{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T21:16:20Z","timestamp":1792617380124,"version":"4.5.0"},"reference-count":106,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Intestinal fungal overgrowth (IFO) is an increasingly recognized yet underexplored component of gut dysbiosis with potential implications for gastrointestinal and systemic disease. While bacterial microbiota have historically garnered research attention, recent advances in sequencing technologies have highlighted the importance of the gut mycobiome in maintaining intestinal homeostasis. Disruption of fungal\u2013bacterial balance, particularly involving Candida albicans, C. tropicalis, and C. glabrata, may contribute to symptom generation through immune activation, epithelial barrier dysfunction, biofilm formation, and the production of toxic metabolites such as acetaldehyde and candidalysin. Emerging clinical evidence suggests that IFO is associated with persistent gastrointestinal symptoms, including bloating, abdominal discomfort, and altered bowel habits, particularly in patients who do not respond to conventional therapies targeting bacterial overgrowth. Furthermore, fungal dysbiosis involving Malassezia restricta and Saccharomyces cerevisiae has been associated with inflammatory bowel disease, metabolic disorders, and systemic immune dysregulation; however, the nature and directionality of these relationships remain incompletely understood. Despite increasing recognition, the diagnosis of IFO remains challenging due to a lack of standardized criteria and validated non-invasive tools. Therapeutic strategies, including antifungal agents such as fluconazole and nystatin, as well as microbiome-targeted interventions, show promise but require further validation. This review provides a comprehensive synthesis of current evidence regarding the epidemiology, pathophysiology, clinical manifestations, diagnostic challenges, and therapeutic implications of IFO, with particular emphasis on species-specific mechanisms. Recognition of the intestinal mycobiome as a potentially important component of gut health may provide new perspectives for understanding gastrointestinal disorders and inform future precision medicine approaches.<\/jats:p>","DOI":"10.3390\/microorganisms14061365","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:18:43Z","timestamp":1781860723000},"page":"1365","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Significance of Intestinal Fungal Overgrowth: Integrating the Gut Mycobiome into Modern Gastroenterology"],"prefix":"10.3390","volume":"14","author":[{"given":"Jisoon","family":"Im","sequence":"first","affiliation":[{"name":"Department of Family Practice and Community Health, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6608-2180","authenticated-orcid":false,"given":"Kyucheol","family":"Lee","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Cheongdamrui Plastic Surgery, Jeju 63083, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0606-987X","authenticated-orcid":false,"given":"Sang-Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"GreenCross I-MED Gangnam Center, Majestar City Tower 1, 4F, 12 Seocho-daero 38-gil, Seocho-gu, Seoul 06655, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soohwan","family":"Jung","sequence":"additional","affiliation":[{"name":"Philip Medical Center, 10 Hwangsaeul-ro, 311 beon-gil, Bundang-gu, Seongnam-si 13590, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1213-5004","authenticated-orcid":false,"given":"Kyu-Nam","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Family Practice and Community Health, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea"},{"name":"Biochemistry & Molecular Medicine, GW Cancer Center, School of Medicine & Health Sciences, The George Washington University, Ross Hall 437C, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8503-4805","authenticated-orcid":false,"given":"Jiyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Biochemistry & Molecular Medicine, GW Cancer Center, School of Medicine & Health Sciences, The George Washington University, Ross Hall 437C, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/nature08821","article-title":"A human gut microbial gene catalogue established by metagenomic sequencing","volume":"464","author":"Qin","year":"2010","journal-title":"Nature"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2440111","DOI":"10.1080\/19490976.2024.2440111","article-title":"The mycobiome as an integral part of the gut microbiome: Crucial role of symbiotic fungi in health and disease","volume":"16","author":"Huang","year":"2024","journal-title":"Gut