Adv Pharm Bull, 2022, 12(4), 747-756

doi: 10.34172/apb.2022.076
TUOMS
https://apb.tbzmed.ac.ir PRESS

Review Article

Role of Fungal Infections in Carcinogenesis and Cancer Development:

A Literature Review
ID
Kamran Hosseini1,2 , Hossein Ahangari3, Florence Chapeland-leclerc4, Gwenael Ruprich-Robert4, Vahideh
ID ID
Tarhriz5* , Azita Dilmaghani6,7*
1
Department of Molecular Medicine, Faculty of Advanced Medical Sciences and Technologies, Shiraz University of Medical
Sciences, Shiraz, Iran.
2
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
3
Department of Food Science and Technology, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences,
Tabriz, Iran.
4
Université de Paris, Faculté des Sciences, Laboratoire Interdiciplinaire des Energies de Demain (LIED), UMR 8236 CNRS,
F-75013, Paris, France.
5
Molecular Medicine Research Center, Bio-Medicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
6
Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
7
Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.

Article info Abstract

Article History: Cancer is a serious debilitating disease and one of the most common causes of death. In recent
Received: 7 April 2021 decades the high risk of various cancers enforced scientists to discover novel prevention and
Revised: 2 August 2021 treatment methods to diminish the mortality of this terrifying disease. Accordingly, its prevention
Accepted: 27 September 2021 can be possible in near future. Based on epidemiological evidence, there is a clear link between
epublished: 29 September 2021 pathogenic fungal infections and cancer development. This association is often seen in people
with weakened immune systems such as the elderly and people with acquired immunodeficiency
Keywords: (AIDS). Carcinoma in these people is first seen chronically and then acutely. Although the
• Cancer different genetic and environmental risk factors are involved in carcinogenesis, one of the most
• Fungi important risk factors is fungal species and infections associating with cancers etiology. Now it
• Infection is known that microbial infection is responsible for initiating 2.2 million new cancer cases. In
• Carcinogenesis this way, many recent studies have focused on investigating the role and mechanism of fungal
• Fungal species infections in diverse cancers occurrence. This review provides a comprehensive framework
of the latest clinical findings and the association of fungal infections with versatile cancers
including esophageal, gastric, colorectal, lung, cervical, skin, and ovarian cancer.

Introduction cancers to drop the incidence of them. Every kind of the

Diseases triggered by excessively dividing of the tissue cancers is affected by special risk factors, e.g., history of
cells that can develop into intrusive lumpy masses is called inflammatory bowel disease (IBD), type 2 diabetes and
cancer, which also is mentioned to as tumors. About 200 family history that are the main risk factors of CRC.2,3
types of cancers in human kind are currently established It is noticeable that there will be increased incidence,
by the National Cancer Institute (http://www.cancer. approximately 50%, and near 17 million deaths by 2030
gov/types) and among them, some cancers can spread and this fact stress the necessity of discovering the more
from their origin to other body tissues in a process so- selective treatments for cancers based on their originating
called metastasis. Cancer classification is based on the factor especially for the cancers triggered by microbial
tissue and/or organ of the origin e.g. carcinomas that infections to diminish the unintended harmful outcomes
refers to the cancers which arise in tissues or cover body on healthy tissues.4
organs. Also, other classes like melanomas, sarcomas, Risk factors involved in cancers can vary by the area
leukemia and lymphomas, are other known kinds of and country parallel to overall cancer incidence and
cancers.1 mortality arises. Factors including age, smoking, diet and
The cancer Tsunami is going to be more expanded. For fat saturated regimes, body weight, alcohol consumption,
instance, 150 000 new cases of colorectal cancers (CRC) exposure to pollutants and/or radioactivity, genetic
are identified annually in the US. So, the studies have background, and the infection by bacterial and fungal
been focused on exploring the risk factors of different species have been coupled to the risk of carcinogenesis

