Amidst a backdrop of coronavirus (COVID-19) and monkeypox infection, the vulnerability of human health can seem inescapable. But just as UK COVID-19 infections are once again falling, a recently published fungal priority pathogen list (FPPL) warns of the significant threats posed by fungal infection. Impact’s Matthew Murray reports.
According to the report, published last month by the World Health Organisation (WHO), invasive fungal diseases (IFDs) are rising overall and particularly among the “immunocompromised populations”.
The report, which brings together knowledge from over 400 experts and 6000 research papers, spotlights a troubling environment of underfunding and limited recognition. A parallel risk of growing antifungal resistance is also highlighted. It is hoped the WHO’s FPPL will focus and drive further research, encourage public health intervention, and help foster greater certainty regarding the global burden of fungal disease.
Following a similar format to a previously published priority list, 19 fungal diseases are listed, ranked, and categorised according to priority (critical, high, and medium priority).
The critical group makes for grim reading. Constituting four fungal pathogens – Cryptococcus neoformans, Candida auris, Aspergillus fumigatus, and Candida albicans – this group represents a selection of high-mortality diseases which are often multi-drug resistant and thus hard to treat.
Neoformans, for instance, is a potentially life-threatening pathogenic yeast inhaled from the environment (such as soil and decaying wood). Initially affecting the lungs, cryptococcosis can quickly spread to the central nervous system and blood, resulting in lengthy hospitalisations. No vaccine is currently available, and in vulnerable populations (such as those with HIV infection), mortality rates range from 41-61%.
This synthesis, whilst worrying, represents the first of its kind within global mycology, and has been brought about by a continued increase in fungal diseases. Indeed, IFDs now cause as many deaths as tuberculosis, and more than malaria.
Without a growth in research and awareness, we are at risk of sleepwalking into another public health problem
But what is causing this escalating fungal threat? And, why now?
A number of compounding factors are involved. However, the authors of the report point primarily to the increasing size of immunocompromised populations, the growth of antifungal resistance, and the impact of coronavirus (COVID-19) on at-risk groups. Recent research also implicates our changing climate in the increasing prevalence of fungal infection.
But despite this growing concern, fungal diseases are currently under-recognised in both the public and scientific realms. At present, less than 1.5% of all research funding into infectious disease is invested into IFDs. It is perhaps unsurprising then that a limited toolbox exists for tackling these diseases – only four classes of antifungal medicine are currently available.
The authors urge for a change in this situation, and it is hoped this report will help instigate change. Improved diagnosis and broader surveillance is needed to tackle the threats posed by this so-called ‘disease X’. Without a growth in research and awareness, we are at risk of sleepwalking into another public health problem.
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