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The European Confederation of Medical Mycology (ECMM), formed due to the surge in invasive fungal infections (IFI), initiated the Excellence Centers program in 2016 to guide stakeholders to leading medical mycology sites. This report focuses on the Cologne ECMM Excellence Center, recognized with Diamond status for active global involvement in 2017. The center offers free consultation via email and phone, responding within 24 h for life-threatening IFI, collecting data on origin, pathogens, infection details, and more. Over two years, 189 requests were received globally, predominantly from Germany (85%), mainly involving Aspergillus spp., Mucorales, and Candida spp. Fungal mixed infections occurred in 4% of cases. The center's service effectively addresses IFI challenges, advocating for a comprehensive study encompassing all ECMM Excellence Centers to enhance global mycological care. Proactive expansion of consultancy platforms is crucial, with future analyses needed to assess expert advice's impact on patient outcomes., (© 2024. The Author(s).)

Fungal diseases impose an escalating burden on public health in Africa, exacerbated by issues such as delayed diagnosis, inadequate therapy, and limited access to healthcare resources, resulting in significant morbidity and mortality. Effectively tackling these challenges demands a comprehensive approach encompassing research, training, and advocacy initiatives. Recent clinical mycology surveys conducted by Global Action for Fungal Infection (GAFFI) and the European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) have underscored gaps in fungal diagnostics and the availability and accessibility of antifungal therapy in Africa. The World Health Organization (WHO) Fungal Priority Pathogens List (FPPL) identifies fungi of critical or high importance to human health, providing a roadmap for action and highlighting the urgent need for prioritizing fungal diseases and developing targeted interventions within the African context. To enhance diagnosis and treatment, it is imperative to invest in comprehensive training programs for healthcare workers across all levels and disciplines. Equipping them with the necessary knowledge and skills will facilitate early detection, accurate diagnosis, and appropriate management of fungal infections. Moreover, implementation science research in medical mycology assumes a pivotal role in bridging the gap between knowledge and practice. By identifying the barriers and facilitators that influence the adoption of diagnostic techniques and public health interventions, tailored strategies can be formulated to improve their implementation within healthcare settings. Advocacy plays a critical role in raising awareness regarding the profound impact of fungal diseases on public health in Africa. Engaging policymakers, healthcare providers, researchers, industry experts and communities underscore the importance of addressing these diseases and galvanize efforts for change. Substantial investment in surveillance, research and development specifically focused on fungal diseases is indispensable for advancing our understanding of local epidemiology, developing effective interventions, and ultimately improving patient outcomes. In conclusion, closing the gaps in diagnosing and treating fungal diseases in Africa demands concerted research and advocacy initiatives to ensure better healthcare delivery, reduced mortality rates, and improved public health outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

Uncommon, or rare, yeast infections are on the rise given increasing numbers of patients who are immunocompromised or seriously ill. The major pathogens include those of the genera Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon (ie, basidiomycetes) and Kodamaea, Malassezia, Pseudozyma (ie, now Moesziomyces or Dirkmeia), Rhodotorula, Saccharomyces, and Sporobolomyces (ie, ascomycetes). A considered approach to the complex, multidisciplinary management of infections that are caused by these pathogens is essential to optimising patient outcomes; however, management guidelines are either region-specific or require updating. In alignment with the One World-One Guideline initiative to incorporate regional differences, experts from diverse geographical regions analysed publications describing the epidemiology and management of the previously mentioned rare yeasts. This guideline summarises the consensus recommendations with regards to