Global warning on increasing fungal resistance and its impact on antifungals

Without immediate action, humanity may face a further escalation of resistance to fungal diseases, warned a renowned group of scientists from around the world. The commentary – published in The Lancet this week – was coordinated by scientists from the University of Manchester, the Westerdijk Institute and the University of Amsterdam. According to the scientists, most of the fungal pathogens identified by the World Health Organization – which are responsible for around 3.8 million deaths a year – are either already resistant to antifungals or are rapidly developing resistance.

The authors argue that the current focus on bacteria is not enough to fully combat antimicrobial resistance (AMR). They demand that the United Nations Conference on Antimicrobial Resistance (AMR) to be held in September must also include the resistance that has evolved in many fungal pathogens.

Devastating health effects

Resistance is now the rule rather than the exception among the four currently available classes of antifungals, making the treatment of many invasive fungal infections difficult – if not impossible. Fungicide-resistant infections include Aspergillus, Candida, Nakaseomyces glabratus and Trichophyton indotineae, all of which can have devastating effects on the health of the elderly or immunocompromised.

Dr Norman van Rhijn of the University of Manchester coordinated the commentary with Professor Ferry Hagen of the University of Amsterdam and the Westerdijk Institute in the Netherlands.

Most people agree that drug-resistant bacterial infections are a significant part of the AMR problem. However, many drug resistance problems in recent decades have also been the result of invasive fungal diseases that have been largely underestimated by scientists, governments, physicians and pharmaceutical companies. The threat of fungal pathogens and antifungal resistance, despite being a growing global problem, is excluded from the debate.”

Dr. Norman van Rhijn, University of Manchester

Unlike bacteria, fungal and human cells are very similar, which experts say makes it difficult to find treatment methods that specifically inhibit fungi while causing as little toxicity to the patient as possible.

Back to the starting point

Professor Ferry Hagen added: “Despite the enormous difficulties in development, several promising new active ingredients, including entirely new classes of molecules, have been tested in clinical trials in recent years. But even before they reach the market after years of development, the agrochemical industry develops fungicides with a similar mode of action, leading to cross-resistance. This brings us back to where we started. It is true that many important crops are affected by fungi, so fungal protection is necessary for food safety. But the question is: at what cost?

The scientists recommend:

• Worldwide agreement restricting the use of certain classes of antifungal molecules for specific applications.
• Collaborate on solutions and regulations that ensure food security and the overall health of animals, plants and humans.
• Combating antibiotic resistance against fungal infections will be a priority at the UN conference in September.