A group of global scientists has issued a stark warning over the escalating threat of resistance in fungal diseases, pressing for immediate action. Published in The Lancet, the commentary coordinated by researchers at The University of Manchester, the Westerdijk Institute, and the University of Amsterdam reveals the critical state of antifungal resistance, which is becoming a formidable challenge against public health.
According to the researchers, the World Health Organization (WHO) has identified numerous fungal pathogens that are either already resistant or quickly developing resistance to antifungal medications. These pathogens are responsible for around 3.8 million deaths each year.
The increasing focus on bacterial antimicrobial resistance (AMR) means fungal AMR is being overlooked, argues Dr Norman van Rhijn from The University of Manchester. He states, “Most people agree that resistant bacterial infections constitute a significant part of the AMR problem. However, many drug resistance problems from the past decades have also resulted from invasive fungal diseases which have been largely unrecognized by scientists, governments, clinicians, and pharmaceutical companies. Despite being a growing global issue, the threat of fungal pathogens and antifungal resistance is being left out of the debate.”
Resistance has become the norm for the four primary classes of currently effective antifungal medications. This resistance makes treating many invasive fungal infections exceptionally challenging, if not impossible. Noteworthy drug-resistant fungal infections include Aspergillus, Candida, Nakaseomyces glabratus, and Trichophyton indotineae, which pose significant health risks, particularly to older individuals and those with compromised immune systems.
Professor Ferry Hagen from the University of Amsterdam and the Westerdijk Institute added that, despite numerous challenges in development, promising new agents and entirely new classes of molecules have entered clinical trials recently. However, one significant issue remains.
“Even before they reach the market after years of development, agrochemical companies develop fungicides with similar modes of action, resulting in cross-resistance. This situation sets us back to square one again,” says Professor Hagen. “Although antifungal protection is crucial for food security due to the impact of fungi on essential crops, this leads to a pivotal question: At what price?”
The researchers emphasize the stark difference between bacterial and fungal infections in treatment. The close similarity between fungal cells and human cells makes it challenging to develop treatments that can effectively inhibit fungi without causing significant harm to patients.
To address these challenges, the scientific community calls for several measures:
- Global consensus on limiting the use of certain antifungal molecules for specific applications.
- Collaborative efforts to develop solutions and regulations that ensure food security while safeguarding the health of humans, animals, and plants.
- Incorporate the issue of fungal AMR into the discussions at the upcoming United Nations meeting on antimicrobial resistance in September.
With resistant fungal strains like Aspergillus fumigatus (often azole-resistant) becoming increasingly difficult to treat, the need for urgent global action is more pressing than ever. Ignoring the growing threat of antifungal resistance could have dire consequences on public health and food security worldwide.