NIJMEGEN — Paul Verweij and 50 scientists from countries including Brazil, Nigeria, and China published a call for action against drug-resistant fungi in Nature Medicine. The group agreed to collaborate on reducing unnecessary agricultural fungicide use and to assess new fungicides for cross resistance risks.

Verweij is a professor of clinical mycology at Radboud University Medical Center in Nijmegen. Drug-resistant fungi are recognized as a global problem requiring international collaboration.

Fungal infections fall into two categories: invasive infections in immunocompromised patients and superficial infections of the skin, hair, and nails. In the past 10 to 20 years, resistance in both categories has increased. A study in the Netherlands found that azole-resistant fungal infections are associated with about a 20% higher mortality rate compared to susceptible infections. The fungal skin disease Trichophyton indotineae can persist in patients despite four years of treatment. Candida auris, a type of yeast that can cause severe infections, is often drug-resistant.

Fungicides used to protect crops such as watermelons, maize, wheat, and flowers are chemically similar to medical azole antifungal drugs. Use of agricultural azole fungicides can lead to fungal resistance that reduces the effectiveness of medical azole drugs. Fungal spores released by molds are dispersed through the air and can travel long distances, potentially reaching jet streams and continents. Humans regularly inhale fungal spores. In lower-middle-income countries, strict infection control measures, diagnostics, and patient follow-up for fungal infections are often unavailable, and patients may die from undiagnosed or resistant fungal infections.

Fungal cells have a cell structure similar to human cells, making it difficult to develop drugs that kill fungi without harming human cells. Only five classes of antifungal drugs have been developed in the past 75 years, with azoles being the most important class. Few antifungal drugs can penetrate the brain to treat fungal brain infections. Basic mycology research requires tools, surveillance systems, and laboratory networks, which often lack funding.

The World Health Organization published its first fungal pathogen priority list in 2022. Fungi were mentioned only twice in the WHO's global action plan on antimicrobial resistance published a decade ago. That plan is currently under revision and is expected to address fungi more thoroughly.