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Lethal Fungi Now a Global Health Threat, WHO Says

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The World Health Organization has created a list of infectious-fungi that it hopes policymakers will use to create global health interventions to protect the world’s peoples from dying as a result of drug-resistant infections.

The Fungal Pathogen Priority List includes lethal fungi diseases that cause meningitis and yeast infections that are difficult to treat with medication. The list focuses on fungal pathogens that cause severe and sudden infections that have long-lasting effects and may cause symptoms such as fatigue, shortness of breath, bloating, diarrhea,  constipation and even death.

According to the report, people most at risk are those with underlying health problems or a weakened immune system, such as chronic lung disease, prior tuberculosis (TB), HIV, cancer, and diabetes mellitus. 

“Critically ill patients in an intensive care unit, patients undergoing invasive medical procedures and receiving broad-spectrum antibiotics, and those taking immune-suppressing medicines are also at risk,” the report read.

Infectious diseases are among the top causes of mortality and a leading cause of disability worldwide. It kills over 1.6 million people each year and causes long-term diseases in hundreds of millions more, according to the global leader in fungal disease advocacy, Global Action for Fungal infections (GAFFI).  

The WHO said drug-resistant bacterial infections are also estimated to contribute to approximately 4.95 million deaths every year, with the greatest burden in areas where resources are limited.

And the risks of becoming infected with an invasive fungal disease (IFD) are rising as the world’s population continues to expand. 

The WHO said that many factors drive drug resistance, including advancements in modern medicine and accessibility to therapies and interventions that impair the immune system, such as chemotherapy and immunotherapy for cancer, and solid organ transplantation. 

Antifungal resistance has major implications for human health and generally leads to prolonged therapy and hospital stays, and an increased need for expensive and often highly toxic second line antifungal medicines. These medicines are often unavailable in low-and middle-income countries which can contribute to increased death. 

But despite the growing concern, the WHO said fungal infections receive very little attention and resources, leading to a scarcity of quality data on fungal disease distribution and antifungal resistance patterns. 

The organization is calling for countries to improve their surveillance of fungal diseases which will require regular access to diagnostics; target support for R&D and innovation including creating new antifungal drugs, as well as improved diagnostics and, enhanced health systems to ensure access to diagnosis, resistance detection and therapy, including a major uplift in training. This, the WHO said, may involve a tiered approach. 

In 2017, the WHO developed its first bacterial priority pathogens list (WHO BPPL) in the context of increasing antibacterial resistance to help galvanize global action, including the research and development (R&D) of new treatments. 

Inspired by the BPPL, the WHO has now developed the first fungal priority pathogens list (WHO FPPL). The WHO FPPL is the first global effort to systematically prioritize fungal pathogens, considering their unmet R&D needs and perceived public health importance. 

The 19 fungal pathogens included were ranked and categorized into three priority groups based on their numerical scores and consensus discussions among the WHO.

  • Critical group: Cryptococcus neoformans, Candida auris, Aspergillus fumigatus and Candida albicans. 
  • High group: Nakaseomyces glabrata (Candida glabrata), Histoplasma spp., eumycetoma causative agents, Mucorales, Fusarium spp., Candida tropicalis and Candida parapsilosis.
  • Medium group: Scedosporium spp., Lomentospora prolificans, Coccidioides spp., Pichia kudriavzeveii (Candida krusei), Cryptococcus gattii, Talaromyces marneffei, Pneumocystis jirovecii and Paracoccidioides spp.

The prioritization process focused on fungal pathogens that can cause invasive acute and subacute systemic fungal infections for which drug resistance or other treatment and management challenges exist.

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