Candida and candidiasis in Portugal: Past situation, current trends and future challenges

Candida infections are among the most common fungal diseases globally, with candidemia posing a serious threat in hospitalized and immunocompromised patients. In Portugal, though Candida albicans is the predominant species identified, other species such as Candida parapsilosis and Nakaseomyces glabratus (formerly Candida glabrata) are increasingly detected, particularly in intensive care units and patients with invasive devices. Emerging multidrug-resistant strains, notably Candidozyma auris (formerly Candida auris), have raised significant concern, with the first Portuguese cases reported recently. Surveillance studies suggest that antifungal resistance rates are generally low, though fluconazole resistance in C. parapsilosis is a concern, since ERG11 mutations were recently detected in several isolates. Echinocandins are recommended as first-line therapy, yet availability is uneven across healthcare centers. Beyond candidemia, superficial infections like vulvovaginal candidiasis and onychomycosis remain highly frequent. Active research in Portugal on Candida biology, virulence, and novel therapies, have been conducting for different research groups. Strengthening surveillance, rapid diagnostics, molecular identification, and infection control measures, alongside mandatory notification of C. auris, are critical for effective management. Integrated strategies under a "One Health" framework are essential to mitigate morbidity, mortality, and resistance trends associated with Candida infections.