Microbes"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Talapko, J., Juzbasic, M., Matijevic, T., Pustijanac, E., Bekic, S., Kotris, I., and Skrlec, I. (2021). Candida albicans\u2014The virulence factors and clinical manifestations of infection. J. Fungi, 7.","DOI":"10.3390\/jof7020079"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Rodrigues, C.F., Rodrigues, M.E., Silva, S., and Henriques, M. (2017). Candida glabrata biofilms: How far have we come?. J. Fungi, 3.","DOI":"10.3390\/jof3010011"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Sadanandan, B., and Yogendraiah, K.M. (2026). Hydrogel-like biofilms of Candida tropicalis: Biofouling of polymeric prosthetic materials and emerging antifungal strategies. Mater. Proc., 29.","DOI":"10.3390\/materproc2026029005"},{"key":"ref_6","first-page":"215","article-title":"Intestinal microbiota: The hidden gems in the gut?","volume":"38","author":"Piewngam","year":"2020","journal-title":"Asian Pac. J. Allergy Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s11894-015-0436-2","article-title":"Small intestinal fungal overgrowth","volume":"17","author":"Erdogan","year":"2015","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1053\/j.gastro.2020.09.014","article-title":"Population-Level Configurations of Gut Mycobiome Across 6 Ethnicities in Urban and Rural China","volume":"160","author":"Sun","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kabwe, M.H., Vikram, S., Mulaudzi, K., Jansson, J.K., and Makhalanyane, T.P. (2020). The gut mycobiota of rural and urban individuals is shaped by geography. BMC Microbiol., 20.","DOI":"10.1186\/s12866-020-01907-3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e0098622","DOI":"10.1128\/msystems.00986-22","article-title":"Host Factors Associated with Gut Mycobiome Structure","volume":"8","author":"Handschuh","year":"2023","journal-title":"mSystems"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/j.chom.2022.04.013","article-title":"Long-term antibiotic exposure promotes mortality after systemic fungal infection by driving lymphocyte dysfunction and systemic escape of commensal bacteria","volume":"30","author":"Drummond","year":"2022","journal-title":"Cell Host Microbe"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e0398225","DOI":"10.1128\/mbio.03982-25","article-title":"Antibiotic-induced microbiota disruption impairs neutrophil-mediated immunity to respiratory Aspergillus fumigatus infection in mice","volume":"17","author":"Aufiero","year":"2026","journal-title":"mBio"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.mib.2020.05.006","article-title":"The gut, the bad and the harmless: Candida albicans as a commensal and opportunistic pathogen in the intestine","volume":"56","author":"Kumamoto","year":"2020","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_14","first-page":"349","article-title":"Candida colonization of the esophagus and gastric mucosa; a comparison of patients taking proton pump inhibitors and those taking histamine receptor antagonist drugs","volume":"14","author":"Mottaghi","year":"2021","journal-title":"Gastroenterol. Hepatol. Bed Bench"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Rodrigues, C.F., Rodrigues, M.E., and Henriques, M. (2019). Candida sp. infections in patients with diabetes mellitus. J. Clin. Med., 8.","DOI":"10.3390\/jcm8010076"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Cheng, Y., Cong, J., Xu, J., Tang, L., Zhou, Z., Yang, X., Hu, Y., Li, Y., He, R., and Xiang, Q. (2025). Research progress on the exacerbation of lipid metabolism by Malassezia and its impact on the skin barrier function. Cosmetics, 12.","DOI":"10.3390\/cosmetics12020067"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.micinf.2010.03.013","article-title":"Host responses to Candida albicans: Th17 cells and mucosal candidiasis","volume":"12","author":"Conti","year":"2010","journal-title":"Microbes Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s12281-023-00456-2","article-title":"The impact of corticosteroids on the outcome of fungal disease: A systematic review and meta-analysis","volume":"17","author":"Li","year":"2023","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Li, W., Chen, H., and Tang, J. (2024). Interplay between bile acids and intestinal microbiota: Regulatory mechanisms and therapeutic potential for infections. Pathogens, 13.","DOI":"10.20944\/preprints202406.1907.v1"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Beam, A., Clinger, E., and Hao, L. (2021). Effect of diet and dietary components on the composition of the gut microbiota. Nutrients, 13.","DOI":"10.3390\/nu13082795"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3","DOI":"10.35946\/arcr.v45.1.03","article-title":"Influence of alcohol on the intestinal immune system","volume":"45","author":"Kreimeyer","year":"2025","journal-title":"Alcohol Res.