*Corresponding Authors: Vahideh Tarhriz and Azita Dilmaghani, Email: [email protected], Email: [email protected]
© 2022 The Author (s). This is an Open Access article distributed under the terms of the Creative Commons Attribution (CC BY), which permits
unrestricted use, distribution, and reproduction in any medium, as long as the original authors and source are cited. No permission is required
from the authors or the publishers.
Hosseini et al

and versatile types of cancers (Figure 1). The studies various organs, especially solid organs has been reviewed
revealed that infection by microbial species as a risk based on the latest clinical research studies and the most
factor, is responsible for initiating of 2.2 million new up-to-date scientific articles published in databases
cancer cases.5 Nowadays, it is estimated that around 16% including PubMed and Scopus. Before this review, there
of the overall cancer incidences is associated to microbial was no complete report on the relationship between fungi
infections and toxicities. On the other hand, it is proposed and carcinogenesis of solid organs; however, the current
that the microbial infection not only can boost the cancer study has thoroughly investigated the gap between the
risk but can also assist its treatment.6 role of different fungi and carcinogenesis.
Invasive fungal infections (IFIs) maintain to pose a
challenge in cancer development and are linked with a The role of fungal infections in esophageal cancer
high incidence of mortality and morbidity. By the last 20 Esophageal carcinoma is the sixth leading cause of
years, despite the development of numerous diagnostics cancer-related mortality and the eighth leading cause of
and therapeutic in the field of fungal infections, the IFI cancer worldwide. The disease is more prevalent in men,9
mortality has sustained to 35.7% growth. This means that but in most countries of the world, the incidence rate per
the cancer growth rate is probably affected by IFI and it’s 100 000 people affects 2.5-5 men and 1.5-2.5 women.10
needed to be scrutinized.7 The most common genera and Histologically, the disease is classified into two categories:
species of fungi involved in cancers are Candida albicans, esophageal adenocarcinoma, which affects the lower
C. glabrata, C. tropicalis, Aspergillus flavus, A. parasiticus,
esophagus, and esophageal squamous cell carcinoma,
Fusarium verticillioides and F. proliferatum. Nevertheless,
which affects the middle and upper esophagus.11
continuous efforts to distinguish the association between
Numerous risk factors for this type of cancer have been
the cancers and fungal infections should be nonstop since
reported, including smoking, alcohol consumption,
it is not expected that the combat against cancer to be won
consumption of hot beverages and foods, poor nutrition,
soon (Figure 2).8
exposure to chemicals, environmental pollutants and
In the present review, the role of opportunistic and
radiation, and exposure to pathogenic and opportunistic
pathogenic fungal infections with carcinogenesis of
microorganisms.12-14 In addition, various fungal infections
can arise for esophageal carcinoma, the most common
fungus is Candida spp., which is an opportunistic yeast
that colonizes the mucosa of the genitourinary and
gastrointestinal tract of healthy people (about 30%-50% of
people) without causing infection. Candida mostly occurs
during the immune system suppression which manifests
by skin, nails, and mucosa (esophagus) signs. In relation
to mucus, this yeast causes chronic mucocutaneous
candidiasis disease (CMCD).15 The most common genera
and species of candida associated with candidiasis are the
following: Candida albicans, C. glabrata, C. tropicalis,16
C. krusei, C. parapsilosis, Torulopsis glabrata, T. tomato,
Aspergillus flavus, A. parasiticus, Fusarium verticillioides,
F. proliferation.17-20 According to a study by Koo et al, in
patients with primary immunodeficiency, esophageal
candidiasis occurs in cancer patients as CMCD with
Figure 1. Different types of risk factors in carcinogenesis
persistent or recurrent thrush. CMCD is caused by at least
five mutations that ultimately affect the IL-17 pathways;
One of these is a mutation in the autosomal dominant gene
gain of function of the STAT 1 signaling protein, in which
a genetic defect intensifies Th1 immune responses and
ultimately reduces the production of IL-17 and IL-22.21
In another study, Domingues-Ferreira et al examined a
patient with chronic mucocutaneous candidiasis who had
decades of treatment-resistance esophageal candidiasis
and eventually developed epidermoid esophageal
cancer. In this patient, modulation of immune function
induced by mitogen suppression and antigen-induced
lymphoproliferation disrupted NK cytotoxic activity and
Figure 2. Different studied fungal genera and species in carcinogenesis. IL-2 secretion, resulting in increased IL-4 secretion and

