Forty years of global research on WHO's four critical priority fungal pathogens: Advances and prospects.

Background: On October 25, 2022, the World Health Organization (WHO) released its first Fungal Priority Pathogen List (FPPL), classifying Cryptococcus neoformans (C. neoformans), Candida auris (C. auris), Aspergillus fumigatus (A. fumigatus), and Candida albicans (C. albicans) as "critical priority" pathogens due to their substantial clinical impact and increasing antifungal resistance. Although bibliometric analyses have been conducted for individual fungal pathogens, a comprehensive and comparative assessment of all four critical pathogens remains lacking. To address this gap, we conducted an integrated bibliometric analysis to analyze global research trends and publication characteristics related to these pathogens, aiming to enhance global awareness and support future preparedness efforts on this important issue.

Methods: We conducted a comprehensive search of the Web of Science Core Collection (WoSCC) database, focusing on English-language review and research articles published from 1983 to 2023. Search terms included the pathogens' names and their Medical Subject Headings (MeSH) terms in the title. The data, including full records and cited references, were exported and analyzed using Microsoft Excel, VOSviewer, CiteSpace, and the Bibliometrix-Biblioshiny package in RStudio.

Results: A total of 19,785 publications were analyzed, showing an increasing trend in fungal research, with developed countries leading in output. Emerging economies, notably China and Brazil, also showed increasing contributions. Key research areas for C. neoformans included capsule formation, oxidative stress, and clinical impacts such as meningitis. For C. auris, studies focused on multidrug resistance, infection control, and diagnostics. A. fumigatus research emphasized antifungal resistance, virulence, and clinical outcomes, while C. albicans studies highlighted biofilm formation, antifungal resistance, and host immune interactions. Antifungal resistance, particularly in emerging pathogens like C. auris, remains a critical concern.

Conclusions: This analysis demonstrated a growing interest in fungal research and highlighted the need for more focus on fungus-host interactions, environmental adaptation, epidemiology of emerging pathogens, and enhanced international collaboration.