the diagnostic and therapeutic options for patients with these rare yeast infections, with the intent of providing practical assistance in clinical decision making. Because there is less clinical experience of patients with rare yeast infections and studies on these patients were not randomised, nor were groups compared, most recommendations are not robust in their validation but represent insights by use of expert opinions and in-vitro susceptibility results. In this Review, we report the key features of the epidemiology, diagnosis, antifungal susceptibility, and treatment outcomes of patients with Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon spp infections., Competing Interests: Declaration of interests KA, DEA, JC, LD-G, CG, P-RH, MI, SSK, OL, LP, TP, RR-R, MR, JS-G, ES, DS, AS, IS, RS, JS, ET, LT, AMT, MH, and FFT declare no competing interests. SA-A reports speaker honoraria from Gilead Sciences and travel grants from Astellas and Pfizer, outside the submitted work. TB reports grants from Gilead Sciences and personal fees from Gilead Sciences and Pfizer, outside the submitted work. SC-AC reports untied educational grants from Merck Sharp and Dohme Australia and F2G and is on the antifungal advisory boards of Merck Sharp and Dohme Australia, Gilead Sciences, and F2G, outside the submitted work. ALC reports grants from Astellas and Pfizer; personal fees from Astellas, Pfizer, Eurofarma, Merck Sharp and Dohme, Gilead Sciences, and Biotoscana-United Medical; and non-financial support from Eurofarma, Gilead Sciences, and Biotoscana-United Medical, outside the submitted work. OAC is supported by the German Federal Ministry of Research and Education; is funded by the Deutsche Forschungsgemeinschaft under Germany's Excellence Strategy (Cologne Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases, EXC 2030—390661388); has received research grants from Actelion, Amplyx, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead Sciences, Janssen, Medicines Company, Melinta, Merck/Merck Sharp and Dohme, Octapharma, Pfizer, and Scynexis; is a consultant to Actelion, Allecra, Amplyx, Astellas, Basilea, Biosys, Cidara, Da Volterra, Entasis, F2G, Gilead Sciences, Matinas, MedPace, Menarini, Merck/Merck Sharp and Dohme, Mylan, Nabriva, Noxxon, Octapharma, Paratek, Pfizer, PSI, Roche Diagnostics, Scynexis, and Shionogi; and has received lecture honoraria from Al-Jazeera Pharmaceuticals, Astellas, Basilea, Gilead Sciences, Grupo Biotoscana, Merck/Merck Sharp and Dohme, and Pfizer, outside the submitted work. JNdAJ reports grants from Fundação de Amparo à Pesquisa do Estado de São Paulo, outside the submitted work. TF reports grants from Ministry of Health, Czech Republic, outside the submitted work. GG-E reports grants from Gador SA Laboratory (Argentina) and travel grants from Pfizer and Grupo Biotoscana, outside the submitted work. NG reports honoraria from Merck Sharp and Dohme, Australia, in 2019 and has participated in educational activities under the auspices of the Australia–New Zealand Mycology Interest Group. The Australia–New Zealand Mycology Interest Group workshops and meetings receive pharmaceutical sponsorship (from Pfizer, Gilead Sciences, Merck Sharp and Dohme, and Mayne Pharma), outside the submitted work. NPG reports grants from the National Institutes of Health, US Center for Disease Control and Prevention, Bill & Melinda Gates Foundation, UK Medical Research Council, and National Health Laboratory Service Research Trust and non-financial support from Gilead Sciences, outside the submitted work. AHG reports grants from Gilead Sciences, Merck Sharp and Dohme, and Pfizer and personal fees from Amplyx, Astellas, Basilea, Gilead Sciences, Merck Sharp and Dohme, Pfizer, F2G, and Synexis, outside the submitted work. CL-F reports grants from Gilead Sciences and Astellas and personal fees from Gilead Sciences, Astellas, Merck Sharp and Dohme, Basilea, and Angelini, outside the submitted work. JM reports grants from Astellas, Gilead Sciences, Merck Sharp and Dohme, and Pfizer, outside the submitted work. PM reports personal fees from Angelini, Basilea, Gilead Sciences, Merck Sharp and Dohme, Nabriva, Pfizer, and Fundación Ciencias de la Salud, outside the submitted work. LO-Z reports grants from Cidara, Scynexis, Amplyx, Pfizer, and Astellas and personal fees from Cidara, Scynexis, F2G, Pfizer, Astellas, Merck, and Gilead Sciences, outside the submitted work. JP reports grants from Merck, Astellas, Pfizer, Amplyx, and Minnetronix and personal fees from Merck, F2G, Scynexis, Amplyx, and Ampili, outside the submitted work. AV reports research grants from Procter and Gamble, L'Oréal Paris, Pfizer, and Astellas and honorarium from Merck Sharp and Dohme, outside the submitted work. NW reports grants from Astellas, bioMerieux, Cepheid, Cidara, Covance, F2G, and Viamet and personal fees from Gilead Sciences and Mayne Pharma, outside the submitted work. Y-CC reports personal fees for lectures from Pfizer, Merck Sharp and Dohme, and Gilead Sciences, outside the submitted work., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

