The emergence of invasive fungal infections clarified | Health


You probably know about athlete’s foot and yeast infections — currently, up to a quarter of people globally have athlete’s foot, while three-quarters of women will develop a vaginal yeast infection in their lifetime. However, these well-known infections are merely scratching the surface of the fungal problem. While you may be familiar with fungal skin infections, you may not be aware of “invasive” fungal infections, which can impact your lungs or spread to your organs through the bloodstream. (Also read: Beware of these 7 fungal infections during the monsoon: from athlete’s foot to nail fungus)

While you may be aware of fungal skin infections, you may not be aware of "invasive" fungal infections, which can impact your lungs or spread to your organs through your bloodstream.(IStock)
While you may be aware of fungal skin infections, you may not be aware of “invasive” fungal infections, which can impact your lungs or spread to your organs through your bloodstream.(IStock)

These infections are increasing in prevalence and can be life-threatening, especially for individuals with compromised immune systems. For years, they have gone unnoticed by the general public. It was only last year that the World Health Organization published its inaugural list of fungi that pose a threat to health.

This general lack of awareness has led to misdiagnoses of fungal infections in clinical settings and hindered the development of medications to address the issue.

Furthermore, it is challenging for the WHO to accurately estimate the disease burden. Experts suggest that up to 1.5 million people per year die from invasive fungal infections — for comparison, this is approximately the same number of deaths attributed to tuberculosis annually.

How does one contract an invasive fungal infection?

We are constantly inhaling fungal spores. These spores come from our compost bins, the moldy bread on our kitchen table, or the flower bulbs we plant in our gardens (more on that later).

Oliver Cornely, the head of the European Center of Excellence for Invasive Fungal Infections, mentioned that these spores do not pose a problem for the vast majority of healthy individuals, whose immune systems can easily combat them.

However, for immunocompromised individuals — such as heavy smokers or those who have recently undergone an organ transplant or cellular therapy — inhaling these spores can sometimes cause issues.

Why are invasive fungal infections on the rise?

Cornely explained that the increase in invasive fungal infections is mainly linked to the growing number of life-saving surgeries.

Today, a significantly larger number of people undergo routine operations and treatments, such as chemotherapy. However, these medical interventions can make individuals more susceptible to invasive fungal infections.

There is also a growing issue of antifungal resistance.

What is antifungal resistance and why is it problematic?

Antifungal resistance is analogous to antibiotic resistance. Certain fungi are resistant to the medications, or antifungals, commonly used to treat them.

According to Cornely, some fungi are inherently resistant to specific classes of antifungals.

Others develop resistance to antifungals because they are exposed to lower doses that do not completely eradicate them, rather than annihilating them. This exposure allows the fungi to build up resistance.

A helpful way to understand this is by considering treatments for peanut allergies. Individuals with peanut allergies consume small amounts of peanuts over time to develop resistance. Eventually, they become immune to the allergens present in peanuts.

This concept applies to fungi as well — when fungi are exposed to small doses of antifungals, they can develop resistance.

This resistance can develop within the body of an individual undergoing antifungal treatment or in nature — antifungals are extensively used in agriculture. The United Nations Food and Agriculture Organization estimates that if antifungals were discontinued in farming, it would result in a 2 billion people food shortage.

“It’s a dilemma,” stated Cornely. “We must use them in agriculture. However, we should refrain from using them for flower bulbs.”

How are antifungals employed in agriculture?

Antifungals are applied to flower bulbs for the same reasons they are used in food production: to prevent consumers from purchasing a daffodil bulb at the florist’s and discovering a large moldy section on it.

Prior to being sold at nurseries, flower bulbs undergo a process known as “bulb dipping,” in which they are immersed in a bath of azoles, the same antifungal agent used to treat invasive fungal infections.

“That’s why you never find a bulb with fungus when you visit the garden center,” explained Cornely. “Normally, like your bread, these things should naturally decompose and be destroyed by Aspergillus fumigators, but that doesn’t happen because they are coated with azoles.”

While this may be beneficial from a practical standpoint — as nobody wants to deal with moldy flowers — Cornely noted that when the bulbs are planted in gardens, the azoles enter the soil, resulting in a high concentration of azoles near the bulb. However, as one moves farther away from the bulb, the concentration decreases until it becomes so low that fungi in the soil can tolerate it, similarly to the small amounts of peanuts individuals consume to treat an allergy. Through this exposure, the fungi become resistant to the azoles.

Cornely mentioned that the same process occurs when an antifungal is used to treat an abscess. In the vicinity of the abscess and directly surrounding it, the level of antifungal is intense enough to eliminate all fungi. However, as one moves farther away, the concentration of the antifungal decreases, increasing the likelihood that fungi within the body will develop resistance rather than succumbing to the exposure.

Which invasive fungal infections are most prevalent?

The most common invasive fungal infections are caused by the Candida and Aspergillus fungi. Aspergillus primarily affects the lungs, while Candida can disseminate through the bloodstream, causing infections in various organs of the body, particularly the eyes, bones, liver, or spleen.

Cornely noted that this can occur through the gastrointestinal tract. In healthy individuals, he explained, it is normal for fungus to be present “alongside myriad bacteria.”

However, in those who have undergone procedures or experienced health issues that compromise the integrity of their mucosa — the soft tissue that lines our organs, protecting them from invasive pathogens — these fungal organisms can become pathogens themselves.

Edited by: Zulfikar Abbany

This story has been published from a wire agency feed without modifications to the text. Only the headline has been changed.

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