18 March 2024 | Sui Ting Hui · Hugh Gifford · Johanna Rhodes
Emerging antifungal resistance in fungal pathogens is a growing public health concern. Fungi, including important human, plant, and animal pathogens, are increasingly causing infections, while resistance to antifungal drugs is evolving. This review highlights the development of resistance in previously susceptible fungal species, such as Aspergillus fumigatus, and newly emerging species like Candida auris and Trichophyton indotineae. Resistance develops when fungi are exposed to antifungal drugs in the environment or in patients.
Aspergillus fumigatus, a common fungal pathogen, has developed resistance to azole antifungal drugs, with resistance alleles such as TR34/L98H and TR46/Y121F/T289A. These mutations are associated with resistance to itraconazole and voriconazole. The resistance is thought to have originated in the environment and been acquired by patients, as evidenced by the presence of resistant isolates in both clinical and environmental samples.
Candida auris is another emerging pathogen with intrinsic resistance to fluconazole and resistance to other antifungal drugs. It has spread globally, with multiple clades identified. Resistance in C. auris is linked to mutations in the ERG11 gene, which is involved in ergosterol biosynthesis. The resistance is also associated with biofilm formation, which contributes to drug tolerance.
Trichophyton indotineae is a newly emerging dermatophyte that has developed resistance to terbinafine and other antifungal drugs. Resistance in this species is linked to mutations in the squalene epoxidase gene, which is involved in ergosterol biosynthesis. The resistance has spread globally, with cases reported in multiple countries.
The development of antifungal resistance is influenced by the use of antifungal drugs in agriculture and the environment, as well as the spread of resistant strains through human and animal populations. The One Health approach is essential to address this issue, as it involves collaboration between human, veterinary, agricultural, and environmental sectors.
The increasing prevalence of antifungal resistance highlights the need for improved antimicrobial stewardship and the development of new diagnostic tools and treatments. Global efforts are needed to monitor and manage the spread of resistant fungal pathogens, as they pose a significant threat to public health.Emerging antifungal resistance in fungal pathogens is a growing public health concern. Fungi, including important human, plant, and animal pathogens, are increasingly causing infections, while resistance to antifungal drugs is evolving. This review highlights the development of resistance in previously susceptible fungal species, such as Aspergillus fumigatus, and newly emerging species like Candida auris and Trichophyton indotineae. Resistance develops when fungi are exposed to antifungal drugs in the environment or in patients.
Aspergillus fumigatus, a common fungal pathogen, has developed resistance to azole antifungal drugs, with resistance alleles such as TR34/L98H and TR46/Y121F/T289A. These mutations are associated with resistance to itraconazole and voriconazole. The resistance is thought to have originated in the environment and been acquired by patients, as evidenced by the presence of resistant isolates in both clinical and environmental samples.
Candida auris is another emerging pathogen with intrinsic resistance to fluconazole and resistance to other antifungal drugs. It has spread globally, with multiple clades identified. Resistance in C. auris is linked to mutations in the ERG11 gene, which is involved in ergosterol biosynthesis. The resistance is also associated with biofilm formation, which contributes to drug tolerance.
Trichophyton indotineae is a newly emerging dermatophyte that has developed resistance to terbinafine and other antifungal drugs. Resistance in this species is linked to mutations in the squalene epoxidase gene, which is involved in ergosterol biosynthesis. The resistance has spread globally, with cases reported in multiple countries.
The development of antifungal resistance is influenced by the use of antifungal drugs in agriculture and the environment, as well as the spread of resistant strains through human and animal populations. The One Health approach is essential to address this issue, as it involves collaboration between human, veterinary, agricultural, and environmental sectors.
The increasing prevalence of antifungal resistance highlights the need for improved antimicrobial stewardship and the development of new diagnostic tools and treatments. Global efforts are needed to monitor and manage the spread of resistant fungal pathogens, as they pose a significant threat to public health.