Clinical Report: Addressing Research Deficiencies in Emerging Fungal Infections

Background

Fungal diseases were historically easy to overlook in clinical practice, with limited funding and specialist expertise concentrated in relatively few centers. In recent years, awareness has increased substantially, including through the WHO fungal priority pathogen list and expanded international guidance. However, major gaps remain in surveillance, diagnostic access, antifungal availability, research infrastructure, and specialist capacity.

Data Highlights

• Severe fungal disease is associated with an estimated 3.8 million deaths annually, including about 2.5 million deaths considered directly attributable.

• The 2022 WHO fungal priority pathogen list ranked 19 species and identified surveillance, diagnostics, and access to antifungals as major weaknesses.

• Candidemia mortality in the ECMM Candida III cohort remained close to 40%.

• Cryptococcal meningitis still causes more than 100,000 deaths annually in people with advanced HIV disease.

Key Findings

• Fungal pathogens have gained greater international recognition, including inclusion in the 2024 United Nations high-level meeting political declaration on antimicrobial resistance.

• Trichophyton indotineae illustrates the emergence of antifungal resistance outside hospitals, with terbinafine resistance associated with point mutations in squalene epoxidase.

• Sporothrix brasiliensis demonstrates changing zoonotic transmission patterns, with spread linked to free-roaming cats across parts of South America.

• Chronic pulmonary aspergillosis may be mistaken for recurrent tuberculosis in people with residual lung damage after tuberculosis because fungal disease is not always investigated.

• The editorial identifies four major unmet needs: better disease counting, broader diagnostic access, stronger clinical trials in high-risk patients, and a larger, better-supported specialist workforce.

Clinical Implications

The editorial argues that awareness is no longer the principal barrier to progress in fungal disease. Greater emphasis is needed on surveillance, access to diagnostic testing, antifungal stewardship, appropriate use of evolving case definitions, stronger clinical trial infrastructure, and specialist expertise. Local epidemiology and susceptibility patterns are particularly important as antifungal resistance continues to evolve.

Conclusion

Fungal infections are receiving greater clinical and policy attention, but major gaps remain in case counting, diagnostic access, clinical research, and workforce capacity. The author argues that fungal disease and antifungal resistance should be incorporated into the infectious disease surveillance, diagnostic, and research infrastructure that already exists rather than treated as separate problems.

Related Resources & Content

1. World Health Organization. WHO. 2025 — WHO Issues Its First-Ever Reports on Tests and Treatments for Fungal Infections.

2. Cornely OA, Sprute R, Bassetti M, et al. The Lancet Infectious Diseases. 2025 — Global Guideline for the Diagnosis and Management of Candidiasis: An Initiative of the ECMM in Cooperation With ISHAM and ASM.

3. Bassetti M, Giacobbe DR, Agvald-Ohman C, et al. Intensive Care Medicine. 2024 — Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU): 2024 Consensus Definitions From ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM.

4. Denning DW. The Lancet Infectious Diseases. 2024 — Global Incidence and Mortality of Severe Fungal Disease.

5. Salmanton-Garcia J, Hoenigl M, Gangneux JP, et al. The Lancet Microbe. 2023 — The Current State of Laboratory Mycology and Access to Antifungal Treatment in Europe: A European Confederation of Medical Mycology Survey.

6. Fisher MC, Alastruey-Izquierdo A, Berman J, et al. Nature Reviews Microbiology. 2022 — Tackling the Emerging Threat of Antifungal Resistance to Human Health.

7. Salmanton-Garcia J, Nobrega de Almeida J Jr, Colombo AL. Clinical Microbiology and Infection. 2026 — Candidozyma auris (formerly Candida auris): Resistant, Long Lasting, and Everywhere.

8. Eyre DW, Sheppard AE, Madder H, et al. New England Journal of Medicine. 2018 — A Candida auris Outbreak and Its Control in an Intensive Care Setting.