748 Advanced Pharmaceutical Bulletin, 2022, Volume 12, Issue 4

 Carcinogenesis of fungal infections

lymphocyte apoptosis.22 By 2018, about 1.8 million new cases of CRC have been
reported.2 The incidence of CRC in men is about 19.7 and
The role of fungal infections in gastric cancer in women 23.6 per 100 000 people and it is more common
Gastric cancer (GC) is the fourth leading cause of in developed countries.52 The mortality rate until 2018
malignancy and the second leading cause of mortality in was about 881 000.2 In general, mutations in oncogenes,
all malignancies worldwide.23,24 The five-year survival rate tumor suppressor genes, and genes involved in DNA
is 90% in Japan and 10%-30% in European countries. Due repair are associated with the development of CRC, and
to the incidence of GC, more than 50% of new cases occur according to the primary origin of the mutation, CRCs
in developing countries.25,26 GC is generally classified into are classified into three categories: sporadic (Most point
four categories: Sporadic gastric cancer (SGCs),27 Early mutations cause this type of CRC and occur in the
onset gastric cancer (EOGC),27 gastric stump cancer genes APC [adenomatous polyposis coli], kRAS, Tp53,
(GSC),28 and hereditary diffuse gastric cancer (HDGC).29 and DCC),53 hereditary (Most point mutations occur in
Risk factors for this cancer include smoking,30 alcohol another allele of the mutated gene, and this inherited form
consumption,31 obesity,32 pernicious anemia and blood is divided into two groups: FAP (familial adenomatous
type A,33 mycotoxins34 and Helicobacter pylori infection.35 polyposis) and HNPCC (Hereditary non-polyposis
Preliminary studies based on culture-dependent CRC due to mutations in DNA repair proteins such as
methods have shown that fungi make up about 70% of the MSH2, MLH1, MLH6, PMS1, and PMS2 occur),54,55 and
digestive system of adults and their number is in the range familial. Environmental and hereditary risk factors play
of 102.36 The presence of some fungi can contribute to an important role in the development of CRC. CRC risk
development of GC, including C. albicans,37 Phialemonium factors are classified into two categories: non-modifiable
spp.,38 Aspergillus spp., Penicillium spp., and Fusarium risk factors such as race,56 sex and age,2 IBD,57 cystic
spp.39 But in general, number of commensal fungal fibrosis,58 and cholecystectomy59 as well as modifiable risk
species are predominant in the gastrointestinal tract, factors such as obesity,60 diet,61 smoking and alcohol,62
including S. cerevisiae, Malassezia spp., and some species and diabetes and resistance to insulin.63
are classified as transient microbiota, e.g., Aspergillus The role of fungal agents in CRC has not been well
spp., Mucor spp., Cryptococcus spp., Rhodotorula spp., understood due to low frequency and lack of reference
Trichosporon spp., Histoplasma spp., Coccidioides spp., genome, but using high-throughput sequencing methods,
Paracoccidioides spp. and Blastomyces spp.40,41 Among they have been able to identify several fungal species,64
these fungi, there is ample evidence that C. albicans is and recently their role in IBD has been proven.65 Among
able to initiate and develop cancerous events through the fungi that are associated with CRC, the following
several mechanisms: (1) Production of carcinogens such can be mentioned: Candida genus such as C. tropicalis
as acetaldehyde, which contribute to the progression of and C. albicans, Phoma,66 Malassezia,67 Trichosporon,68
cancer (C. albicans, C. tropicalis, C. parapsilosis produce Cladosporium69 and so on. In addition to the above, fungi
more acetaldehyde than other species of Candida).41 (2) such as Paracoccidioides, Histoplasma, Cryptococcus,
Induction of inflammatory processes that contributes to Aspergillus, Penicillin, Zygomycetes, Pneumocystis,
tumor metastasis (using cytokines such as CXCL1, CXCL2, Scedosporiosis cause colonic involvement and may
CXCL3, TNF-α, and IL-18 facilitates tumorigenesis, eventually be involved in CRC formation.70 In this
angiogenesis, and metastasis).34,42-45 (3) Processes related regard, a number of studies have revealed the relationship
to molecular mimicry (molecular mimic of the protein between fungal agents and CRC. According to a study by
associated with complement receptor 3 (CR3-CP) C. Luan et al, they examined fungal microbiota of biopsy
albicans that supports cancer progression).46 (4) The Th17 specimens from intestinal adenomas and adjacent tissues
response (Th17 is a subset of CD4 + T cells that are active using the deep sequencing technique and found that
in response against C. albicans, and another cytokine 45% of fungal microbiota contained the opportunistic
from the Th17 family, IL-23, increases angiogenesis pathogen Candida and Phoma and approximately
and tumor growth, and antagonizes IL-12 and IFN.47,48 1% Cladosporium, Trichosporon, Rhodotorula,
Another study showed that 54.2% of patients with gastric Thanatephorus, and Plectosphaerella.66 In another study by
ulcer and 10.3% of patients with chronic gastritis had Gao in 2017, it was found that the ratio of ascomycota to
candidiasis, which was evident in 20% of patients with basidiomycota was different in the three groups of control,
gastric cancer.49,50 polyp, and CRC, so that ascomycota has a frequency of
37-54% and basidiomycota 4-5%.71 In 2019, Coker et
The role of fungal infections in colorectal cancer al also examined colonic fungal microbiota, which are
CRC, the most common type of cancer worldwide, is the used as diagnostic markers for CRC, such as A. flavus,
third leading cause of cancer and the fourth leading cause Kwoniella mangrovensis, Pseudogymnoascus sp. VKM
of cancer deaths, with a mortality rate of about 700 000. F-4518, Debaryomyces fabryi, A. sydowii, Moniliophthora
Overall, CRC accounts for 11% of all diagnosed cancers.51 perniciosa, K. heavenensis, A. ochraceoroseus, Talaromyces

