Clinical Scorecard: Addressing Research Deficiencies in Emerging Fungal Infections: Awareness is No Longer the Limiting Factor

At a Glance

Key Highlights

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

• Emerging fungi such as Trichophyton indotineae and Sporothrix brasiliensis illustrate changing patterns of antifungal resistance, zoonotic transmission, and geographic spread.

• Candida auris can colonize skin, persist on surfaces, tolerate routine cleaning, and spread between hospitals with patients.

• Echinocandin resistance is being reported more often, and the author notes that empirical treatment choices are safer when guided by local epidemiology and susceptibility data.

• Expanded case definitions have been developed because invasive fungal disease now occurs in patient populations beyond the classical neutropenic population, including patients with influenza, COVID-19, and critical illness.

Guideline-Based Recommendations

The source is an editorial rather than a clinical guideline. The following reflects recommendations, guidance, and priorities discussed by the author and cited organizations.

Diagnosis

• Use appropriate contemporary case definitions for invasive fungal disease, including definitions developed for patients outside traditional hematology populations.

• Improve access to fungal diagnostics, including galactomannan, beta-D-glucan, fungal polymerase chain reaction, mass spectrometry identification, and susceptibility testing.

Management

• In C. auris outbreaks, screening and isolation capacity are emphasized as important components of containment.

• Empirical antifungal choices should be informed by local epidemiology and susceptibility patterns because resistance and species distributions vary substantially between regions and countries.

Monitoring & Follow-up

• Incorporate fungal diseases and antifungal resistance into existing notifiable-disease and antimicrobial resistance surveillance systems to improve case counting.

• Strengthen local and national surveillance of antifungal resistance and fungal epidemiology to better guide clinical decisions.

Risks

• Bruton tyrosine kinase inhibitors, other small-molecule kinase inhibitors, chimeric antigen receptor T cells, bispecific antibodies, and broader use of biologics have expanded the population at risk for invasive fungal disease.

• Older patients and those with multiple chronic conditions, including cirrhosis, chronic obstructive pulmonary disease, diabetes, and dialysis, increasingly appear among populations at risk.

Patient & Prescribing Data

The editorial discusses a broad range of patients at risk for invasive fungal disease, including individuals receiving immunomodulatory and hematologic therapies, critically ill patients, people with advanced HIV disease, and older patients with multiple chronic illnesses.

Antifungal treatment choices should take local epidemiology and susceptibility patterns into account, particularly as echinocandin and azole resistance continue to emerge.

Clinical Best Practices

• Strengthen fungal surveillance and incorporate fungal pathogens into existing infectious disease and antimicrobial resistance monitoring systems.

• Expand access to essential fungal diagnostic testing in hospitals caring for immunocompromised or critically ill patients.

• Improve clinical trial infrastructure and specialist workforce capacity so that patients with the highest mortality risks are better represented and expert guidance can be implemented effectively.

Related Resources & Content

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

• 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.

• 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.

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

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