{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T13:35:41Z","timestamp":1775050541839,"version":"3.50.1"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Deep fungal infections (DFIs) represent a significant and growing threat to hospitalized patients, contributing to substantial morbidity and mortality worldwide. The healthcare landscape has undergone notable changes in recent years, particularly with the impact of the COVID-19 pandemic, which has altered host immunity and care pathways, potentially influencing the epidemiology of DFIs.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to delineate the clinical characteristics, mycological profiles, risk factors of deep fungal infections, and to evaluate factors associated with mortality among inpatients in a general hospital in southwestern China from 2020 to 2024.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a retrospective analysis of 886,056 patients in the hospital from 2020 to 2024, including the epidemiological characteristics, treatment, and prognosis of deep fungal infections.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 462 cases (0.052%) with deep fungal infections were identified, accounting for 0.052% of the total number of hospitalizations. The incidence of deep fungal infections in the hospital showed an increasing trend from 2020 to 2024. Compared with previous studies,\n Candida<\/jats:italic>\n remained the predominant pathogen (84.20%), with increased proportions of\n Aspergillus<\/jats:italic>\n (13.90%) and\n Cryptococcus<\/jats:italic>\n (6.71%). A new case of\n Mucor<\/jats:italic>\n infection (0.22%) was reported. The respiratory tract remains the most common site of infection (88.60%). In terms of treatment, most patients received azole therapy (88.30%), with those treated with echinocandins showing significantly higher survival rates (\n P<\/jats:italic>\n = 0.033). Multiple logistic regression analyses revealed that mixed infections, hematologic diseases, and biological agents were significant risk factors for poor prognosis (all\n P<\/jats:italic>\n &lt; 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Compared with earlier research (2015\u20132019), the number of deep fungal infection cases from 2020 to 2024 has shown a significant and sustained increase. Moreover, the threat posed by\n Aspergillus<\/jats:italic>\n and\n Cryptococcus<\/jats:italic>\n has increased. Although clinical data remain limited, these findings provide valuable insights for the prevention, diagnosis, and treatment of deep fungal infections. Compared with earlier research (2015\u20132019), the number of deep fungal infection cases from 2020 to 2024 has shown a significant and sustained increase. Moreover, the threat posed by\n Aspergillus<\/jats:italic>\n and\n Cryptococcus<\/jats:italic>\n has increased. Although clinical data remain limited, these findings provide valuable insights for the prevention, diagnosis, and treatment of deep fungal infections.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1766256","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:58:24Z","timestamp":1775044704000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics and etiological analysis of deep fungal infections in a general hospital in Southwest China (2020\u20132024)"],"prefix":"10.3389","volume":"14","author":[{"given":"Shuwei","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenghui","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuye","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Qun","family":"Kuang","sequence":"additional","affiliation":[{"name":"Research Center for Clinical Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongbin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e428","DOI":"10.1016\/S1473-3099(23)00692-8","article-title":"Global incidence and mortality of severe fungal disease","volume":"24","author":"Denning","year":"2024","journal-title":"Lancet Infect Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1016\/j.idc.2021.08.002","article-title":"Nosocomial fungal infections","volume":"35","author":"Suleyman","year":"2021","journal-title":"Infect Dis Clin North Am."},{"key":"B3","doi-asserted-by":"publisher","first-page":"myad021","DOI":"10.1093\/mmy\/myad021","article-title":"Real-life epidemiology and current outcomes of hospitalized adults with invasive fungal infections","volume":"61","author":"Monzo-Gallo","year":"2023","journal-title":"Med Mycol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"199","DOI":"10.12788\/cutis.0088","article-title":"Risk for deep fungal infections during IL-17 and IL-23 inhibitor therapy for psoriasis","volume":"106","author":"Lee","year":"2020","journal-title":"Cutis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1111\/myc.13225","article-title":"Increased incidence of candidemia in a tertiary care hospital with the COVID-19 