Background: We compared medication adherence and satisfaction between miconazole mucoadhesive buccal tablets (MBT) and miconazole oral gel (MOG) in patients with oral candidiasis.
Methods: This observational study included patients diagnosed with oral candidiasis and treated with miconazole by our department between June 2021 and August 2024. MBT was prescribed as first-line therapy according to Infectious Diseases Society of America guidelines, whereas MOG was selected when MBT use was anticipated to be difficult (e.g., denture wearers). After approximately 14 days of therapy, patients completed a questionnaire on treatment completion, daily adherence, usability, and satisfaction. Baseline data were extracted from medical records. Statistical comparisons used Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables.
Results: Forty-six patients (Age median 77.0 years [IQR: 69.5–80.5], 72% female) were analyzed. Baseline characteristics were comparable between groups. The treatment completion rate was 79% for MOG and 67% for MBT (p = 0.510). Daily adherence was significantly higher in the MBT group (89%) than in the MOG group (53%, p = 0.015). The most frequent reason for non-completion in the MBT group was “easy detachment” of the tablet. Usability was rated as acceptable by approximately 70% of patients in both groups. While median satisfaction scores did not differ significantly, a higher proportion of MBT users reported high satisfaction (≥ 8/10).
Conclusion: Once-daily MBT may improve daily adherence compared with MOG, particularly in elderly patients receiving multiple medications. However, detachment issues may limit completion rates, highlighting the importance of patient-specific formulation selection and administration strategies.

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Background: Oral antifungal therapy is the standard treatment for onychomycosis. However, many physicians still prefer topical agents because of concerns about adverse effects.
Objectives: This study evaluated changes in hepatic and renal function parameters during fosravuconazole therapy and assessed the utility of an algorithmic approach for interpreting these abnormalities.
Methods: Laboratory parameters including aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ glutamyltransferase (γ-GTP), serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were compared between baseline and follow-up. Fold changes were calculated, and γ-GTP was classified according to the LiverTox database. Each parameter was assessed using an algorithm for managing hepatic and renal side effects.
Results: A total of 128 cases were analyzed. Median baseline values were AST 22 U/L, ALT 19 U/L, γ-GTP 25 U/L, sCr 0.75 mg/dL, and eGFR 74.9 mL/min/1.73 m². At follow-up, values were AST 22 U/L, ALT 22 U/L, γ-GTP 51.5 U/L, sCr 0.86 mg/dL, and eGFR 67.1 mL/min/1.73 m². γ-GTP showed significantly greater fold changes than other parameters (p < 0.001). Thresholds for discontinuation were met in 3 hepatic (2.3%) and 5 renal (3.9%) cases. No patient developed clinical symptoms, and only one discontinued treatment.
Conclusions: Algorithm-based monitoring enabled safe fosravuconazole administration. This practical approach may help clinicians adopt oral antifungal therapy more confidently as first-line treatment for onychomycosis.

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Medical mycology is a traditional field of medicine that has developed over a long history through the contributions of numerous researchers and clinicians. This paper focuses on the most influential individuals, discoveries, and inventions within the field, examining the development of medical mycology from the perspective of a return to its origins, including on-site investigations. This return to origins is not merely a historical retrospective but also an effort to reevaluate and deepen our understanding through practical research, aiming to explore the foundational studies that marked the beginning of medical mycology and its related disciplines. Furthermore, this paper highlights the conceptual meaning of the “light and shadow” of medical mycology. While the field has made substantial progress, it has often been overshadowed by the remarkable achievements of other disciplines, such as botany, symbolized by Linnaeus, and bacteriology, represented by Koch. This study attempts to reassess the history and significance of medical mycology. Additionally, it examines the resurgence of medical mycology and the dramatic paradigm shift triggered by a single publication from the United States. Through these considerations, this paper aims to provide a long-term and multidimensional reexamination of the progress of medical mycology.

