morbidity and mortality rate compared to bacterial endocarditis. Candida species are the most common isolated pathogens involved in fungal endocarditis. Diagnosis is suspected in patients with underlying conditions such as cancer, myelodysplastic syndrome, diabetes, or intravascular catheters, where the modified Duke criteria apply. Management of the patient requires a multidisciplinary team (cardiologist, infectious diseases consultant, cardiac surgeon) along with antifungal treatment. We present the case of a 60-year-old male with biological prosthetic aortic valve replacement in the previous year for bicuspid aortic stenosis, admitted for a 5-day history of fever, nausea and minor urinary symptoms. The blood cultures were positive for Candida parapsilosis. Transthoracic cardiac ultrasound revealed a hypoechogenic mass attached to the aortic valve at the prosthetic fixation site. Although diagnosis was rapidly confirmed and treatment was administered shortly after first suspected, the patient developed, at first, cavernous sinus thrombosis and, later, fatal ST elevation myocardial infarction. The patient died despite efficient antifungal therapy, initially with Anidulafungin in monotherapy and later in combination with Fluconazole. The reported case emphasizes the importance of managing fungal endocarditis, the need for urgent diagnostic attention and multidisciplinary team approach by infectious diseases specialist, cardiologist, neurologist and heart surgeon.