From Resistance to AI:  Key Fungal Diagnostic Trends Emerging from TIMM 2025

The Trends in Medical Mycology (TIMM) 2025 conference in Bilbao gathered experts from around the world to discuss advances in fungal disease management. From guidelines to case studies, molecular diagnostics consistently emerged as the foundation for progress — guiding treatment, supporting stewardship, and shaping surveillance strategies in invasive fungal infections.

One message was clear: advanced molecular diagnostics are no longer a supporting role — they are central to antifungal stewardship, resistance monitoring, and patient outcomes.

Here are some key insights our Scientific Team captured at TIMM 2025 that will influence laboratory practice and clinical decision-making in the years ahead

1. Combination Diagnostics Take Center Stage

Early sessions on global guidelines for Aspergillus and Candidozyma auris reinforced that no single test can stand alone. Experts emphasized the need to combine culture, biomarkers (BDG,GM), histopathology, imaging, and molecular tools to improve diagnostic certainty and rule out infection earlier.

• Multiple BDG positives were recommended to improve specificity and reduce over treatment.
• PCR remains central as the test approach for the laboratory diagnosis of fungal infections, especially when combined with GM and culture. Calls for global harmonization of PCR methods reflected a push toward standardisation across laboratories.

Dr Lewis White (Principal Clinical Scientist in Public Health Wales Microbiology, Cardiff) highlighted the challenge that most invasive fungal infection (IFI) diagnoses are not definitive when based on a single test. Instead, clinicians rely on a mosaic of evidence: mycology, imaging, host factors, and clinical presentation. Emerging machine learning approaches can help to weigh these different inputs, assigning value to concordant and discordant results. This proof-of-principle suggests a future where AI supports clinicians by integrating test results and clinical risk into clearer, evidence-weighted classifications of IFI.

‍These discussions align with the ongoing role of standardized, validated molecular panels already available in routine diagnostics, helping laboratories harmonize results and reduce variability.

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2. Antifungal Resistance Moves Into the Mainstream

A recurring theme was the growing challenge of anti fungal resistance, particularly in dermatophytes and invasive fungal diseases:

• The CEDAR study (Copenhagen) reported that SQLE mutations remain the main driver of terbinafine resistance in Trichophyton indotineae (95.5% of isolates) and T. rubrum (62.5%).
• Belgian surveillance data confirmed T. indotineae is now circulating in Europe (5.8% prevalence), with terbinafine resistance rates above 80%. Azole resistance mechanisms, such as CYP51B duplications, were also discussed.
• For Aspergillus fumigatus, resistance testing (azole, echinocandin) is now considered essential where clinical suspicion arises.
• ‍Candidozyma (Candida) auris  incidence continues to increase in multiple European countries, with ECDC urging stronger screening, reporting, and lab readiness.

The relevance of PathoNostics’ Resistance assays was reinforced at TIMM, reflecting the push to bring resistance testing into routine diagnostics, not just reference labs:

• DermaGenius® Resistance – multiplex detection of dermatophyte species and SQLE mutations.
• AsperGenius® Resistance – simultaneous identification of Aspergillus species and resistance-associated mutations.

Together, these real-time PCR kits directly address the growing challenge of antifungal resistance and support timely antifungal stewardship.

Pneumocystis jirovecii pneumonia (PJP) was a major diagnostic focus. Data from CHU UCL Namur (Belgium)showed:

• BAL PCR achieved 100% sensitivity and specificity (Ct 30, cut-off6367 copies/mL).
• Serum BDG offered high sensitivity but lower specificity, underlining its value as a rapid adjunct rather than a stand-alone tool.

Findings like these confirm the importance of molecular diagnostic testing for invasive fungal infections that are difficult to diagnose. PneumoGenius®, for example, directly supports rapid, quantitative detection of     P. jirovecii, enabling clinicians to act quickly in immunocompromised patients. 

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4. Regional and Epidemiological Insights

• Tinea capitis prevalence remains strikingly high in parts of Africa (up to 61% of school children in Guinea), with significant social impact on education and social inclusion. Accurate species-level diagnosis is essential for surveillance and public health interventions.
• In Austria, Prof. Cornelia Lass-Flörl highlighted the unusual epidemiology of Aspergillus terreus in Tyrol, where it remains disproportionately prevalent and resistant compared with other regions.
• The One Health perspective was emphasized by several speakers, pointing to climate change, urbanization, and environmental exposure as drivers of new fungal threats.
  

The emphasis on epidemiology and surveillance resonates with the role of multiplex PCR assays such as DermaGenius® Complete, which provide species-level insight for dermatophytes, and CandidaGenius®, a targeted screening assay for Candidozyma auris. Both contribute to early detection and improved monitoring of emerging fungal threats.

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5. The Direction of Travel: Integration and Stewardship

The overarching theme at TIMM 2025 was not only the validation of individual assays but also their integration into diagnostic algorithms that directly support stewardship.

• Diagnostic-driven antifungal stewardship reduces unnecessary treatment, lowers costs, and improves survival.
• AI and digital tools promise to add value by standardizing interpretation and supporting over-stretched clinical teams.
• Future directions include cfDNA PCR for Aspergillus, wider adoption of multiplex resistance panels, and expansion of diagnostics into point-of-care formats.

TIMM 2025 left no doubt: diagnostics is the linchpin of modern mycology. From global surveillance challenges to the promise of AI, the conference spotlighted both progress and unmet needs.

At PathoNostics, we see our role as part of this wider ecosystem — following the science, sharing knowledge, and supporting laboratories worldwide with accurate, rapid, and clinically relevant diagnostic tools. Our portfolio covers both species-level detection and the identification of key resistance markers, helping laboratories  deliver accurate and useful diagnostics for the patients who need them most.

To learn more about our diagnostic solutions, visit the Products page on our website.

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