Abstract Background In 2022, the World Health Organization published for the first time a list of 19 priority fungal pathogens that cause invasive diseases and threaten public health. However, in low-income settings, lack of access to proper diagnosis means that fungal infections are often missed, and broad-spectrum antifungal drugs are prescribed in the absence of a confirmed diagnosis, which can accelerate the development of drug resistance. This study aimed to describe the prevalence of fungal strain types recovered from Brazilian samples over a 5-year period (January 2020 to December 2024). Methods This study was based on the analysis of 29,990 clinical samples processed by a microbiology laboratory. Briefly, the specimens collected were inoculated onto two agar broths (Sabouraud’s Dextrose Agar (SDA) and Mycosel agar (MA)) for specific fungi culture and inoculated onto Columbia blood agar (CBA), chocolate agar (CA) and MacConkey agar (MCA) for general culture. SDA and MA were maintained at room temperature for up to 2 weeks while CBA, CA and MCA were maintained at 35°C ± 1 for 24–48 h. Final identification of fungi was performed by MALDI-TOF mass spectrometry (Vitek-MS). For filamentous fungi only, an in-house protocol with formic acid and acetonitrile treatment was used. Results During the 5-year period, a total of 29,990 fungi (2020; 3,953), (2021; 6,749), (2022; 5,875), (2023; 5,981) and (2024; 7,432) were isolated from culture. The frequency of microorganism’s groups was yeasts (29,793; 99.34%) and dimorphic/filamentous fungi (197; 0.66%). The yeasts group included 28,757 Candida spp. (96.42%), 671 Trichosporum spp. (2.25%), 234 Cryptococcus spp. (0.78%), 58 Saccharomyces spp. (0.19%), 42 Kodamaea spp. (0.14%), 24 Rhodotorula spp. (0.08%), 3 Lodderomyces spp. (0.01%) and only one Lachancea spp., Malassezia spp., Hanseniaspora spp. and Aureobasidium spp., respectively. The filamentous fungi were distributed as 63.96% (126/197) dermatophytes (97 Trichophyton spp. and 29 Microsporum app.) and 36.04% (71/197) non-dermatophytes (22 Fusarium spp., 12 Acremonium spp., 11 Saprochaete spp., 5 Geotrichum spp., 4 Sporothrix spp., 4 Purpureocillium spp., 3 Penicillium spp., 3 Rhizopus spp., 2 Aspergillus spp., 2 Neosartorya spp., one Neoscytalidium spp., Sarocladium spp. and Alternaria spp., respectively.) These microorganisms were isolated mainly from urine (n=17,835), blood (n=5,408), vaginal discharge (n=2,521), stool (n= 397), aerobic culture (n= 1,955), fungal culture (n=1,519) and others. The highest incidence of fungal infection was among women (61.70%) and the main age group was over 50 years (64.39%), while 30-49 years accounted for 17.05% of cases. Conclusion In this study, we observed an increase in the incidence of fungal infections, especially by Candida spp. coinciding with the onset of the COVID-19 pandemic. Although Candida albicans remain the leading cause of invasive candidiasis, a growing proportion of diagnoses have been attributed to C. tropicalis and C. glabrata, as well as other yeasts such as Trichosporon asahii and Cryptococcus neoformans. These data highlight the frequency and characteristics of fungal pathogenic agents in the current Brazilian scenario.
Nürmberger et al. (Wed,) studied this question.