With increasing numbers of patients needing intensive care or who are immunosuppressed, infections caused by moulds other than Aspergillus spp or Mucorales are increasing. Although antifungal prophylaxis has shown effectiveness in preventing many invasive fungal infections, selective pressure has caused an increase of breakthrough infections caused by Fusarium, Lomentospora, and Scedosporium species, as well as by dematiaceous moulds, Rasamsonia, Schizophyllum, Scopulariopsis, Paecilomyces, Penicillium, Talaromyces and Purpureocillium species. Guidance on the complex multidisciplinary management of infections caused by these pathogens has the potential to improve prognosis. Management routes depend on the availability of diagnostic and therapeutic options. The present recommendations are part of the One World-One Guideline initiative to incorporate regional differences in the epidemiology and management of rare mould infections. Experts from 24 countries contributed their knowledge and analysed published evidence on the diagnosis and treatment of rare mould infections. This consensus document intends to provide practical guidance in clinical decision making by engaging physicians and scientists involved in various aspects of clinical management. Moreover, we identify areas of uncertainty and constraints in optimising this management., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: To provide a basis for clinical management decisions in Paecilomyces variotii infection., Methods: Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed., Results: We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases., Conclusions: P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.)

Objectives: Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI., Methods: Extremely rare IFI collected in the FungiScope Ⓡ registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales., Results: Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScope Ⓡ . Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales., Conclusions: Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens., Competing Interests: Declaration of Competing Interest PK reports personal fees from Astellas Pharma GmbH, Gilead Sciences GmbH, Akademie für Infektionsmedizin e.V., MSD Sharp & Dohme GmbH, and University Hospital, LMU Munich; non-financial support from Miltenyi Biotec GmbH; and other support from Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany, outside the submitted work. SCAC reports grants from MSD Australia, outside the submitted work. NK reports personal fees from Astellas, Gilead, MSD, and Pfizer, outside the submitted work. DCS reports grants from Merck and personal fees from Merck, Astellas, and AVIR, outside the submitted work. MH reports grants from Gilead, outside the submitted work. SCM reports personal fees from Octapharma, outside the submitted work. RH reports grants from Gilead, Novartis, and Pfizer and personal fees from Astellas, Basilea, Gilead, MSD, Novartis, and Pfizer, outside the submitted work. GK reports personal fees from Astellas Pharma, Gilead Sciences, Merck Sharp and Dohme, Pfizer, and Sandoz outside the submitted work. CLF reports grants from Astellas Pharma and Gilead Sciences; personal fees from Angelini, Basilea, Biomerieux, Gilead Sciences, and Merck Sharp and Dohme; and other support from Astellas Pharma, Basilea, Biomerieux, Gilead Sciences, and Merck Sharp and Dohme, outside the submitted work. KM reports grants as a clinical trial investigator from Gilead Sciences, Inc., clinical research grants from Ansun, Astellas, Merck, Rebiotix, Scynexis, and Shire; and consultant fees/honoraria from Chimerix, GlaxoSmithKline, Merck, and Scynexis outside the submitted work. DCV reports support from Avir Pharma, Cidara Therapeutics, CSL Behring, and Fonds de la Recherche en Santé du Quebec, during the conduct of the study (salary support), outside the submitted work. OAC reports grants from Actelion, Amplyx, Astellas, Basilea, Cidara, Da Volterra, F2G, Gilead, Janssen Pharmaceuticals, Medicines Company, MedPace, Melinta Therapeutics, Merck/MSD, Pfizer, and Scynexis and personal fees from Actelion, Allecra Therapeutics, Amplyx, Astellas, Basilea, Biosys UK Limited, Cidara, Da Volterra, F2G, Entasis, Gilead, Grupo Biotoscana, Matinas, MedPace, Menarini Ricerche, Merck/MSD, Nabriva Therapeutics Octapharma, Paratek Pharmaceuticals, Pfizer, PSI, Rempex, Roche Diagnostics, Scynexis, Seres Therapeutics, and Tetraphase outside the submitted work. Other authors: none, (Copyright © 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)

