Fungal infections in diabetes and metabolic disorders: Current insights into epidemiology, pathogenesis, diagnosis, and antifungal therapy

Authors: Ahed J Alkhatib

Ger. J. Microbiol. 2026. vol. 6, Iss. 2 pp:16-29
Doi: https://doi.org/10.51585/gjm.2026.2.0062

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Abstract:

Fungal infections constitute a significant yet frequently underestimated comorbidity in diabetes and metabolic disorders. Metabolic disturbances impair immune defenses, thereby increasing susceptibility to a broad spectrum of fungal pathogens. Restricting attention to the Candida genus does not adequately reflect the wider clinical risk; this review catalogs relevant yeast and mold pathogens, including opportunistic species beyond Candida. Established host factors are summarized, the microbiological mechanisms of pathogenesis and metabolic adaptation are outlined, and associations between fungal pathology and the prevalence, incidence, and clinical manifestations of diabetes are examined. While candidiasis is most prevalent, solitary pulmonary aspergilloma, rhinocerebral mucormycosis, and cryptococcal meningitis are also clinically significant. Candida bloodstream and urinary isolates frequently involve non-albicans species, particularly C. glabrata. Mold pathogens, notably Aspergillus and Mucorales, are commonly associated with inhaled spores. Considerable variability among studies highlights a critical knowledge gap in the epidemiology of fungal infections in metabolic disorders. A comprehensive understanding of diabetes-associated fungal pathogens and their microbiological context is essential as clinical practice increasingly acknowledges the interplay among hemostasis, microbiology, and environmental factors.

Keywords:

Metabolic disorders, Opportunistic fungal pathogens, Non-albicans Candida, Aspergillus, Diabetes-associated mycoses

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