pandemic","volume":"64","author":"Nucci","year":"2020","journal-title":"Mycoses"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1111\/myc.13332","article-title":"Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients","volume":"64","author":"Kayaaslan","year":"2021","journal-title":"Mycoses"},{"key":"B7","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.jointm.2021.07.001","article-title":"COVID-19-associated pulmonary aspergillosis (CAPA)","volume":"1","author":"Dimopoulos","year":"2021","journal-title":"J Intensive Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin Infect Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"104616","DOI":"10.1016\/j.micpath.2020.104616","article-title":"Distribution of invasive fungal infections: molecular epidemiology, etiology, clinical conditions, diagnosis and risk factors: A 3-year experience with 490 patients under intensive care","volume":"152","author":"Borjian Boroujeni","year":"2021","journal-title":"Microb Pathog"},{"key":"B10","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/jcla.21580","article-title":"Incidence of pulmonary aspergillosis and correlation of conventional diagnostic methods with nested PCR and real-time PCR assay using BAL fluid in intensive care unit patients","volume":"27","author":"Zarrinfar","year":"2013","journal-title":"J Clin Lab Anal."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e04889","DOI":"10.1002\/ccr3.4889","article-title":"First report of invasive Aspergillus rhinosinusitis in a critically ill COVID-19 patient affected by acute myeloid leukemia, northeastern Iran","volume":"9","author":"Hosseinikargar","year":"2021","journal-title":"Clin Case Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"895329","DOI":"10.3389\/fcimb.2022.895329","article-title":"Phaeohyphomycosis in China","volume":"12","author":"He","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.3390\/microorganisms10051010","article-title":"Invasive and subcutaneous infections caused by filamentous fungi: report from a Portuguese multicentric surveillance program","volume":"10","author":"Ver\u00edssimo","year":"2022","journal-title":"Microorganisms"},{"key":"B14","doi-asserted-by":"publisher","first-page":"842434","DOI":"10.3389\/fpubh.2022.842434","article-title":"Deep fungal infections among general hospital inpatients in Southwestern China: a 5-year retrospective study","volume":"10","author":"Wen","year":"2022","journal-title":"Front Public Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1980","DOI":"10.1016\/j.cmi.2025.07.016","article-title":"Beyond guidelines: what do I need to know when dealing with fungal diagnostics?","volume":"31","author":"C","year":"2025","journal-title":"Clin Microbiol Infect"},{"key":"B17","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3390\/jof5010004","article-title":"A moldy application of MALDI: MALDI-ToF mass spectrometry for fungal identification","volume":"5","author":"Patel","year":"2019","journal-title":"J Fungi"},{"key":"B18","doi-asserted-by":"publisher","first-page":"322","DOI":"10.3390\/microorganisms12020322","article-title":"MALDI-TOF MS: a reliable tool in the real life of the clinical microbiology laboratory","volume":"12","author":"Calderaro","year":"2024","journal-title":"Microorganisms"},{"key":"B19","doi-asserted-by":"publisher","first-page":"30218","DOI":"10.3390\/jof10030218","article-title":"Chromogenic, biochemical and proteomic identification of yeast and yeast-like microorganisms isolated from clinical samples from animals of Costa Rica","volume":"10","author":"Calder\u00f3n-Hern\u00e1ndez","year":"2024","journal-title":"J Fungi"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e14056","DOI":"10.1111\/1755-0998.14056","article-title":"Teknonaturalist: a snakemake pipeline for assessing fungal diversity from plant genome bycatch","volume":"25","author":"Bard","year":"2024","journal-title":"Mol Ecol Resour"},{"key":"B21","doi-asserted-by":"publisher","first-page":"S109","DOI":"10.1093\/cid\/ciaa1836","article-title":"Molecular techniques for genus and species determination of fungi from fresh and paraffin-embedded formalin-fixed tissue in the revised EORTC\/MSGERC definitions of invasive fungal infection","volume":"72","author":"Lockhart","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1164\/rccm.202410-2045ST","article-title":"Treatment of invasive pulmonary aspergillosis and preventive and empirical therapy for invasive candidiasis in adult pulmonary and critical care patients: an official American thoracic society clinical practice guideline","volume":"211","author":"Epelbaum","year":"2025","journal-title":"Am J Respir Crit Care Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e213706","DOI":"10.1001\/jamasurg.2021.3706","article-title":"A clinical decision tool for selection of patients with symptomatic cholelithiasis for cholecystectomy based on reduction of pain and a pain-free state following surgery","volume":"156","author":"Latenstein CSS","year":"2021","journal-title":"JAMA Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e00562","DOI":"10.1128\/mbio.00562-25","article-title":"Key