Fungal Infections and Antifungal Resistance Need Urgent UN Action

The world is facing an antibiotic-resistance crisis that contributes to almost 5 million deaths each year. Yet bacteria are not the only pathogens evolving in ways that modern medicine struggles to control.

Fungal infections are likewise developing resistance to treatment, creating what some researchers describe as a "silent pandemic" requiring urgent action.

"The threat of fungal pathogens and antifungal resistance, even though it is a growing global issue, is being left out of the debate," says Norman van Rhijn, a molecular biologist at the University of Manchester in the UK.

This September, the United Nations will hold a meeting in New York City on antimicrobial resistance, covering resistant bacteria, fungi, viruses and parasites. Before the event, van Rhijn and an international group of scientists are calling on governments, researchers and the pharmaceutical industry to "look beyond just bacteria."

In correspondence published in The Lancet, they argue that fungal infections are omitted from too many efforts intended to combat antimicrobial resistance.

Fungal infections and antifungal resistance

Unless swift attention and action are taken, particularly severe fungal infections - already affecting 6.5 million people annually and causing 3.8 million deaths each year - may become still more hazardous.

"The disproportionate focus on bacteria is concerning because many drug resistance problems over the past decades were the result of invasive fungal diseases, which are largely under-recognized by the community and governments alike," write van Rhijn and his co-authors. The researchers represent institutions in China, the Netherlands, Austria, Australia, Spain, the UK, Brazil, the US, India, Türkiye and Uganda.

In 2022, the World Health Organization released its Fungal Priority Pathogen List, described as "the first global effort to systematically prioritize fungal pathogens".

The organisms identified as posing the greatest danger to human health included Aspergillus fumigatus, a mould-derived pathogen that infects the respiratory system; Candida, which may cause a yeast infection; Nakaseomyces glabratus, which can affect the urogenital tract or bloodstream; and Trichophyton indotineae, which can infect skin, hair and nails.

Older people and those with weakened immune systems face the greatest risk.

Why treatments for fungal pathogens are limited

Fungi are more complex organisms than bacteria or viruses, and their structure is more closely related to that of animals. Consequently, developing medicines that destroy fungal cells without harming other essential cells in the body is more difficult and costly for scientists.

"To treat deep or invasive fungal infections, only four systemic antifungal classes are available and resistance is now the rule rather than the exception for those currently available classes," the correspondence authors write.

Several potentially promising antifungal medicines have emerged over recent decades. However, the competition between pathogens and treatments is partly being accelerated by the agrochemical sector.

"Even before [these drugs] reach the market after years of development and clinical trials, fungicides with similar modes of action are developed by the agrochemical industry resulting in cross-resistance for critical priority pathogens," the researchers explain in their correspondence.

"Antifungal protection is required for food security. The question is, how do we balance food security with the ability to treat current and future resistant fungal pathogens?"

Balancing food security and future antifungal treatment

This dilemma has received extensive discussion in relation to antibiotics, but far less attention regarding antifungals. Van Rhijn and his colleagues propose a global agreement that restricts certain antifungal drugs to defined uses, alongside co-ordinated regulations that reconcile food security with public health.

The UN meeting in September "must serve as a starting point" for a co-ordinated, wide-ranging response to antimicrobial resistance, the researchers conclude.

No microbe should be left behind.

The study was published in The Lancet.