Fungal Infections Silent Pandemic: While antibiotic resistance mostly concerns bacteria, a recent Lancet study urges focusing on fungal infections, which could become a 'silent pandemic'. In the run-up to the United Nations' second high-level meeting on antimicrobial resistance (AMR), The Lancet noted that there is a "need to look beyond just bacteria and include fungi." "The disproportionate focus on bacteria is concerning because many drug resistance problems over the past decades were the result of invasive fungal diseases, largely under-recognised by the community and governments alike," the September 2024 paper read. It further noted that "diagnosing fungal infections is often delayed or difficult, which increases inappropriate use of antimicrobial treatment and the risk of resistance emergence in vivo." The paper notes that antifungal drug development is hampered by the "close similarities" between fungal and human cells compared with bacterial and human cells; "the search for compounds that selectively inhibit fungi with minimal toxicity to the patient is laborious and requires substantial financial resources." Let's understand fungal infections and why they are so difficult to treat. Calling the rise in fungal infections "a major public health crisis," Dr Ravi Shekher Jha, director of pulmonology, MD, MRCP Fortis Hospital, Faridabad, pointed out that one reason it’s flying under the radar is that "many people aren’t aware of the severity of the issue. "Yet, the impact is serious, especially in vulnerable populations," said Dr Jha. The paper pointed out that diagnosing fungal infections is more difficult and takes longer (compared to bacterial infections), and hence, the use of inappropriate antifungal agents is unfortunately very common, resulting in greater antifungal resistance. Dr Vaishali Sharma, laparoscopic surgeon and IVF specialist, AIIMS, shared that fungal infections can be difficult to treat. "Its incidence is rising recently, but don't confuse it with common vaginal yeast (candida) infection. While common candidiasis causes white discharge and is easily treatable with antifungals, other fungal infections, such as Candida species, present challenges. Its symptoms may not be noticeable because patients are already sick and are in the hospital with another serious illness," elucidated Dr Sharma. Agreeing that climate change is a big factor, Dr Jha said, "Fungi that were once confined to certain regions are spreading because of warmer, more humid conditions. A good example is Candida auris, which is particularly dangerous in hospitals. Unlike bacteria, fungi can be tougher to eradicate from surfaces and equipment, which is causing outbreaks in healthcare settings." Another issue is the growing number of immunocompromised patients. Dr Jha stated, "Whether it’s due to cancer treatments, organ transplants, or chronic illnesses like diabetes, more people are at risk. The challenge is compounded by the fact that fungal infections are often misdiagnosed or diagnosed too late, leading to worse outcomes." The most common species that can potentially cause invasive infections are C. albicans, C. glabrata, C. krusei, C. tropicalis, and C. parapsilosis. These five species are responsible for more than 90 per cent of invasive infections, according to the National Center for Biotechnology Information's (NCBI) May 2022 study. It also highlighted the need for "further search for new classes of antifungals" which consider the potential multi-drug resistance cases. As such, complicating things further is antifungal resistance. "Just like bacteria can become resistant to antibiotics, some fungi no longer respond to the usual treatments, making infections harder to treat. This is particularly worrying because there aren’t many antifungal drugs, and new ones aren’t being developed quickly enough. Rampant and unchecked use of antimicrobials and OTC antibiotics is further worsening this," said Dr Jha. Therefore, experts urge better public awareness, improved diagnostic tools, and stronger surveillance in healthcare settings. "If we don’t act soon, this 'silent' threat could grow into a much bigger problem," said Dr Jha. DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
