Conference Calendar
Past Quiz Results
Revisiting ISHAM Asia 2021
The first AFWG CaseClinic is now live!
First-ever Study of Mycology Lab Practices in Asia
New Diagnostic Mycology E-learning Course
Antifungal prophylaxis: Whom, what and when
Fereydounia khargensis: A New Opportunistic Yeast Reported from Malaysia
9 Years of MMTN: Improving Fungal Disease Management in Asia Pacific
Echinocandins: Clinicians' Guide
Five controversies in mycology
Fungemia blood culture media
Deep dermatophytosis
AFWG Education Module 4: Is Antifungal Susceptibility Testing Useful for Clinical Management?
AFWG Education Module 5: TDM of Antifungal Agents - Essential or Optional?
AFWG Education Module 6: Antifungal Stewardship
10 common mistakes in laboratory mycology
Itraconazole: A Quick Guide for Clinicians
Evolving Fungal Landscape in Asia
10 common mistakes in clinical mycology
Laboratory Diagnosis of Pythiosis
ICMR Issues C. auris Advisory
Strengths and Limitations of Imaging for Diagnosis of IFI
Candidemia: Lessons Learned from Asian Studies for Intervention
Spotting invasive pulmonary aspergillosis in COVID-19 patients
Pivotal Asian Invasive Mold Study
Impact of the COVID-19 pandemic on IFI epidemiology and trends
Mycetoma in Asia: Still veiled in mystery
Identifying IFI risk factors in patients with COVID-19
ASID ANZMIG x AFWG: Fungal Frontiers in the Asia Pacific – Webinar 2
New Antifungal Agents
Gilead IFI Masterclass: Current updates on the management of IFIs in immunocompromised hosts
The AFWG Masterclass: Advanced fungal education at your fingertips
A challenging case: A crisis unfolds
The role of antifungal stewardship in improving IFI outcomes
Making Precise Diagnoses: Experience from the Laboratory Skills Enhancement Course
A challenging case: A 68-year-old man with nasal and palatal ulcers
AFWG Online Education Module 3: Optimizing Dosing in IFI Management
AFWG Online Education Module 2: Antifungal Prophylaxis in Solid Organ Transplantation
AFWG Education Module 1: The Value of Clinical Mycology Laboratories
How do I interpret Candida in the urine?
How do I interpret Candida in respiratory tract cultures?
Cryptococcosis in HIV and non-HIV infected patients
Human Pythiosis
AFWGOnline Privacy Policy has been Updated
Management of fungal infections in high-risk patients
Striving for Perfection: Experience from the Laboratory Foundation Training Course
Know your fungal landscape in Vietnam
Recent Advances of Fungal Diagnostics in Asian Laboratories
Deep Dermatophytosis: A Case Report
Management of cryptococcosis and talaromycosis
A challenging case: A 49-year-old woman with sarcoidosis
Emerging yeast infections in Asia
Outbreak of Superbug Candida auris: Asian Scenario and Interventions
Championing Medical Mycology: Thoughts on the AFWG Laboratory Skills Enhancement Course
Mucormycosis and Pythiosis – New Insights
AML and the high risk of multiple infectious complications
Do We Need Modification of Recent IDSA & ECIL Guidelines while Managing Patients in Asia?
A hospital’s experience with candidemia and empirical therapy
Top 5 most viewed AFWG videos on YouTube
Fungal Academy 2015
Fluconazole in 2015
Fungal isolation protocol
Influencing Aspergillus
Fungal Asthma
Laboratory Diagnosis of IPA
Educational Organizations
Literature Updates


Evolving Fungal Landscape In Asia

Share this

this page

Professor Yee-Chun Chen
Professor of Medicine
National Taiwan University Hospital and College of Medicine; and
Investigator, National Institute of Infectious Diseases and Vaccinology
National Health Research Institutes

