Candida Auris

The World Health Organization has created a first-ever priority list of fungi that it says pose the greatest emerging threats to public health.

The goal is to encourage more attention to these pathogens in public policy and research, the organization announced on Tuesday. 

The 19 highlighted fungi on the list have become increasingly common. They are also growing more resistant to treatment, and there are only four classes of antifungal medicines currently available, the WHO said.

Incidence expanding 

Emerging evidence shows that the incidence and geographic range of fungal diseases are expanding worldwide due to global warming and increased international travel and trade.

The most invasive forms of these fungal infections typically affect severely ill patients and those with compromised immune systems. This includes people with chronic respiratory disease such as COPD, cancer and organ transplants. The reported incidence of fungal infections increased significantly among hospitalized patients during the pandemic, while fungi that cause common infections have become more drug-resistant, WHO reported.

Humans and fungi have a mutual coexistence that has been “tipping out of balance,” according to a 2021 report in Scientific American. “Fungi are surging beyond the climate zones they long lived in, adapting to environments that would once have been inimical, learning new behaviors that let them leap between species in novel ways,” the science magazine stated.

Yet fungal diseases receive less than 1.5% of all infectious disease research funding, according to a WHO report. There is therefore limited evidence to back current healthcare treatment guidelines, experts said.

A forgotten disease

“Fungi are the forgotten infectious disease. They cause devastating illnesses but have been neglected so long that we barely understand the size of the problem,” said Justin Beardsley, MD, PhD, of the University of Sydney Infectious Diseases Institute in Australia. Beardsley led the WHO’s Fungal Priority Pathogens List’s study group. 

At the top of the WHO’s list are fungal species that have increasing resistance to antifungal agents. These include fungi associated with infections, such as Candida Auris, known to spread in nursing homes and other healthcare facilities, and the airborne Aspergillus fumigatus, which lives in the soil and is increasingly the cause of lung infections in vulnerable populations.

More attention and data is needed to improve the global response, WHO experts said.

“Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide” said Hanan Balkhy, MD, WHO assistant director-general, Antimicrobial Resistance. 

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