Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

Abstract

: The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses. Invasive candidiasis is increasingly caused by non-albicans Candida spp., including C. auris, a multidrug-resistant yeast with the potential for nosocomial transmission that has rapidly spread globally. The use of mould-active antifungal prophylaxis in patients with cancer or transplantation has decreased the incidence of invasive fungal disease, but shifted the balance of mould disease in these patients to those from non-fumigatus Aspergillus species, Mucorales, and Scedosporium/Lomentospora spp. The agricultural application of triazole pesticides has driven an emergence of azole-resistant A. fumigatus in environmental and clinical isolates. The widespread use of topical antifungals with corticosteroids in India has resulted in Trichophyton mentagrophytes causing recalcitrant dermatophytosis. New dimorphic fungal pathogens have emerged, including Emergomyces, which cause disseminated mycoses globally, primarily in HIV infected patients, and Blastomyces helicus and B. percursus, causes of atypical blastomycosis in western parts of North America and in Africa, respectively. In North America, regions of geographic risk for coccidioidomycosis, histoplasmosis, and blastomycosis have expanded, possibly related to climate change. In Brazil, zoonotic sporotrichosis caused by Sporothrix brasiliensis has emerged as an important disease of felines and people.

Essential Oils of Lamiaceae Family Plants as Antifungals

“…Recently, C. auris has been reported from 36 countries from six continents [18]. About 30% of isolates demonstrate reduced susceptibility to amphotericin B, and 5% can be resistant to the echinocandins [19,20]. The estimated mortality from C. auris fungemia range from 28% to 60% [21].…”

“…include β-caryophyllene (41 plants), linalool (27 plants), limonene (26), β-pinene (25), 1,8-cineole (22), carvacrol (21), α-pinene (21), p-cymene(20), γ-terpinene(20), and thymol(20) …”

Repositionable Compounds with Antifungal Activity against Multidrug Resistant Candida auris Identified in the Medicines for Malaria Venture’s Pathogen Box

“…Due to its prevalence and high morbidity and mortality rate, this infection presents a great challenge to clinicians. Even though Candida albicans is the main causative agent for these infections, infections caused by non-albicans Candida species (NACS) have increased in the last few decades, currently accounting for approximately half of the cases [6]. The most recent NACS to emerge as a formidable opportunistic pathogen is Candida auris.…”

Immunotherapy against Systemic Fungal Infections Based on Monoclonal Antibodies

“…Systemic mycoses in humans appear when there is poor host control of yeasts, hyphal fragments, spores or conidia, which predisposes the infection to progress through the bloodstream. Thereafter, the conidia/hyphal fragments or yeast cells can reach any organ [5,15]. Systemic mycoses are frequently difficult to treat, as most of them occur in vulnerable individuals, with defective innate and adaptive immune responses [2,14,16].…”

“…Systemic mycoses are frequently difficult to treat, as most of them occur in vulnerable individuals, with defective innate and adaptive immune responses [2,14,16]. Diseases with worldwide occurrences, such as candidiasis and aspergillosis, are frequent and severe, and are currently causing the highest rate of hospitalization due to fungi [1,7,15]. Estimated costs of care for patients with only four of the major mycoses-aspergillosis, candidiasis, cryptococcosis, and histoplasmosis-have been calculated as up to $5.1 billion dollars annually in the US [7,17].…”