Clinically Important Emerging and Uncommon Fungal Pathogens in Asia: Epidemiology, Antifungal Resistance and Challenges in Diagnosis and Management.

Fungal infections in Asia are influenced by warm, humid climates, high population density and expanding healthcare systems, which together facilitate the emergence, transmission and detection of both common and rare pathogens. While Candida and Aspergillus species remain the leading causes of invasive fungal disease, increasing attention has focused on uncommon yeasts and rare moulds, many of which show intrinsic or acquired antifungal resistance. Advances in molecular diagnostics and susceptibility testing have improved identification of emerging pathogens, including uncommon Candida species and rare moulds such as Mucorales, filamentous Basidiomycetes, non-marneffei Talaromyces, Oomycetes and thermally dimorphic fungi like Emergomyces. These organisms primarily affect immunocompromised individuals and present significant diagnostic and therapeutic challenges due to identification difficulties, variable susceptibility patterns and limited clinical experience. Clinical presentations range from fungaemia and invasive pulmonary disease to cutaneous and disseminated infections. Treatment is guided by pathogen and susceptibility profiles, commonly involving echinocandins, amphotericin B and azoles. In some cases, particularly infections caused by Oomycetes and Mucorales, prompt surgical intervention is essential. This review provides a comprehensive overview of current epidemiological trends, risk factors, clinical features, antifungal susceptibility patterns and treatment outcomes associated with rare and emerging fungal pathogens in Asia. By highlighting these increasingly recognized infections, it aims to enhance awareness among clinicians and mycologists, promote evidence-based diagnostic and therapeutic approaches and inform future research addressing this evolving and clinically significant public health challenge.