Review of the Microbial Spectrum of Mixed Respiratory Fungal Infections.

BACKGROUND

This review examines the increasing clinical challenge of mixed respiratory fungal infections (MRFIs), emphasizing interkingdom interactions and their impact on disease progression and patient outcomes.

MAIN BODY: We critically analyze current literature on the clinical implications, risk factors, and diagnostic complexities of MRFIs, with a primary focus on fungal-bacterial, fungal-viral, and fungal-parasitic co-infections. Fungal-bacterial co-infections, often involving Candida spp. and Pseudomonas aeruginosa, significantly worsen disease severity. Fungal-viral co-infections, particularly in COVID-19 patients with Candida albicans and Aspergillus fumigatus, represent a major threat. While rare, fungal-parasitic co-infections pose risks for immunocompromised individuals. The review highlights diagnostic difficulties due to non-specific symptoms and the vital need to distinguish colonization from true infection. It also explores the complex symbiotic, synergistic, and antagonistic relationships between fungi and other microorganisms, alongside the immune-modulating role of commensal fungi.

CONCLUSION

Ultimately, this review seeks to enhance understanding of MRFIs to improve diagnostic and therapeutic strategies and patient care.