WHO draws attention to fungi that are the biggest health threats

The World Health Organization (WHO) has released a ranking of fungi that threaten human health. It is the organization’s biggest effort yet to bring attention to a constellation of pathogens that often receive little attention despite their growing presence, treatment-resistant and deadly.

The organization presented a list of 19 invasive fungal diseases, including four it characterized as “critical priorities”, which collectively kill 1.3 million people and contribute to the deaths of another 5 million annually. Many of these deaths occur among people with HIV, cancer, tuberculosis and other underlying health conditions that leave them vulnerable to infection.

Health officials say mortality from fungal infections is likely to be much higher, as many hospitals and clinics, especially in poorer countries, lack the diagnostic tools needed to detect them.

“Invasive fungal infections are becoming more prevalent, but they are often not recognized in patients or treated correctly,” said Dr. Carmem L. Pessoa-Silva, a WHO professional who works with disease monitoring and control, speaking at a press conference on Tuesday (25th). “We don’t have a real view of the dimensions of the problem.”

The WHO characterized the report as a call to action, and officials said they hoped the text would raise awareness among governments, drug developers, doctors and health policy experts about the urgency of the problem.

Also according to the WHO, climate change has helped to increase the geographic area of ​​presence of some fungi. The coronavirus pandemic has also led to a rise in fungal infections among Covid patients who have gone to ICUs, where resistant pathogens such as Candida auris sometimes they spread, invading the body through breathing tubes and intravenous lines.

In India, mucormycosis, a rare but aggressive pathogen often referred to as “the black fungus”, has stalked thousands of Covid patients, some of whom have required disfiguring facial surgery to remove the infections.

Similar to harmful bacteria that evolve and gain resistance to antibiotics from being overused with people and agriculture, in recent years antifungal drugs have also been losing their healing power. Scientists say the rising rate of resistance to aspergillus fumigatusa common fungus that can be fatal to people with weakened immunity, has been linked to the intensive use of fungicides in the cultivation of species such as grapes, corn and cotton.

From the moment a fungal infection invades the bloodstream, treatment is exponentially difficult. For example, the mortality rate due to blood infections caused by fungi of the candida is 30%. This percentage is substantially higher among patients with Candida auris, one of four “critical priority” fungi cited in the WHO report. A yeast first identified in Japan in 2009, the fungus has since spread to four dozen countries and is often resistant to more than one drug.

There are only four classes of drugs to treat fungal infections “and there are very few others in development,” said Dr. Hatim Sati, another WHO official who helped write the report. According to him, many of the existing drugs are so toxic that some patients cannot take them.

Doctors and researchers said they were encouraged by the WHO’s decision to raise awareness of fungal infections. “This should have been done a long time ago. Fungal diseases have long been relegated to neglect, while the problem has been growing exponentially,” commented infectious disease specialist Cornelius Clancy of the VA Pittsburgh Health Care System, who did not contribute to the study.

Dr David Denning, CEO of the Global Action for Fungal Infections action group, said that in some ways insufficient surveillance is at the root of this neglect.

The fact that fungal infections go undiagnosed means patients often go untreated, he said, citing research in Kenya that concluded that better surveillance efforts to detect fungal meningitis could save 5,000 lives a year of people living with HIV.

The annual cost of generalized exams would be around US$50,000.

The lack of diagnosis has other consequences that are not seen, Denning said. He gave the hypothetical example of a leukemia patient who develops a fungal infection that turns out to be fatal. “If the person dies of a fungal infection, their family members may want to donate money to a leukemia research organization,” he said. “They will not donate it to an entity that works with fungal diseases, because they only know about leukemia.”

^{Translation by Clara Allain}