The Quiet and Underappreciated Rise of Drug-Resistant Invasive Fungal Pathogens

Human fungal pathogens are attributable to a significant economic burden and mortality worldwide. Antifungal treatments, although limited in number, play a pivotal role in decreasing mortality and morbidities posed by invasive fungal infections (IFIs). However, the recent emergence of multidrug-resi...

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Bibliographic Details
Main Authors: Amir Arastehfar, Cornelia Lass-Flörl, Rocio Garcia-Rubio, Farnaz Daneshnia, Macit Ilkit, Teun Boekhout, Toni Gabaldon, David S. Perlin
Format: Article
Language:English
Published: MDPI AG 2020-08-01
Series:Journal of Fungi
Subjects:
Online Access:https://www.mdpi.com/2309-608X/6/3/138
Description
Summary:Human fungal pathogens are attributable to a significant economic burden and mortality worldwide. Antifungal treatments, although limited in number, play a pivotal role in decreasing mortality and morbidities posed by invasive fungal infections (IFIs). However, the recent emergence of multidrug-resistant <i>Candida auris</i> and <i>Candida glabrata</i> and acquiring invasive infections due to azole-resistant <i>C. parapsilosis</i>, <i>C. tropicalis</i>, and <i>Aspergillus</i> spp. in azole-naïve patients pose a serious health threat considering the limited number of systemic antifungals available to treat IFIs. Although advancing for major fungal pathogens, the understanding of fungal attributes contributing to antifungal resistance is just emerging for several clinically important MDR fungal pathogens. Further complicating the matter are the distinct differences in antifungal resistance mechanisms among various fungal species in which one or more mechanisms may contribute to the resistance phenotype. In this review, we attempt to summarize the burden of antifungal resistance for selected non-<i>albicans</i><i>Candida</i> and clinically important <i>Aspergillus</i> species together with their phylogenetic placement on the tree of life. Moreover, we highlight the different molecular mechanisms between antifungal tolerance and resistance, and comprehensively discuss the molecular mechanisms of antifungal resistance in a species level.
ISSN:2309-608X