-Curr. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1038\/s41591-023-02243-5","article-title":"Dysbiosis of a microbiota-immune metasystem in critical illness is associated with nosocomial infections","volume":"29","author":"Schlechte","year":"2023","journal-title":"Nat. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cong, L., Chen, C., Mao, S., Han, Z., Zhu, Z., and Li, Y. (2023). Intestinal bacteria-a powerful weapon for fungal infections treatment. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1187831"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cusumano, G., Flores, G.A., Venanzoni, R., and Angelini, P. (2025). The impact of antibiotic therapy on intestinal microbiota: Dysbiosis, antibiotic resistance, and restoration strategies. Antibiotics, 14.","DOI":"10.3390\/antibiotics14040371"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Chow, E.W.L., Pang, L.M., and Wang, Y. (2021). From Jekyll to Hyde: The yeast-hyphal transition of Candida albicans. Pathogens, 10.","DOI":"10.20944\/preprints202106.0386.v1"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lu, Y., Su, C., Wang, A., and Liu, H. (2011). Hyphal development in Candida albicans requires two temporally linked changes in promoter chromatin for initiation and maintenance. PLoS Biol., 9, Erratum in PLoS Biol. 2011, 9.","DOI":"10.1371\/annotation\/7b97b9ec-881a-4940-83ab-01f5318fd819"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4161\/viru.22913","article-title":"Candida albicans pathogenicity mechanisms","volume":"4","author":"Mayer","year":"2013","journal-title":"Virulence"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s12281-008-0026-y","article-title":"Phenotypic switching in fungi","volume":"2","author":"Jain","year":"2008","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1186\/s12943-025-02348-0","article-title":"Biofilm formation by the host microbiota: A protective shield against immunity and its implication in cancer","volume":"24","author":"Montanari","year":"2025","journal-title":"Mol. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/mBio.00338-19","article-title":"Effects of a novel probiotic combination on pathogenic bacterial-fungal polymicrobial biofilms","volume":"10","author":"Hager","year":"2019","journal-title":"mBio"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rodrigues, M.E., Gomes, F., and Rodrigues, C.F. (2019). Candida spp.\/bacteria mixed biofilms. J. Fungi, 6.","DOI":"10.3390\/jof6010005"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1979877","DOI":"10.1080\/19490976.2021.1979877","article-title":"The interplay between gut bacteria and the yeast Candida albicans","volume":"13","author":"Perez","year":"2021","journal-title":"Gut Microbes"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Yogendraiah, K.M., Sadanandan, B., Kyathsandra Natraj, L., Vijayalakshmi, V., and Shetty, K. (2025). Optimization of Candida tropicalis growth conditions on silicone elastomer material by response surface methodology. Front. Bioeng. Biotechnol., 13.","DOI":"10.3389\/fbioe.2025.1572694"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1086\/523110","article-title":"Immune recognition of Candida albicans beta-glucan by dectin-1","volume":"196","author":"Gow","year":"2007","journal-title":"J. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1084\/jem.20132349","article-title":"CARD9 mediates Dectin-1-induced ERK activation by linking Ras-GRF1 to H-Ras for antifungal immunity","volume":"211","author":"Jia","year":"2014","journal-title":"J. Exp. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"780","DOI":"10.4049\/jimmunol.1500909","article-title":"IL-17-mediated immunity to the opportunistic fungal pathogen Candida albicans","volume":"195","author":"Conti","year":"2015","journal-title":"J. Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Briard, B., Malireddi, R.K.S., and Kanneganti, T.D. (2021). Role of inflammasomes\/pyroptosis and PANoptosis during fungal infection. PLoS Pathog., 17.","DOI":"10.1371\/journal.ppat.1009358"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1136\/gutjnl-2015-310746","article-title":"Fungal microbiota dysbiosis in IBD","volume":"66","author":"Sokol","year":"2017","journal-title":"Gut"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.jcmgh.2021.11.008","article-title":"Candida tropicalis infection modulates the gut microbiome and confers enhanced susceptibility to colitis in mice","volume":"13","author":"Buela","year":"2022","journal-title":"Cell. Mol. Gastroenterol. Hepatol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Spatz, M., and Richard, M.L. (2020). overview of the potential role of Malassezia in gut health and disease. Front. Cell. Infect. Microbiol., 10.","DOI":"10.3389\/fcimb.2020.00201"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Yang, Q., Ouyang, J., Pi, D., Feng, L., and Yang, J. (2022). Malassezia in inflammatory bowel disease: Accomplice of evoking tumorigenesis. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.846469"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/JLB.2MA0820-259R","article-title":"Malassezia spp. induce inflammatory cytokines and activate NLRP3 inflammasomes in phagocytes","volume":"109","author":"Wolf","year":"2021","journal-title":"J. Leukoc. Biol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Barbara, G., Barbaro, M.R., Fuschi, D., Palombo, M., Falangone, F., Cremon, C., Marasco, G., and Stanghellini, V. (2021). Inflammatory and microbiota-related regulation of the intestinal epithelial barrier. Front. Nutr., 8, Erratum in Front. Nutr. 2021, 8, 790387.","DOI":"10.3389\/fnut.2021.718356"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Morelli, M., and Queiroz, K. (2025). Breaking barriers: Candidalysin disrupts epithelial integrity and induces inflammation in a gut-on-chip model. Toxins, 17.","DOI":"10.3390\/toxins17020089"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"161","DOI":"10.4103\/jomfp.jomfp_494_20","article-title":"Capacity of Candida species to produce acetaldehyde at various concentrations of alcohol","volume":"26","author":"Reddy","year":"2022","journal-title":"J. Oral Maxillofac. Pathol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.alcohol.2008.03.131","article-title":"Alcohol, intestinal bacterial growth, intestinal permeability to endotoxin, and medical consequences: Summary of a symposium","volume":"42","author":"Purohit","year":"2008","journal-title":"Alcohol"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4281","DOI":"10.3390\/ijerph7124281","article-title":"Cellular and mitochondrial effects of alcohol consumption","volume":"7","year":"2010","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1128\/CMR.12.1.80","article-title":"Candida glabrata: Review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans","volume":"12","author":"Fidel","year":"1999","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sahu, B.K., Patra, S.K., Sahu, M.C., and Panda, S.K. (2026). Natural product-based approaches to overcome Candida glabrata and emerging AMR threats. Front. Antibiot., 5.","DOI":"10.3389\/frabi.2026.1767032"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1128\/microbiolspec.MB-0011-2014","article-title":"Bacterial extracellular polysaccharides in biofilm formation and function","volume":"3","author":"Limoli","year":"2015","journal-title":"Microbiol. Spectr."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Malinovska, Z., Conkova, E., and Vaczi, P. (2023). Biofilm formation in medically important Candida species. J. Fungi, 9.","DOI":"10.3390\/jof9100955"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.2217\/fmb.13.101","article-title":"Mechanisms of Candida biofilm drug resistance","volume":"8","author":"Taff","year":"2013","journal-title":"Future Microbiol."},{"key":"ref_53","first-page":"e70629","article-title":"Biofilm formation in chronic infections: A comprehensive review of pathogenesis, clinical implications, and novel therapeutic approaches","volume":"16","author":"Sahoo","year":"2024","journal-title":"Cureus"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1128\/CMR.00013-08","article-title":"Candida parapsilosis, an emerging fungal pathogen","volume":"21","author":"Trofa","year":"2008","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"ofaf742","DOI":"10.1093\/ofid\/ofaf742","article-title":"Genomic Insights of Candida krusei, an Emerging Fungal Pathogen With Intrinsic Antifungal Resistance","volume":"13","author":"Jain","year":"2025","journal-title":"Open Forum Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.immuni.2021.04.013","article-title":"Fungus fuels mucosal wounds in Crohn\u2019s disease","volume":"54","author":"Magnaye","year":"2021","journal-title":"Immunity"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Das, D., HogenEsch, H., and Thangamani, S. (2023). Intestinal colonization with Candida auris and mucosal immune response in mice treated with cefoperazone oral antibiotic. