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Review Article Volume 14 Issue 2
Clinical microbiology of fungal infections: from diagnosis to drug resistance
Vasudevan Ranganathan, Padma Madham
Received: June 13, 2026 | Published: June 22, 2026
Citation: Ranganathan V, Madham P. Clinical microbiology of fungal infections: from diagnosis to drug resistance. J Bacteriol Mycol Open Access. 2026;14(2):74-80. DOI: 10.15406/jbmoa.2026.14.00433
Abstract
Fungal infections represent a growing global health challenge, particularly among immunocompromised individuals, critically ill patients, and those undergoing prolonged antibiotic or immunosuppressive therapy. The clinical microbiology of fungal infections plays a central role in bridging the gap between early diagnosis and effective treatment outcomes. Accurate diagnosis begins with conventional methods such as direct microscopy using potassium hydroxide (KOH) preparations, Gram staining, and culture on selective media like Sabouraud dextrose agar, which remain foundational for identifying common fungal pathogens. However, these approaches are often slow, leading to delays in initiating appropriate therapy. Advances in diagnostic microbiology, including antigen detection assays such as galactomannan and β-D-glucan tests, have significantly improved early detection of invasive fungal infections. Molecular techniques like polymerase chain reaction (PCR), DNA sequencing, and MALDI-TOF mass spectrometry now enable rapid and precise species-level identification, which is critical given the varying antifungal susceptibility profiles among species of Candida, Aspergillus, and Cryptococcus. Despite these improvements, antifungal drug resistance has emerged as a major clinical concern. Mechanisms of resistance include mutations in target enzymes such as ERG11 in azoleresistant Candida species, overexpression of efflux pumps, biofilm-associated tolerance, and alterations in cell wall composition that reduce drug binding. The widespread and sometimes empirical use of antifungal agents has further accelerated resistance development. Clinical microbiology laboratories play a vital role in antifungal susceptibility testing and in guiding evidence-based therapy tailored to local epidemiological trends. Integration of rapid diagnostics with resistance profiling is essential for improving patient outcomes. Ultimately, a comprehensive understanding of fungal pathogenesis, diagnostic innovations, and resistance mechanisms is crucial for managing fungal diseases effectively in modern clinical settings.
Keywords: Microbial infections, fungal infection, MDR
©2026 Ranganathan, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.