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Azole antifungals are the cornerstone of therapy for aspergillosis, yet the global rise in azole-resistant Aspergillus fumigatus has become a major clinical concern. Resistance rates vary widely across regions, with particularly serious implications for chronic pulmonary aspergillosis (CPA), which requires long-term azole therapy. Resistance mechanisms largely involve cyp51A mutations, although additional genetic alterations and environmental factors, such as agricultural azole use, also play important roles. Cross-resistance among azoles is frequent, leaving clinicians with limited alternatives, such as liposomal amphotericin B or echinocandins, which are constrained by toxicity, fungistatic activity, and intravenous administration. Currently, antifungal susceptibility testing for filamentous fungi remains technically demanding and is not routinely available in many countries, including Japan, further complicating its management. Emerging approaches include the development of novel antifungal compounds and optimization of existing drugs through inhaled or nanoformulated delivery systems. Furthermore, fungal vaccines are attracting increasing attention as promising long-term solutions to stagnant antifungal pipelines and the growing challenge of drug resistance.

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Dermatophytosis remains one of the most common superficial fungal infections worldwide, and antifungal-resistant strains have recently emerged as an increasing clinical concern. In Japan, the prevalence of terbinafine-resistant Trichophyton species is currently estimated to be 2%, with most isolates harboring squalene epoxidase (SQLE) gene mutations such as Leu393Phe and Phe397Leu. This review summarizes recent epidemiological findings and representative clinical cases to illustrate the practical management strategies for antifungal-resistant dermatophytosis in Japan. Three illustrative cases were presented. Case 1 involved Trichophyton interdigitale carrying a Phe397Leu mutation that was unresponsive to terbinafine but was successfully treated with topical efinaconazole and luliconazole. Case 2 described a cluster infection of terbinafine-resistant Trichophyton rubrum (Leu393Phe) in a group home, where oral fosravuconazole achieved complete cure. Case 3 reported five soldiers with terbinafine-resistant dermatophytosis caused by Phe397Leu or Phe415Ile mutations, which were likely associated with prolonged topical SQLE inhibitor use. Resistance is often induced by the long-term or intermittent application of SQLE inhibitors, including over-the-counter topical terbinafine and butenafine. For suspected terbinafine-resistant infections, non-SQLE azoles, such as luliconazole and lanoconazole, are recommended because of their 10- to 100-fold increased activity against Trichophyton species. Oral fosravuconazole and topical agents such as 10% efinaconazole or 5% luliconazole have proven effective for onychomycosis. Ongoing surveillance, appropriate antifungal stewardship, and timely adjustment of treatment regimens are essential to prevent the further spread of antifungal-resistant dermatophytosis.

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Yeasts show few distinct morphological characteristics. The two basic forms of yeast, unicellular yeast and multicellular hyphal form, exhibit dimorphism. In a recent study on Trichosporon asahii, a dimorphic basidiomycetous yeast that causes trichosporonosis, the addition of magnesium induced hyphal formation and changes in organelle distribution. A detailed observation of organelle distribution revealed that the responses to magnesium addition varied widely among Trichosporonales yeasts. In this review, we show that differences in organelle phenotypes upon magnesium addition possibly contribute to the practical identification and classification of Trichosporonales yeasts.

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This review summarizes current knowledge on ocular fungal infections, with emphasis on the clinical characteristics, diagnostic approaches, and management of keratitis and endophthalmitis caused by uncommon fungal pathogens. Filamentous fungi such as Fusarium and Aspergillus often cause rapidly progressive disease, whereas Candida species typically infect eyes with preexisting ocular surface abnormalities or systemic risk factors. Diagnosis relies primarily on microscopy and culture, supplemented by molecular techniques where available. Management requires organism-directed antifungal therapy, with surgical intervention reserved for refractory or vision-threatening cases. Despite advances in diagnostic modalities and therapeutics, fungal keratitis and endophthalmitis remain important causes of visual morbidity, underscoring the need for early recognition and appropriate treatment.

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Tinea corporis caused by Trichophyton indotineae infection is a worldwide epidemic and represents a growing challenge, given that many strains of this dermatophyte are resistant to the antifungal drugs (allylamine and azoles) typically used to treat dermatophytosis. Phytochemicals isolated from essential oils are effective alternatives for inhibiting microbial pathogens. In the present study, we performed in vitro susceptibility testing of the phytochemicals citral and thymol against T. indotineae strains, including a multi-drug-resistant isolate. The susceptibility of T. indotineae to citral, and thymol was assessed using the modified CLSI M38-A2 guideline broth microdilution method. The ranges of the minimum inhibitory concentration (MIC, expressed as a percentage) of the phytochemicals in all isolates were 0.0015 to 0.006% for citral and thymol. Citral and thymol appear effective against T. indotineae at the tested concentrations, and therefore may be of use in skin care items intended to protect from this infection.

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