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Hosseini et al

islandicus, Malassezia globosa, Pseudogymnoascus sp. amphotericin B in combination with voriconazole.85

VKM F-4520, A. rambellii, Pneumocystis murina and
Nosema apis and also found fungi such as Malassezia, The role of fungal infections in cervical cancer
Moniliophthora, Rhodotorula, Acremonium, Thielaviopsis Cervical cancer (CC) is the third most common cancer of
and Pisolithus is associated with CRC.72 the female reproductive system in the world.86 According
to a 2012 report, the standard rate for cervical cancer is
The role of fungal infections in lung cancer about 14 cases per 100 000 people.9 In general, by 2018,
Lung cancer (LC) is one of the most common causes of about 530 000 women were diagnosed with CC, of which
cancer death in the world. LC incidence is 1.35 million 257 000 died.87 The incidence of CC is higher in African
new cases (representing 12.4% of all new cancer cases) and South Asian countries, and its incidence and mortality
and mortality is 1.18 million deaths (accounting for 17.6% vary in most parts of the world. As a result, developed
of the global total).26 The five-year survival rate in newly countries account for 86% of all CC cases and 88% of all
diagnosed LC is 15%.73 Men are more likely to develop CC deaths.24,87 The incidence rate of CC in Iran is about
LC than women, and it affects more African American 2.61 per 100 000 people.88 The five-year survival rate in
men.74 One of the major causes of LC is disruption of the developed countries is about 66%.89 There are a number
molecular pathways of the lung cell, which alters normal of risk factors for CC, including: reproductive factors,
cell growth, differentiation, and apoptosis.75 In general, obesity, sexual behavior, diet, multiparity, prolonged use
LC is pathologically present in two forms: NSCLC (non- of hormonal contraceptives, poor socioeconomic status,
small cell lung carcinoma) (85% of cases) and SCLC smoking, Multiple pregnancies, and finally the presence
(small-cell lung carcinoma) (15% of cases).76 Many of bacterial, viral and fungal infectious agents.90 A 2018
internal and external factors are considered as risk factors study identified several fungi from the cervicovaginal
of LC, including smoking, arsenic in drinking water, region, including Candida, Malassezia, Sporidiobolaeae,
radioactive radon gas, asbestos, tuberculosis, COPD, Saccharomyces, Nakaseomyces, Gjaerumia, and
HIV infection,77 and mutations in genes EGFR,78 BRAF,79 Pleosporales. According to a study by Moradi et al in
91