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1123200"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/j.1365-2249.2003.02392.x","article-title":"Anti-Saccharomyces cerevisiae antibodies (ASCA) in Crohn\u2019s disease are associated with disease severity but not NOD2\/CARD15 mutations","volume":"135","author":"Walker","year":"2004","journal-title":"Clin. Exp. Immunol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"103486","DOI":"10.1016\/j.autrev.2023.103486","article-title":"From ASCA breakthrough in Crohn\u2019s disease and Candida albicans research to thirty years of investigations about their meaning in human health","volume":"23","author":"Sendid","year":"2024","journal-title":"Autoimmun. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Murzyn, A., Krasowska, A., Stefanowicz, P., Dziadkowiec, D., and \u0141ukaszewicz, M. (2010). Capric acid secreted by S. boulardii inhibits C. albicans filamentous growth, adhesion and biofilm formation. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0012050"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Filipe Rosa, L., Gonda, S., Roese, N., and Bischoff, S.C. (2025). Saccharomyces boulardii CNCM I-745 Supernatant Improves Markers of Gut Barrier Function and Inflammatory Response in Small Intestinal Organoids. Pharmaceuticals, 18.","DOI":"10.3390\/ph18081167"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Pontier-Bres, R., and Czerucka, D. (2026). The probiotic yeast Saccharomyces boulardii CNCM I-745 prevents autophagy in macrophages and epithelial cells infected with Vibrio parahaemolyticus. Front. Microbiol., 17.","DOI":"10.3389\/fmicb.2026.1771497"},{"key":"ref_63","first-page":"e105283","article-title":"Small intestinal fungal overgrowth mimicking a surgical abdomen and presenting as bowel obstruction: A case report and literature review","volume":"18","author":"Aamery","year":"2026","journal-title":"Cureus"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Soliman, N., Kruithoff, C., San Valentin, E.M., Gamal, A., McCormick, T.S., and Ghannoum, M. (2025). Small intestinal bacterial and fungal overgrowth: Health implications and management perspectives. Nutrients, 17.","DOI":"10.3390\/nu17081365"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2399360","DOI":"10.1080\/19490976.2024.2399360","article-title":"Effect of diet on the gut mycobiome and potential implications in inflammatory bowel disease","volume":"16","author":"Buttar","year":"2024","journal-title":"Gut Microbes"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Askew, C., Sellam, A., Epp, E., Hogues, H., Mullick, A., Nantel, A., and Whiteway, M. (2009). Transcriptional regulation of carbohydrate metabolism in the human pathogen Candida albicans. PLoS Pathog., 5.","DOI":"10.1371\/journal.ppat.1000612"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/0306-9877(95)90515-4","article-title":"Chronic intestinal candidiasis as a possible etiological factor in chronic fatigue syndrome","volume":"44","author":"Cater","year":"1995","journal-title":"Med. Hypotheses"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Hadrich, I., Turki, M., Chaari, I., Abdelmoula, B., Gargouri, R., Khemakhem, N., Elatoui, D., Abid, F., Kammoun, S., and Rekik, M. (2025). Gut mycobiome and neuropsychiatric disorders: Insights and therapeutic potential. Front. Cell. Neurosci., 18.","DOI":"10.3389\/fncel.2024.1495224"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e70168","DOI":"10.1002\/mco2.70168","article-title":"Gut microbiota dysbiosis: Pathogenesis, diseases, prevention, and therapy","volume":"6","author":"Shen","year":"2025","journal-title":"MedComm"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e155786","DOI":"10.1172\/JCI155786","article-title":"Fungal microbiome in inflammatory bowel disease: A critical assessment","volume":"132","author":"Underhill","year":"2022","journal-title":"J. Clin. Investig."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Chen, S., Yi, M., Yi, X., Zhou, Y., Song, H., and Zeng, M. (2025). Unveiling the fungal frontier: Mycological insights into inflammatory bowel disease. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1551289"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2168992","DOI":"10.1080\/19490976.2023.2168992","article-title":"Fungal feelings in the irritable bowel syndrome: The intestinal mycobiome and abdominal pain","volume":"15","year":"2023","journal-title":"Gut Microbes"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1111\/jdi.13183","article-title":"Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors","volume":"11","author":"Lao","year":"2020","journal-title":"J. Diabetes Investig."