The black list of fungi that make us sick: why are they so dangerous?

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Infectious diseases are still among the leading causes of mortality; mainly in low-income countries, where they account for six of the ten leading causes of death. However, its overall incidence has been decreasing in recent years. And although the latter is true for diseases caused by bacteria and viruses (leaving aside the exceptional situation of the covid-19 pandemic), unfortunately it does not occur with invasive fungal diseases (IFD). Global cases of EFI are increasing, especially among people with some form of immune deficiency. The appearance of new pathogens, the increase in resistance, and the lack of antifungal drugs have made ILDs candidates for causing silent health crises in the future. The threat is in the air Fungi form a group of highly dangerous microorganisms as pathogens for the following reasons. Related News standard No The WHO warns: these are the 19 most dangerous fungi for humans and the diseases that cause PD standard Yes ‘Conan’, the ‘invincible’ bacterium that could survive 280 million years in the subsoil of Mars Patricia Biosca Structurally, they are more similar to animals than bacteria or viruses. That’s why it’s so hard to find antifungal magic bullets that cause limited side effects on patients. They can be spread through microscopic airborne spores: up to 50,000 per cubic meter have been detected. If we take into account that we breathe around 8,000 liters of air a day, we could come into contact with around 50 million fungal spores every day. And that’s just considering the airways. Although our immune barriers protect us from possible fungal infections, the increase in people with weakened defenses for various reasons means that the population susceptible to fungal infections is growing. WHO Priority Fungal Pathogen List To address the threat of IFD-causing fungi, the World Health Organization (WHO) has recently published the Priority Fungal Pathogen List (PPPL), developed through a multi-year international cooperative process. . This list completes a previous effort aimed at drawing up the List of Priority Pathogenic Bacteria, made public in 2017. The LHPP has focused on pathogens that cause invasive, acute or subacute infections, in which health threats due to to the increase in resistance to antifungal drugs or to other types of treatments. The purpose of the WHO in developing the LHPP is to focus diagnostic and surveillance efforts on these pathogens, stimulate research, development, and innovation in the treatment of the diseases they cause, and stimulate the design of public health intervention measures. The LHPP is divided into three sections: Critical group. Here are the most damaging pathogens: Cryptococcus neoformans, Candida auris, Aspergillus fumigatus, and C. albicans. High priority group. This category includes C. glabrata, Histoplasma spp., the causative agents of skin diseases called eumycetomas, Mucorales, Fusarium spp., C. tropicalis and C. parapsilosis. Medium priority group. It is that of Scedosporium spp., Lomentotospora prolificans, Coccidioides spp., C. krusei, Crypococcus gattii, Talaromyces marneffei, Pneumocystis jirovecii and Paracoccidioides. Causes of epidemics, opportunistic, emerging… Some of these microorganisms can give rise to epidemic outbreaks, as occurs with Histoplasma or C. auris. Others are opportunistic that infect special risk groups (patients with HIV infection, for example). Although treatments are available, they do not prevent high mortality and are not affordable in low-income countries. Additionally, certain fungi can be considered emerging pathogens. This is the case of the aforementioned C. auris, which is resistant to most antifungals, high temperatures and the most common disinfectants. And finally, there are globally distributed pathogens, such as Fusarium , that exhibit innate resistance to most available fungicides. The development of the list has revealed that the increased threat caused by IDF is due to the increase in resistance to antifungals, diagnostic limitations and lack of access to treatment measures, especially in lower-income countries. . The problem of resistance to antifungals can be framed within the generalized increase in resistance to antibiotics worldwide. In addition, in the case of antifungals, the situation is aggravated for two reasons. On the one hand, the number of families of this type of drugs is very limited. There are only four types of so-called systemics (azoles, echinocandins, pyrimidines, and polyenes) whose administration requires experience and pharmacological surveillance for interactions that is not always possible. On the other hand, the massive use of azoles in agriculture facilitates the appearance of resistance that disables the use of these compounds. Objective: to improve treatment and diagnosis There is therefore an urgent need to investigate more in the development of new chemotherapeutic compounds to treat IFD and to regulate their use in applications other than clinical practice. This is the only way to prevent the appearance of resistance, especially in species with a wide distribution or capable of causing epidemic outbreaks. Additionally, the limitations of the diagnosis of EFIs constitute another relevant factor when addressing the problem. Often, the symptoms of these infections are atypical, diagnostic tests have low sensitivity or specificity, and the time required to make a diagnosis is too long, which prevents effective treatment in the initial stages of infection. Desktop code Image for mobile, amp and app Mobile code AMP code APP code Once again, as in the case of antifungals, it is necessary to promote research for the development of new faster and safer diagnostic systems and a training effort. Pathogenic fungi that cause systemic infections are a growing danger and cause for concern in public health and hospital settings, not only in low-income countries, but throughout the world. The List of Priority Pathogenic Fungi is a call to action to organize research, development and control measures against the diseases they cause. This article was originally published on The Conversation. ABOUT THE AUTHOR Antonio G. Pisabarro and Denisse Patricia Rivera de la Torre Antonio G. Pisabarro is Professor of Microbiology, Department of Health Sciences, Institute for Multidisciplinary Research in Applied Biology, Public University of Navarra. Denisse Patricia Rivera de la Torre is a Professor of Public Health and Epidemiology at the University of Sonora, Universidad de Sonora.

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