In Young Yoo, M.D., Ph.D., Sungjin Jo, M.D., Ph.D., Joo An Kwon, M.T., Jay Ho Han, M.D., Ph.D., Hae Kyung Lee, M.D., Ph.D., and Yeon-Joon Park, M.D., Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2025.0047

Onychomycosis is a prevalent fungal infection of the nail apparatus, predominantly caused by dermatophytes. However, nondermatophytic molds, while less common, represent an increasingly recognized etiological group. Among these, Aspergillus, Scopulariopsis, Neoscytalidium, and Fusarium species are frequently implicated. Advancements in molecular diagnostic techniques have facilitated the identification of rare and emerging fungal pathogens implicated in onychomycosis. This case report details the first recorded case of onychomycosis caused by Nothophoma quercina, a fungal species that was previously recognized only as a plant pathogen. A 44-year- old male with severe atopic dermatitis receiving long-term immunosuppressive therapy with cyclosporine and dupilumab developed persistent nail abnormalities. Mycological evaluation, which included potassium hydroxide testing, fungal culture, and molecular analysis, confirmed Nothophoma quercina as the causal organism. The presence of this rare fungus in a human infection underscores the expanding spectrum of nondermatophytic onychomycosis and emphasizes the need to consider atypical pathogens in immunocompromised individuals. The growing use of molecular techniques has facilitated the detection of novel fungal species that may have been previously misidentified or disregarded using conventional methods. This case highlights the need for clinicians to exercise caution while assessing refractory onychomycosis, particularly in high-risk patients. Greater awareness and continued research into rare fungal pathogens will enhance the diagnostic accuracy and developing appropriate antifungal management strategies.

Background/Objectives: We evaluated the diagnostic performance of the Alifax Molecular Mouse (MM) sepsis panel for rapidly directly detecting pathogens and resistance genes in positive blood culture broths. Methods: In this prospective single-center study, 40 positive blood culture specimens were analyzed using four MM cartridges targeting Gram-positive and -negative bacteria and major antimicrobial resistance genes. The results were compared with those obtained using the routine microbiological protocol, including organism identification using the MALDI Biotyper system and antimicrobial susceptibility testing using the VITEK 2 and MicroScan WalkAway systems. Additionally, the MM panel results were compared with those obtained using the FilmArray BCID2. Results: Compared with the routine protocol, the MM panel achieved a positive percent agreement (PPA) of 89.5% (34/38; 95% confidence interval [CI], 75.9–95.8%) for bacterial identification, indicating moderate-to-good diagnostic performance. For antimicrobial resistance gene detection, the PPA was 92.1% (35/38; 95% CI, 79.2–97.3%). Compared with the FilmArray BCID2, the overall agreement of the MM panel was 89.4% (34/38) for bacterial identification and 84.2% (32/38) for antimicrobial resistance gene detection. The MM panel generated clinically actionable results within 1 h (mean turnaround time, 55.5 min; 95% CI, 55.1–55.9 min), substantially reducing the turnaround time compared with the conventional microbiological workflow, which requires 1.5–2 days for subculture and automated antimicrobial susceptibility testing. Conclusions: The MM sepsis panel enabled rapid, direct identification of bloodstream pathogens and key antimicrobial resistance markers from positive blood cultures, substantially reducing turnaround time and exhibiting its potential as an adjunct to routine microbiological workflows.