The world is in the midst of an antibiotic resistance crisis that’s linked to around 5 million deaths per year, but bacteria aren’t the only mutating pathogens we have to worry about.
Some researchers say fungal infections are also adapting beyond the capabilities of our medical science, causing a “silent pandemic” that needs urgent action.
“Fungal pathogens and the threat of antifungal resistance are left out of the discussion, even though they are a growing problem worldwide,” explains molecular biologist Norman van Rijn at the University of Manchester, UK.
The United Nations is hosting a conference on antibiotic resistance in New York City this September, which will discuss resistant bacteria, fungi, viruses and parasites.
Ahead of the event, van Rijn and an international team of scientists are calling on governments, the research community and the pharmaceutical industry to “think beyond bacteria”.
Writing in The Lancet, they write that fungal infections have been left out of many efforts to tackle antibiotic resistance.
Without urgent attention and action, a particularly nasty fungal infection that already infects 6.5 million people and kills 3.8 million each year could become even more dangerous.
“The excessive focus on bacteria is of concern, as many of the drug resistance problems of the past decades are the result of invasive fungal diseases, which have gone largely unrecognized by communities and governments,” van Rijn and his colleagues, from laboratories in China, the Netherlands, Austria, Australia, Spain, the United Kingdom, Brazil, the United States, India, Turkey and Uganda, wrote.
In 2022, the World Health Organization released the Fungal Priority Pathogens List, “the first global effort to systematically prioritize fungal pathogens.”
Pathogens considered to be the most dangerous to human health include Aspergillus fumigatus, which arises from mold and infects the respiratory system; Candida, which causes yeast infections; Nakaseomyces glabratus, which infects the urogenital tract and bloodstream; and Trichophyton indochineae, which infects the skin, hair, and nails.
Those most at risk are the elderly and those with weakened immune systems.
Compared to bacteria and viruses, fungi are more complex organisms, most similar in structure to animals, making it more difficult and expensive for scientists to develop drugs that kill fungal cells without harming other important cells in the body.
“Only four systemic antifungal drugs are available to treat deep or invasive fungal infections, and resistance to these currently available classes is now the rule rather than the exception,” the letter authors wrote.
Several promising new antifungal agents have been discovered in the past few decades, but the arms race between pathogens and drugs has been fueled in part by the agrichemical industry.
“Even before[these agents]reach the market after years of development and clinical trials, the pesticide industry has developed fungicides with similar mechanisms of action, resulting in cross-resistance against critical priority pathogens,” the researchers explained in the letter.
“Food security requires antifungal protection. The question is, how do we balance food security with our ability to treat current and future resistant fungal pathogens?”
This is a conundrum that has been debated at length for antibiotics but less so for antifungals. Van Rijn and his team recommend global agreements to restrict certain antifungals to specific purposes, and coordinated regulation to balance food security and health.
The UN conference in September “should serve as the starting point” for a coordinated and multi-disciplinary approach to tackling antibiotic resistance, the researchers conclude.
You need to make sure that no microorganisms remain.
The study was published in the Lancet.