KRAS,80 and so on. As mentioned, one of the risk factors Iran, one of the important fungi that is the link between
for LC is people with immunocompromised systems who cervicovaginal infections and cervical cancer was C.
become susceptible to lung disease and eventually LC by albicans, which was reported in women with high
exposure to opportunistic fungi such as Aspergillus sp., socioeconomic status in Bandar Abbas.92 In 2015, Neves
Cryptococcus sp., Pneumocystis sp. and endemic fungi.81 et al studied a 42-year-old woman who had received
For example, in opportunistic IPA (invasive pulmonary immunosuppressive therapy for cervical neoplasia and
aspergillosis), people with immunocompromised systems developed fungemia due to Cryptococcus laurentii with
are susceptible to Aspergillus and Cryptococcus and a weakened immune system and was eventually treated
pose a serious threat to people with cancer.82 Thus, the with fluconazole.93
differential diagnosis of LC solid tumors has revealed
types of fungi such as Trichosporon, Fusarium, Rhizopus, The role of fungal infections in skin cancer
Histoplasma capsulatum, H. immitis, and Cryptococcus Skin cancer (SC) is one of the most common types of
neoformans. It has been shown that in patients with LC cancer among white populations and is generally classified
who receive corticosteroids, they open the way for the into two categories: melanoma and non-melanoma
entry of opportunistic pathogens such as Aspergillus (NMSC).94 According to the latest statistics from 2020,
and P. jiroveci and exacerbate the disease.83 Another the number of new cases of skin cancer is estimated at
study reported that the dimorphic and opportunistic 108 420 people and the approximate number of deaths
fungal pathogen T. marneffei, the causative agent of is about 11 480 people.95 Remember that the increase
talaromycosis, causes lung infections in people with in melanoma incidence is not parallel to the increase in
immunocompromised systems. Following a study by mortality rates. NMSC, which includes Bowens disease,
Ching-López and Rodríguez Pavón, a 56-year-old HIV- basal cell carcinoma (BCC), and squamous cell carcinoma
free woman was reported to have talaromycosis and (SCC), is more prevalent among Caucasian populations.96
co-infected with stage IV NSCLC. The patient received Increased incidence of SC is associated with several
liposomal amphotericin B but she died due to a decrease factors including UV exposure, light skin (albinism), old
in blood oxygen levels as well as a decrease in the level age, male gender, chemicals (such as arsenic), radiation
of blood cells.84 Another study by Watanabe et al was exposure, XP, weakened immune system, smoking, and
conducted in 2019 on a 69-year-old man who underwent viral (HPV) and fungal infections.97 Fungal infections
chemoradiotherapy due to LC but later developed SIPA have been shown to occur more frequently in people
(subacute invasive pulmonary aspergillosis), a disease with weakened immune systems. Initially, most fungal
caused by A. fumigatus, due to immunocompromised infections were due to the presence of Candida species,
system. For the treatment of fungal infections, he received but recently it has been shown that the frequency of

