Fungal resistance a growing healthcare threat

The European Society of Clinical Microbiology and Infectious Disease (ESCMID) is imploring global healthcare professionals and bodies to take a more active role in the growing problem of fungal resistance. The society believes that fungal infections are neglected worldwide, with over 300 million people of all ages suffering from a serious fungal infection every year.

The ESCMID Fungal Infection Study Group (EFISG) argues that fungal resistance represents a huge healthcare threat, with a rising prevalence of invasive and deadly forms of fungal diseases in the developed world. Meanwhile, very treatable fungal infections are killing huge numbers in the developing world, due to limited access to good diagnostics and basic drugs. Cryptococcal infections cause half a million deaths every year, making them the second-largest killer in Africa behind HIV.

The major problem in the developed world has been the reliance on fungicides in crop protection and the agricultural industry over the past several decades. Compounding this use is the fact that many of the newer fungicides are molecularly closely related to the human medicines that have been increasingly used since the turn of the century. Thus, what has now emerged, particularly in Europe, has been a rise in resistance.

Azole resistance in Aspergillus fumigatus has already spread across many countries. It is far higher in Europe than the USA, as a result of less available land and greater pressures to maximise crop yields, leading to greater antifungicide usage. Additionally, across the EU there are now some 250,000 cases each year of patients with chronic pulmonary aspergillosis (20,000 after cancer treatment) — and resistance rates continue to rise.

EFISG is thus calling for young clinicians, scientists and diagnosticians to join its global study group to help improve patient care, diagnostic methods and guidelines. EFISG Chairman Professor Andrew J Ullmann said the group’s role at ESCMID is to try and mitigate the spread of fungal resistance, but “more young scientists and clinicians are needed to help our research and improve best practice in clinical settings”.

The group notes that diagnostic procedures are still very poor, with autopsy reports showing that 30% of patients who had haematological malignancies also had a fungal disease — but only a quarter of these were diagnosed prior to death. It is therefore imperative that we develop good guidelines for industry professionals and seek to improve diagnostic procedures. The group also argues for ‘susceptibility testing’ to help predict the most vulnerable patients, so that healthcare professionals can provide treatment and preventative measures earlier.