The World Health Organization (WHO) has released a new “blueprint” to help countries respond to the growing threat of fungal infections and antifungal resistance.
Released yesterday, the document provides a framework to strengthen national and regional responses to fungal diseases, which affect more than 300 million people each year yet remain widely under-recognized, underdiagnosed, and poorly managed. Although fungi can cause a wide range of superficial and easily treatable infections like ringworm, of particular concern are the invasive infections caused by fungal species that have become highly resistant to the limited number of antifungal drugs available and have high mortality rates.
The blueprint is the latest in an ongoing effort by the WHO to address a threat that the international health organization believes is expanding because of climate change, increased global travel, and widespread use of antifungal pesticides in agriculture. In 2022, the organization released its first-ever list of fungal “priority pathogens,” identifying 19 fungal species that have emerged as public health threats and should be targets for development of new antifungal therapies and diagnostic tests.
The document calls on countries to focus on four core domains to reduce preventable deaths from fungal infections and mitigate antifungal resistance: strengthening awareness, preparedness, and response; expanding equitable access to antifungal medications and diagnostics while also boosting research into new treatments and tests; building lab networks and surveillance systems to track and detect fungal infections; and addressing social, agricultural, and environmental determinants of fungal disease and antifungal resistance.
The WHO is hoping that policy makers incorporate the blueprint into national health plans and their response to antimicrobial resistance (AMR).
“Fungal disease and antifungal resistance remain an under addressed priority across national health plans, AMR strategies, and surveillance systems. This Blueprint provides countries with a practical framework to strengthen their response,” Hatim Sati, technical officer in the Department of Antimicrobial Resistance at WHO, said in a press release.
CDC report notes doubling of Candida auris cases
Among the fungal pathogens the WHO is most concerned about is Candida auris, a multidrug-resistant yeast that was first identified in Japan in 2009 and has since spread to healthcare facilities around the world. Invasive infections caused by C auris, which spreads easily in healthcare settings and in some cases is resistant to all classes of antifungal medication, are fatal in 29% to 62% of patients, many of whom require complex medical care and have weakened immune systems that leave them vulnerable to infection.
Although the yeast is often found on the skin of critically ill hospital patients and doesn’t always cause symptoms, it can cause severe illness and become deadly when it gets into the urine and blood.
A surveillance study today from researchers with the US Centers for Disease Control and Prevention (CDC) and state public health departments highlights the spread of C auris in US hospitals in recent years. The study, published in Morbidity and Mortality Weekly Report, shows that 13,507 clinical C auris cases were reported to the CDC over a three-year period, rising from 2,882 in 2022 to 4,428 in 2203 and 6,197 in 2024.
Most cases (87.8%) were in patients age 45 and older and more than 90% were in acute care hospitals (76.6%) and long-term acute care hospitals (17.8%), which typically treat the most critically ill and frailest patients. The most common specimen types were urine (31.5%) and blood (30.2%).
Fungal disease and antifungal resistance remain an under addressed priority across national health plans, AMR strategies, and surveillance systems. This Blueprint provides countries with a practical framework to strengthen their response.
The first C auris case in the United States was detected in 2016, and many of the early cases were associated with healthcare exposure in other countries, the report notes. But most recent cases have been acquired in US hospitals.
“In certain states and jurisdictions, C. auris has become endemic, leading to sustained high rates of transmission and increasing prevalence across health care facilities,” the authors wrote. They added that the continued rise in cases “underscores ongoing transmission in health care settings and the importance of infection prevention and control efforts, with continued support from federal, state, and local public health partners to prevent further spread.”
Chronic illness, lasting social and economic consequences
Other fungi of concern globally include additional Candida species (Candida albicans and Candida glabrata), Aspergillus fumigatus (an environmental mold that can cause severe lung infections and is a particular threat for cystic fibrosis patients), and Cryptococcus neoformans, a pathogenic fungus that lives in the environment and can cause severe lung and brain infections after inhaling the spores.
The WHO notes that, even when non-fatal, infections by these and other pathogenic fungi “can cause chronic, debilitating illness and lasting social and economic consequences.” And the burden typically falls on those people with compromised immune systems, including people with HIV, cancer patients, transplant recipients, and those with chronic lung disease or trauma. But the impact isn’t limited to those groups, the WHO warns.
“Even among immunocompetent individuals, where fungal disease was once considered uncommon or mild, outcomes can be severe due to diagnostic delays, limited access to antifungal medicines, AFR [antifungal resistance], and the increasing use of therapies that suppress or modulate the immune system,” the WHO report states.
Low- and middle-income countries (LMICs) are particularly at risk, the WHO says, with factors like poverty, overcrowding, and inadequate housing heightening vulnerability and expanding the reach of pathogenic fungi. Patients in LMICs are also less likely to have access to proper diagnostics and treatment.