750 Advanced Pharmaceutical Bulletin, 2022, Volume 12, Issue 4

 Carcinogenesis of fungal infections

Aspergillus sp. is increasing.98 In general, two types of Results and Discussion

fungal infections are involved in skin cancer: infections From the literature, it appears that fungal infections
caused by pathogenic fungi such as C. neoformans, H. may play a significant role in the risk for precancerous
capsulatum, C. immitis, Trichosporon spp. etc., as well as lesions. The most common fungal species involved in
opportunistic fungi such as Candida sp. (e.g., C. albicans, cancers development are Aspergillus flavus, A. parasiticus,
C. tropicalis, C. glabrata, C. parapsilosis), Aspergillus, Fusarium proliferatum, F. verticillioides, Candida
Mucorales, Fusarium, Rhizopus.99 As mentioned, albicans, C. tropicalis, and C. glabarata.115 Furthermore,
opportunistic fungal infections cause disease in people the ability of fungal species in carcinogens production
with weakened immune systems. In this regard, Pulido such as acetaldehyde, nitrosamine, mycotoxins, and the
et al. in 2018 studied solid organ transplant recipients generation of proinflammatory cytokines, can be risk
(SOTR) in such a way that by immunosuppression, graft factors in the promotion of various cancers.26
survival is increased and this factor causes skin cancer and Moreover, the potential role of fungal infections in
a variety of infections, followed by Those opportunistic oncogenic processes is the subject of debate in recent
infections are caused by black filamentous fungi such surveys of this topic. There are suggestions that fungal
as A. alternata, A. infectoria, C. cladosporioides, M. infection is a cause of cancers development possibly when
arundinis, and E. oligosperma.100 Another study was the infection is chronic and connected to risk factors such
conducted in 2016 by Brothers and Daveluy on a 61-year- as alcohol, tobacco, and etc.; however, each class of cancer
old man whose immune system was suppressed due to is influenced by different risk factors, such as family
receiving chemotherapy drugs for multiple myeloma. history, type 2 diabetes, and obesity, which are the main
Following the injury, his finger became sore with a rose risk factors of cancer.50,52
thorn and despite the weak immune system, the wound Along with the increased incidence of cancer associated
developed and squamous cell carcinoma developed and with fungal infections more thorough surveys of the
C. parapsilosis was isolated from the patient.101 epidemiology of cancer patients with fungal infections
can help to determine which patients are most likely to be
The role of fungal infections in ovarian cancer infected. Therefore, superior monitoring and diagnostic
Ovarian cancer (OC) is the seventh most common type of efforts can expand the accuracy of diagnosis of fungal
cancer in women in the world and after breast cancer is infection and will increase patient outcomes by permitting
the second most common type of cancer in women over intervention at an earlier stage of invasive cancers.2,3 The
40 (in a developed country).102,103 The highest incidence value of controlled clinical studies of patients with fungal
rates are observed in Eastern and Southern Europe and infections will greatly increase our knowledge of the most
the lowest rates are observed in China.104 The five-year operative methods of treating disseminated cancer disease
survival rate in the early stages of OC is about 29%, in immune-compromised cancer patients.
but when the tumor progresses it reaches about 92%.105
According to the latest statistics by 2020, the number of Conclusion
new OC cases is estimated at 21,750 and the number of Several specific fungi are associated with carcinogenesis
deaths estimated at 13 940.95 Pathologically, OC is divided (Table 1). Recent studies indicated that the pathogenic
into three categories: epithelial OC (90% of cases), stromal fungal populations were increased in cancerous patients.
OC (5-6% of cases), and genital OC (2-3% of cases).106 It has been shown that the development of carcinogenesis
OC-related risk factors include: Reproductive risk factors is closely related to a fungal profile. The most common
(such as continuous ovulation)107 and hormonal factors genera of fungi that contribute to the development of
(such as gonadotropins),108 family history and genetic versatile cancers are Candida sp., Aspergillus sp., and
predisposition (such as mutations in genes BRCA1, Fusarium sp. causing an inflammation and consequently
BRCA2 and MMR),109 ethnicity and race (such as Jews, contributing to the progression of various cancers.
Dutch, and French Canadians), diet (fiber and vitamin low Although, the link between infectious fungi and
D intake),110 lactation,111 obesity,112 smoking113 and alcohol carcinogenesis is not undeniable, we cannot restrict to
consumption.114 Although fungal infections are not a the study of fungal microbiota. In fact, we need to explore
risk factor for OC, a research team in 2017 studied the the intimate connections that could exist with fungi and
association between OC and fungal infections. According their possible role on carcinogenesis through their effect
to the study, the following fungi were found in cancer on the varied and complex immune system. It seems
samples: Pneumocystis, Acremonium, Cladophialophora, that the manipulation of fungal profile can be a helpful
Malassezia, Microsporidia Pleistophora, Ajellomyces, approach in the rapid improvement of patients after anti-
Aspergillus, Candida, Cladosporium, Coccidioides, cancer treatment. Therefore, the focus on the potential
Cryptococcus, Cunninghamella, Issatchenkia, Nosema, effect of infectious fungi on the initiation of cancers and
Paracoccidioides, Penicillium, Pleistophora, Rhizomucor, consequently the treatment of fungal infectious disease as
Rhizopus, Rhodotorula, Trichophyton.115 a global approach is indispensable to predicate the possible

