The National Reference Center for Invasive Fungal Infections (NRZMyk) is celebrating its 10^th anniversary and therefore invited to a festive event at the Leibniz-HKI in Jena to mark the occasion. The NRZMyk has laboratories in Jena and Würzburg and supports doctors in the diagnosis and treatment of difficult-to-detect fungal infections, which can sometimes be life-threatening.

Exactly 79 patient samples reached the National Reference Center for Invasive Fungal Infections in 2014. It had newly been set up under the direction of Prof. Oliver Kurzai at the Leibniz Institute for Natural Product Research and Infection Biology (Leibniz-HKI) in Jena. The task: The experts for pathogenic fungi are to help the attending physicians in difficult cases to find out whether the patients are actually suffering from a fungal infection, which pathogen is involved and what is the best way to combat it. Fungal infections are often not recognizable at first glance and the pathogens cannot always be transferred from the patient sample to a laboratory culture. This is a problem for doctors: They have to interpret the mostly unspecific symptoms of patients and decide on an effective treatment. Conventional laboratory diagnostics also quickly reach their limits here, as specialist knowledge is required: “The special thing about fungal infections is that there are so many different types of fungi that can cause disease,” explains Dr. Grit Walther, who heads the NRZMyk laboratory at the Leibniz-HKI.

Around 1300 samples are received at NRZMyk every year

A 2017 study found that there are between 2.2 and 3.8 million species of fungi worldwide. Around 1000 of these have so far been described as causing infections in humans. “When we get rare fungi, it’s often a small study that we have to do until we have the right marker gene to identify the species.” Today – 10 years after its establishment – doctors from all over Germany send around 1,300 patient samples to the reference center every year. This enormous increase shows how important the diagnosis of pathogenic fungi is in medical practice. Only when the pathogen is known, suitable treatment measures can be determined. At the same time, it is clear that this requires specific knowledge that may not be available in individual medical practices or routine laboratories. For this reason, the Federal Ministry of Health is setting up national reference centers for important pathogen groups following a corresponding recommendation by an international panel of experts. Since 2018, some samples have also been processed at the Institute of Hygiene and Microbiology at the University of Würzburg, of which Prof. Oliver Kurzai has been the director since 2017. Since then, both NRZMyk sites have shared the workload.

Behind every sample is a human fate

While in the early days the samples mainly came from large institutions such as hospitals and university clinics, every medical care center now knows the reference center, reports Dr. Grit Walther. In the first decade of its existence, the NRZMyk has identified fungi from 7000 samples. Behind each of these samples lies a human fate. Invasive fungal infections in particular, in which the pathogen penetrates deep into the tissue or spreads through the bloodstream in the body, are often associated with great suffering and frequently end fatally.

Expertise and specialist knowledge about fungi

Diagnoses and resistance tests are the NRZMyk’s daily routine after receiving patient samples. The center also monitors the spread and frequency of invasive fungal infections in Germany. For example, the NRZMyk has been monitoring and documenting the spread of the new pathogen Candida auris in Germany since it first appeared. “In 2023, the NRZMyk data formed the basis for the introduction of mandatory laboratory reporting for Candida auris,” explains Kurzai. If such outbreaks are detected, the NRZMyk offers advice on how to contain them. With this extensive specialist knowledge, the reference center is also a sought-after partner in national and international research projects.

It is also important to the NRZMyk staff to bring knowledge about infectious fungi to where it is needed first. The center therefore advises and trains medical institutions, doctors and health authorities.

10 years of NRZMyk

On the occasion of the 10^th anniversary of the founding of the NRZMyk at the Jena site, a festive event was held at the Leibniz-HKI on September 17. The speeches were held by two renowned experts in medical mycology: Prof. Birgit Willinger from the Medical University of Vienna addressed current challenges in medical mycology in times of climate change and pandemic in particular. Prof. Oliver Cornely from the University Hospital of Cologne gave an overview of the development and current status of mycology in Germany. The head of the NRZMyk, Prof. Oliver Kurzai, and the two laboratory heads Dr. Grit Walther (Jena) and Dr. Alexander Aldejohann (Würzburg) shed some light on the development of the reference center. The focus here was on newly emerging fungal pathogens, which have also received a great deal of media attention since the coronavirus pandemic, and modern molecular biological diagnostic methods. The latter are gradually replacing the time-consuming pathogen detection through laboratory cultivation.

For the Leibniz-HKI, the NRZMyk is an important channel for the transfer of knowledge from basic research to clinical practice. New findings on suitable marker molecules on the cell surface of fungi can be used directly for the development of diagnostic methods. In addition, the Institute receives numerous clinical isolates of fungal pathogens through NRZMyk, which can be used for research, among other things, to test new active substances against rare and resistant fungi.