The
World Health Organization has released a ranking of fungi that threaten human health,
in its most ambitious effort to draw attention to a constellation of pathogens
that are largely overlooked, even as they have become increasingly widespread,
resistant to treatment, and deadly.
اضافة اعلان
The health agency
listed 19 invasive fungal diseases, including four it described as a “critical
priority”, that collectively kill 1.3 million people and contribute to the death
of five million others each year. Many of those deaths occur among people with
HIV, cancer, tuberculosis, and other underlying health conditions that leave
them vulnerable to infection.
Health officials
say the death toll from fungal infections is likely much higher because many
hospitals and clinics, especially in poorer countries, lack the diagnostic
tools for detecting them.
“The bottom line is
that invasive fungal infections are becoming more prevalent, but frequently
they are not recognized in patients and not correctly treated,” Dr Carmem L.
Pessoa-Silva, a WHO official focused on disease surveillance and control, said
at a news conference last week. “We do not have a real sense of the size of the
problem.”
The WHO framed the
report as a call to action, and officials said they hoped it would help lead to
a greater sense of urgency among governments, drug developers, doctors, and
health policy experts.
Climate change has
helped to increase geographic range and prevalence of some infections, the WHO
said. The coronavirus pandemic has also led to a spike in fungal infections
among
COVID patients who end up in intensive care units, where stubborn
pathogens like Candida auris sometimes flourish, then invade the body through
breathing tubes and intravenous lines.
Much like
pernicious bacteria that evolve and become resistant to antibiotics through
their overuse in people and agriculture, antifungal medications have been
losing their curative punch in recent years. Scientists have said that rising
rates of resistance to Aspergillus fumigatus, a common mold that can be fatal
to those with weakened immunities, have been tied to the prodigious use of
fungicides on cash crops like grapes, corn, and cotton.
Once a fungal
infection enters the bloodstream, treatment becomes exponentially more
difficult: Bloodstream infections with fungi in the candida family, for
example, have a mortality rate of 30 percent. That figure is substantially
higher among patients with Candida auris, one of the four “critical priority” fungi
cited in the WHO report. The fungus, a yeast first identified in Japan in 2009,
has spread to four dozen countries and is often resistant to more than one
drug.
There are only four
classes of drugs that treat fungal infections, “and very few new ones in the
pipeline”, said Dr Hatim Sati, another WHO official who helped to write the
report. Many of the existing drugs are so toxic, he said, that some patients
cannot safely take them.
Doctors and
researchers said they were encouraged by the WHO’s decision to turn a spotlight
onto fungal infections. “This is long overdue given that fungal diseases have
long been neglected even as the problem grows at an exponential rate,” said Dr
Cornelius Clancy, an infectious diseases doctor at the VA Pittsburgh Health Care
System who did not contribute to the report.
Dr David Denning,
CEO of the advocacy group Global Action for Fungal Infections, said that in
some ways, poor surveillance was the root of that neglect.
The failure to
diagnose fungal infections means that patients often go untreated, he said,
citing research in Kenya, which found that better surveillance efforts for
fungal meningitis would save 5,000 lives annually among people with HIV.
The annual cost for
widespread testing, he said, would be around $50,000.
The lack of diagnosis has other unseen consequences, Denning
said. He offered the hypothetical example of a leukemia patient who develops a
fungal infection that proves fatal. “If that person dies from a fungal
infection, their relatives might want to give money to a leukemia charity,” he
said. “They aren’t going to give it to the fungal disease charity because the
leukemia is the thing they knew about.”
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