Fungal pathogens pose a significant threat to public health, food biosecurity and biodiversity. Despite this, they are largely ignored by the public, the press and funding bodies. From a public health perspective, there remains relatively little global recognition that over 300 million people suffer from serious fungal-related diseases, or that fungi are responsible for an estimated 1.6 million deaths each year – a higher mortality rate than that of malaria.1


Around 21–36% of cryptococcosis cases occur in patients with cirrhosis, making it the most common host factor associated with these infections in HIV-uninfected patients.2-4 Furthermore, in a recent multivariate analysis, cirrhosis was 1 of 2 factors (along with cerebrospinal fluid antigen titer) shown to be an independent predictor of mortality.4 The minimum inhibitory concentration (MIC) of different antifungal agents, particularly fluconazole, may vary according to genotype; hence it is important to determine MICs for clinical isolates.


A recent laboratory-based surveillance study conducted in 25 hospitals across Asia demonstrated that candidemia is common across the region, with an overall incidence of more than 1 episode per 1,000 discharges, and a wide distribution across services (Figure).5 Candida tropicalis was the most frequently isolated non-albicans species, particularly in tropical countries.5,6 Risk factors for candidemia include age, moderate-to-severe renal diseases, leukemia, lymphoma, gastrointestinal malignancies, metastatic solid tumors and chronic pulmonary diseases.7

Figure. Distribution of patients with candidemia by hospital service (numbers denote percentages)5

In a pan-Asian study, reduced susceptibility to fluconazole was common in non-albicans Candida species, suggesting that echinocandins should be the antifungal of choice in clinically unstable or high-risk patients with documented candidemia.6 International guidelines recommend echinocandins as initial therapy for candidemia in most cases.8,9


In a recent study conducted in 5 Asian countries, Aspergillus species was the most common etiology of microbiologically confirmed cases with proven/probable invasive mold infection (71.6%) – largely due to A. fumigatus and A. flavus.10 The most frequently observed host factor was prolonged steroid use (39.4%) and the most common underlying condition was diabetes (30.9%).10

Azole resistance in A. fumigatus is an emerging global health problem, including in Asia.11-13 This could affect the current primary treatment recommendation, which is based around voriconazole monotherapiy.14 Alternative treatment strategies, including azole-echinocandin combinations or liposomal amphotericin B, may be necessary in areas with environmental resistance rates of ≥10%.15

Highlights of the Medical Mycology Training Network Conference, August 5–6, 2017, Kuala Lumpur, Malaysia.


  1. Leading International Fungal Education (LIFE). The burden of fungal disease: New evidence to show the scale of the problem across the globe. February 2017. Available at: Accessed September 2017.
  2. Jean SS, et al. QJM 2002;95:511-518.
  3. Chuang YM, et al. Eur J Clin Microbiol Infect Dis 2008;27:307-310.
  4. Tseng HK, et al. PLoS ONE 2013;8:e61921.
  5. Tan BH, et al. Clin Microbiol Infect 2015;21:946-953.
  6. Tan TY, et al. Med Mycol 2016;54:471-477.
  7. Chen PY, et al. J Microbiol Immunol Infect 2014;47:95-103.
  8. Pappas PG, et al. Clin Infect Dis 2016;62:409-417.
  9. Tissot F, et al. Haematologica 2017;102:433-444.
  10. Porpon R, et al. Med Mycol 2017 [Epub ahead of print].
  11. Verweij PE, et al. Clin Infect Dis 2016;62:362-368.
  12. Meis JF, et al. Philos Trans R Soc Lond B Biol Sci 2016;371.
  13. Wu CJ, et al. Mycoses 2015;58:544-549.
  14. Patterson TF, et al. Clin Infect Dis 2016;63:e1-e60.
  15. Verweij PE, et al. Drug Resist Updat 2015;21-22:30-40.

This field is required. Please enter your email address.
Thank you for signing up for the AFWG newsletter.
Your subscription has been updated.