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/s41522-025-00848-x","article-title":"The association of proton pump inhibitors and inflammatory bowel disease from the perspective of gut microbiota perturbation","volume":"11","author":"Hu","year":"2025","journal-title":"npj Biofilms Microbomes"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/1751-7915.13479","article-title":"Problems with the concept of gut microbiota dysbiosis","volume":"13","author":"Brussow","year":"2020","journal-title":"Microb. Biotechnol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1038\/nri.2017.55","article-title":"Fungal dysbiosis: Immunity and interactions at mucosal barriers","volume":"17","author":"Iliev","year":"2017","journal-title":"Nat. Rev. Immunol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1038\/ajg.2017.46","article-title":"Hydrogen and methane-based breath testing in gastrointestinal disorders: The North American consensus","volume":"112","author":"Rezaie","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.chom.2019.08.011","article-title":"Regional diversity of the gastrointestinal microbiome","volume":"26","author":"Leone","year":"2019","journal-title":"Cell Host Microbe"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"4169","DOI":"10.1128\/AEM.71.8.4169-4175.2005","article-title":"Comparison between cultured small-intestinal and fecal microbiotas in beagle dogs","volume":"71","author":"Mentula","year":"2005","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1053\/j.gastro.2020.06.090","article-title":"AGA clinical practice update on small intestinal bacterial overgrowth: Expert review","volume":"159","author":"Quigley","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.1038\/s41598-021-81996-w","article-title":"Comparison of DNA sequencing and morphological identification techniques to characterize environmental fungal communities","volume":"11","author":"Shinohara","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"S331","DOI":"10.1093\/infdis\/jiz151","article-title":"From the pipeline to the bedside: Advances and challenges in clinical metagenomics","volume":"221","author":"Dekker","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_83","first-page":"837","article-title":"Yeasts in the gut: From commensals to infectious agents","volume":"106","author":"Schulze","year":"2009","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Brandt, P., Garbe, E., and Vylkova, S. (2020). Catch the wave: Metabolomic analyses in human pathogenic fungi. PLoS Pathog., 16.","DOI":"10.1371\/journal.ppat.1008757"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2105610","DOI":"10.1080\/19490976.2022.2105610","article-title":"Bacterial-fungal metabolic interactions within the microbiota and their potential relevance in human health and disease: A short review","volume":"14","author":"Lapiere","year":"2022","journal-title":"Gut Microbes"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Sharma, J., Mudalagiriyappa, S., and Nanjappa, S.G. (2022). T cell responses to control fungal infection in an immunological memory lens. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.905867"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Anju, V.T., Busi, S., Imchen, M., Kumavath, R., Mohan, M.S., Salim, S.A., Subhaswaraj, P., and Dyavaiah, M. (2022). Polymicrobial infections and biofilms: Clinical significance and eradication strategies. Antibiotics, 11.","DOI":"10.3390\/antibiotics11121731"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Patnaik, A., Kayal, T., and Basu, S. (2025). Polymicrobial infections: A comprehensive review on current context, diagnostic bottlenecks and future directions. Acta Microbiol. Hell., 70.","DOI":"10.3390\/amh70040039"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Brick, C., Su, H., Taylor, K., and Burgell, R. (2024). Moving beyond symptom criteria to diagnose and treat functional disorders: Patient-reported symptoms of functional lower gastrointestinal disorders correlate poorly with objective assessment of luminal contents seen on intestinal ultrasound. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164759"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"100148","DOI":"10.1016\/j.cmpbup.2024.100148","article-title":"Artificial intelligence for clinical prediction: Exploring key domains and essential functions","volume":"5","author":"Khalifa","year":"2024","journal-title":"Comput. Methods Programs Biomed. Update"},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Branda, F., Petrosillo, N., Ceccarelli, G., Giovanetti, M., De Vito, A., Madeddu, G., Scarpa, F., and Ciccozzi, M. (2025). Antifungal agents in the 21st century: Advances, challenges, and future perspectives. Infect. Dis. Rep., 17.","DOI":"10.3390\/idr17040091"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1056\/NEJM199012203232501","article-title":"A randomized, double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome","volume":"323","author":"Dismukes","year":"1990","journal-title":"N. Engl. J. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e00800","DOI":"10.1016\/j.btre.2023.e00800","article-title":"Probiotics and their postbiotics for the control of opportunistic fungal pathogens: A review","volume":"38","author":"Divyashree","year":"2023","journal-title":"Biotechnol. Rep."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"e38088","DOI":"10.1097\/MD.0000000000038088","article-title":"Mechanisms of microbiota modulation: Implications for health, disease, and therapeutic interventions","volume":"103","author":"Ugwu","year":"2024","journal-title":"Medicine"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Kunyeit, L., K A, A.A., and Rao, R.P. (2020). Application of probiotic yeasts on Candida species associated infection. J. Fungi, 6.","DOI":"10.3390\/jof6040189"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1111\/j.1567-1364.2009.00559.x","article-title":"The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation","volume":"9","author":"Krasowska","year":"2009","journal-title":"FEMS Yeast Res."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Jawhara, S. (2023). Healthy diet and lifestyle improve the gut microbiota and help combat fungal infection. Microorganisms, 11.","DOI":"10.3390\/microorganisms11061556"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Gaspar, B.S., Ro\u015fu, O.A., Enache, R.M., Manciulea, M., Pavelescu, L.A., and Cre\u0163oiu, S.M. (2025). Gut Mycobiome: Latest Findings and Current Knowledge Regarding Its Significance in Human Health and Disease. J. Fungi, 11.","DOI":"10.3390\/jof11050333"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"3663","DOI":"10.1038\/s41467-018-06103-6","article-title":"Gut fungal dysbiosis correlates with reduced efficacy of fecal microbiota transplantation in Clostridium difficile infection","volume":"9","author":"Zuo","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/j.coph.2013.08.008","article-title":"Antifungal therapy with an emphasis on biofilms","volume":"13","author":"Pierce","year":"2013","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1093\/jpids\/piad014","article-title":"A Practical Guide to Antifungal Susceptibility Testing","volume":"12","author":"Otto","year":"2023","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Tits, J., Cammue, B.P.A., and Thevissen, K. (2020). Combination Therapy to Treat Fungal Biofilm-Based Infections. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21228873"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e01020\u201320","DOI":"10.1128\/mBio.01020-20","article-title":"Fun(gi)omics: Advanced and Diverse Technologies to Explore Emerging Fungal Pathogens and Define Mechanisms of Antifungal Resistance","volume":"11","author":"Ball","year":"2020","journal-title":"mBio"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Wijayawardene, N.N., Boonyuen, N., Ranaweera, C.B., de Zoysa, H.K.S., Padmathilake, R.E., Nifla, F., Dai, D.Q., Liu, Y., Suwannarach, N., and Kumla, J. (2023). OMICS and Other Advanced Technologies in Mycological Applications. J. Fungi, 9.","DOI":"10.3390\/jof9060688"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Zhang, H., Song, D., Luo, Q., Yu, J., Wei, Y., Chen, D., Wu, G., Zhang, Z., Li, Z., and Jiang, H. (2024). Multi-omics analysis reveals indicator features of microbe-host interactions during Candida albicans colonization and subsequent infection. Front. Microbiol., 15.","DOI":"10.3389\/fmicb.2024.1476429"},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Mishra, K., Bukavina, L., and Ghannoum, M. (2021). Symbiosis and Dysbiosis of the Human Mycobiome. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.636131"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/6\/1365\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:45:04Z","timestamp":1781862304000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/6\/1365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":106,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["microorganisms14061365"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14061365","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]}}}