fungal coinfections: epidemiology, mechanisms of pathogenesis, and beyond","volume":"16","author":"Silva","year":"2025","journal-title":"mBio (Am Soc Microbiol)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1007\/s12016-022-08921-5","article-title":"Risk and protective factors for COVID-19 morbidity, severity, and mortality","volume":"64","author":"Zhang","year":"2022","journal-title":"Clin Rev Allergy Immunol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1038\/s41581-020-00357-4","article-title":"Immunity, endothelial injury and complement-induced coagulopathy in COVID-19","volume":"17","author":"Perico","year":"2020","journal-title":"Nat Rev Nephrol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1111\/myc.13239","article-title":"Epidemiology of aspergillosis in hospitalised Spanish patients\u2014A 21-year retrospective study","volume":"64","author":"Gonz\u00e1lez-Garcia","year":"2021","journal-title":"Mycoses"},{"key":"B28","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1111\/myc.13213","article-title":"Invasive pulmonary aspergillosis in the COVID-19 era: an expected new entity","volume":"64","author":"Machado","year":"2020","journal-title":"Mycoses"},{"key":"B29","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/1471-2334-13-10.","article-title":"A risk factor analysis of healthcare-associated fungal infections in an intensive care unit: a retrospective cohort study","volume":"13","author":"Yang","year":"2013","journal-title":"BMC Infect Dis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1128\/mbio.03078-23","article-title":"Cryptococcus neoformans rapidly invades the murine brain by sequential breaching of airway and endothelial tissues barriers, followed by engulfment by microglia","volume":"15","author":"Francis","year":"2024","journal-title":"mBio"},{"key":"B31","doi-asserted-by":"publisher","first-page":"721","DOI":"10.3390\/jof8070721","article-title":"Invasive fungal diseases in hospitalized patients with COVID-19 in Israel: a multicenter cohort study","volume":"8","author":"Elbaz","year":"2022","journal-title":"J Fungi"},{"key":"B32","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1111\/myc.13211","article-title":"Risk factors for candidaemia: a prospective multi-centre case-control study","volume":"64","author":"Keighley","year":"2020","journal-title":"Mycoses"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3000605241237878","DOI":"10.1177\/03000605241237878","article-title":"Efficacy and safety of caspofungin for the treatment of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease","volume":"52","author":"Li","year":"2024","journal-title":"J Int Med Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e70040","DOI":"10.1111\/myc.70040","article-title":"Souza GH, Santos DA, Bastos RW, Rossato L. Fungal infections associated with TNF-inhibitors: a 20-year of a systematic review fungal infections and TNF-inhibitors","volume":"68","author":"Barbosa LSP","year":"2025","journal-title":"Mycoses"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1256158","DOI":"10.3389\/fcimb.2024.1256158","article-title":"Diagnosis and management of invasive fungal diseases in non-neutropenic ICU patients, with focus on candidiasis and aspergillosis: a comprehensive review","volume":"14","author":"Azim","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1007\/s00134-024-07341-7","article-title":"Invasive fungal diseases in adult patients in intensive care unit (FUNDICU): 2024 consensus definitions from ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM","volume":"50","author":"Bassetti","year":"2024","journal-title":"Intensive Care Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"106553","DOI":"10.1016\/j.ijantimicag.2022.106553","article-title":"Human tissue distribution of caspofungin","volume":"59","author":"Marx","year":"2022","journal-title":"Int J Antimicrob Agents"},{"key":"B38","doi-asserted-by":"publisher","first-page":"3025","DOI":"10.1038\/s41564-024-01819-2","article-title":"Most azole resistance mutations in the Candida albicans drug target confer cross-resistance without intrinsic fitness cost","volume":"9","author":"B\u00e9dard","year":"2024","journal-title":"Nat Microbiol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"4687","DOI":"10.2147\/IDR.S403863","article-title":"Fungal spectrum and susceptibility against nine antifungal agents in 525 deep fungal infected cases","volume":"16","author":"Cai","year":"2023","journal-title":"Infect Drug Resist."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1766256\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:58:25Z","timestamp":1775044705000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1766256\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":39,"alternative-id":["10.3389\/fpubh.2026.1766256"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1766256","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1766256"}}