Emerging Fungal Infections: from the Fields to the Clinic, Resistant Aspergillus fumigatus and Dermatophyte Species: a One Health Perspective on an Urgent Public Health Problem

Abstract

Purpose of Review For this review, we use a One Health approach to examine two globally emerging public health threats related to antifungal drug resistance: triazole-resistant Aspergillus fumigatus infections, which can cause a life-threatening illness in immunocompromised hosts, and antifungal-resistant dermatophytosis, which is an aggressive skin infection caused by dermatophyte molds. We describe the state of current scientific knowledge and outline necessary public health actions to address each issue. Recent Findings Recent evidence has identified the agricultural use of triazole fungicides as an important driver of triazole-resistant A. fumigatus infections. Antifungal-resistant dermatophyte infections are likely driven by the inappropriate use of antifungal drugs and antibacterial and corticosteroid creams. Summary This review highlights the need for a One Health approach to address emerging antifungal resistant infections, emphasizing judicious antifungal use to preserve available treatments; strengthened laboratory capacity to identify antifungal resistance; and improved human, animal, and environmental surveillance to detect emerging resistance, monitor trends, and evaluate the effectiveness of efforts to decrease spread.

A One Health approach to overcoming fungal disease and antifungal resistance

“…The requirement for prolonged antifungal use to treat clinical infections, as well as over-or misuse leads to increased levels of antifungals in water run-off and irrigation sources, further impacting the environment and the animals living within it. antifungal resistance in the clinic have been critically explored and reviewed (Azevedo et al, 2015;Fisher et al, 2022;Langfeldt et al, 2022;Verweij et al, 2022). For instance, research in A. fumigatus is at the forefront of cross-resistance profiling, directly linking fungal profiles to clinical azoles following exposure to agricultural azoles (Faria-Ramos et al, 2014).…”

Host, pathogenic fungi and the microbiome: A genetic triangle in infection

“…Morbidity and mortality in fungal disease remain very high despite recent advances in the diagnostic and treatment of these conditions ( 5 – 7 ). There are only three classes of antifungal drugs available to treat these disease and, antifungal resistance linked to the use of agricultural use of triazole fungicides is on the rise ( 8 ). The development of new antifungal drugs to treat human fungal disease is challenging as both, host and pathogen are eukaryotes and, there are different potential druggable targets exposed at different points of fungal morphogenesis.…”

Epidemiological study of antifungal‐resistant dermatophytes isolated from Japanese patients

“…Trichophyton interdigitale and Trichophyton rubrum are anthropophilic species that are most frequently isolated from tinea unguium, tinea pedis, and tinea corporis worldwide 1,2 . In recent years, the emergence of antifungal‐resistant dermatophytes has been reported in fungal infections around the world 1–3 . In 2020, we investigated the antifungal susceptibility of clinical isolates from Japanese patients to assess the terbinafine (TRF)‐resistance patterns in T. interdigitale and T. rubrum strains 4 .…”

“…1,2 In recent years, the emergence of antifungal-resistant dermatophytes has been reported in fungal infections around the world. [1][2][3] In 2020, we investigated the antifungal susceptibility of clinical isolates from Japanese patients to assess the terbinafine (TRF)-resistance patterns in T. interdigitale and T. rubrum strains. 4 The isolation rates of TRF-resistant strains (5 strains of T. rubrum) were 2.3% in 210 cases and 3.9% in 128 T. rubrum infections in 2020.…”