Background: The new Rasamsonia spp. complex can develop invasive infection in immunosuppression or chronic pulmonary disease. It has potential to be misidentified as other genera due to morphological similarities. Nowadays, there is a gap of knowledge on this fungi., Objectives: To provide knowledge base of risk factors and therapeutic decisions in invasive Rasamsonia spp. complex infection., Patients/methods: Cases of invasive infection due to Rasamsonia spp. (formerly Geosmithia/Penicillium spp.) from FungiScope ® registry and all reported cases from a literature were included., Results: We identified 23 invasive infections due to Rasamsonia spp., six (26.1%) in the FungiScope ® registry. Main risk factors were chronic granulomatous disease (n = 12, 52.2%), immunosuppressive treatment (n = 10, 43.5%), haematopoietic stem cell transplantation (n = 7, 30.4%), graft-versus-host disease and major surgery (n = 4, 17.4%, each). Predominantly affected organs were the lungs (n = 21, 91.3%), disease disseminated in seven cases (30.4%). Fungal misidentification occurred in 47.8% (n = 11), and sequencing was used in 69.6% of the patients (n = 16) to diagnose. Breakthrough infection occurred in 13 patients (56.5%). All patients received antifungal treatment, mostly posaconazole (n = 11), caspofungin (n = 10) or voriconazole (n = 9). Combination therapy was administered in 13 patients (56.5%). Susceptibility testing showed high minimum inhibitory concentrations for azoles and amphotericin B, but not for echinocandins. No preferable treatment influencing favourable outcome was identified. Overall mortality was 39% (n = 9)., Conclusion: Rasamsonia spp. are emerging fungi causing life-threatening infections, especially in immunocompromised and critically ill patients. Mortality is high. Treatment is challenging and clinicians dealing with this patient population should become aware of this infection constituting a medical emergency., (© 2019 The Authors. Mycoses published by Blackwell Verlag GmbH.)

Objectives: Current knowledge on infections caused by Scedosporium spp. and Lomentospora prolificans in children is scarce. We therefore aim to provide an overview of risk groups, clinical manifestation and treatment strategies of these infections., Methods: Pediatric patients (age ≤18 years) with proven/probable Scedosporium spp. or L. prolificans infection were identified in PubMed and the FungiScope® registry. Data on diagnosis, treatment and outcome were collected., Results: Fifty-five children (median age 9 years [IQR: 5-14]) with invasive Scedosporium spp. (n = 33) or L. prolificans (n = 22) infection were identified between 1990 and 2019. Malignancy, trauma and near drowning were the most common risk factors. Infections were frequently disseminated. Most patients received systemic antifungal therapy, mainly voriconazole and amphotericin B, plus surgical treatment. Overall, day 42 mortality was 31%, higher for L. prolificans (50%) compared to Scedosporium spp. (18%). L. prolificans infection was associated with a shorter median survival time compared to Scedosporium spp. (6 days [IQR: 3-28] versus 61 days [IQR: 16-148]). Treatment for malignancy and severe disseminated infection were associated with particularly poor outcome (HR 8.33 [95% CI 1.35-51.40] and HR 6.12 [95% CI 1.52-24.66], respectively). Voriconazole use at any time and surgery for antifungal treatment were associated with improved clinical outcome (HR 0.33 [95% CI 0.11-0.99] and HR 0.09 [95% CI 0.02-0.40], respectively)., Conclusions: Scedosporium spp. and L. prolificans infections in children are associated with high mortality despite comprehensive antifungal therapy. Voriconazole usage and surgical intervention are associated with successful outcome., (Copyright © 2019 University Hospital of Cologne. Published by Elsevier Ltd.. All rights reserved.)