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Hosseini et al

Table 1. The latest clinical finding and the association of fungal infections with versatile cancers.
Cancer type Fungal agents References

C. albicans, C. glabrata, C. tropicalis 16

Candida sp.
C. krusei, C. parapsilosis 116

Esophageal
Torulopsis sp. T. glabrata, T. tomata 17,117,118
cancer
Aspergillus sp. A. flavus, A. parasiticus
18-20,119

Fusarium sp. F. verticillioides, F. proliferation

C. albicans, Phialemonium spp., Aspergillus spp., Penicillium spp., Fusarium spp. 37,38,39

Gastric cancer S. cerevisiae, Malassezia spp., Mucor spp., Cryptococcus spp., Rhodotorula spp., Trichosporon spp., Histoplasma spp., 40,41
Coccidioides spp., Paracoccidioides spp. and Blastomyces spp.
Aspergillus sp. A. flavus, A. parasiticus
39

Gallbladder Penicillium 120,121

cancer Candida sp. C. albicans, C. glabrata, C. tropicalis

122

51

Blastomyces dermatitidis, Cryptococcus neoformans

C. tropicalis, C. albicans, Phoma, Malassezia, Trichosporon, Cladosporium

66-69
Paracoccidioides, Histoplasma, Cryptococcus, Aspergillus, Penicillin, Zygomycetes, Pneumocystis, Scedosporiosis
70
Colorectal cancer Rhodotorula, Thanatephorus, Plectosphaerella 66

72
A. flavus, Kwoniella mangrovensis, Pseudogymnoascus sp., Debaryomyces fabryi, A. sydowii, Moniliophthora perniciosa, K.
heavenensis, A. ochraceoroseus, Talaromyces islandicus, Malassezia globosa,
Pseudogymnoascus sp., A. rambellii, Pneumocystis murina, Nosema apis, Malassezia, Moniliophthora, Rhodotorula,
Colorectal cancer 72
Acremonium, Thielaviopsis, Pisolithus
Aspergillus sp., Cryptococcus sp., Pneumocystis sp. 81

Trichosporon, Fusarium, Rhizopus, Histoplasma capsulatum, H. immitis, P. jiroveci 83

Lung cancer
T. marneffei 84

A. fumigatus 85

Prostate cancer Candida sp., Aspergillus sp., C. neoformans, C. immitis, H. capsulatum, B. dermatitidis 123

Candida, Malassezia, Sporidiobolaeae, Saccharomyces, Nakaseomyces, Gjaerumia, Pleosporales 91

Cervical cancer
Cryptococcus laurentii 93

C. neoformans, H. capsulatum, C. immitis, Trichosporon spp., Mucor, Fusarium, Rhizopus 99

Skin cancer Candida sp., C. albicans, C. tropicalis, C. glabrata, C. parapsilosis 99

A. alternata, A. infectoria, C. cladosporioides, M. arundinis, E. oligosperma 100

Aspergillus, Candida, Coccidioides, Cunninghamella, Geotrichum, Pleistophora, Rhodotorula, Filobasidiella, Mucor,

Breast cancer Trichophyton, Epidermophyton, Fonsecaea, Pseudallescheria, Penicillium, Ajellomyces, Alternaria, Rhizomucor, Piedraia, 124

Malassezia

Pneumocystis, Acremonium, Cladophialophora, Malassezia, Microsporidia Pleistophora, Ajellomyces, Aspergillus, Candida,

Ovarian cancer Cladosporium, Coccidioides, Cryptococcus, Cunninghamella, Issatchenkia, Nosema, Paracoccidioides, Penicillium, 115

Pleistophora, Rhizomucor, Rhizopus, Rhodotorula, Trichophyton

subsequences of our current public health strategies.

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