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

Area of Science:

• Mycology
• Infectious Diseases
• Public Health

Background:

• Candida infections, including candidemia, are common globally, particularly threatening hospitalized and immunocompromised individuals.
• While Candida albicans is prevalent in Portugal, non-albicans species (Nakaseomyces glabratus, Candida parapsilosis) and multidrug-resistant Candida auris are increasing.
• Superficial Candida infections like vulvovaginal candidiasis and onychomycosis are highly frequent.

Purpose of the Study:

• To review the current landscape of Candida infections in Portugal.
• To highlight challenges including antifungal resistance and emerging pathogens.
• To emphasize the need for improved surveillance and integrated management strategies.

Main Methods:

• Review of surveillance data and scientific literature on Candida infections in Portugal.
• Analysis of species distribution, antifungal resistance patterns, and clinical significance.
• Discussion of current research and recommendations for future strategies.

Main Results:

• Candida albicans remains predominant, but other species and multidrug-resistant Candida auris are emerging concerns.
• Fluconazole resistance in Candida parapsilosis is noted, linked to ERG11 mutations.
• Echinocandin availability for first-line therapy is inconsistent across Portuguese healthcare centers.

Conclusions:

• Strengthening surveillance, rapid diagnostics, molecular identification, and infection control are crucial for managing Candida infections.
• Mandatory notification of Candida auris and integrated "One Health" approaches are essential.
• Continued research into Candida biology, virulence, and novel therapies is vital to combat morbidity, mortality, and resistance.