Millions of fatalities worldwide: fungal diseases – an underestimated danger

About 1.7 million people die from fungal infections worldwide every year. Symptoms are often not properly identified. In addition, like bacteria, more and more fungi are developing resistance.

By Yasmin Appelhans, NDR

Bernhard Hube has no understanding that his field of research is so unknown. He is Professor of Microbiology at the Leibniz Institute for Natural Product Research and Infection Biology in Jena. He researches microscopic fungi that can infect people: “The fact is that fungi kill as many people a year as tuberculosis and even more than malaria. This fact is simply neglected.”

Fungal infections kill an estimated 1.7 million people worldwide each year. For comparison: Depending on the estimate, malaria kills between 400,000 and 600,000 people.

Disease often goes undetected

Adilia Warris is Professor of Pediatric Infectious Diseases at the University of Exeter in England and also specializes in fungal infections. These can affect adults and children alike, she says. The fact that little is said about them, despite their widespread distribution, has to do with who the fungi infect, she believes. Because unlike bacterial or viral infections, not the entire population is at risk. “Fungal diseases only affect people who are already weak or susceptible with other diseases. I think that’s one reason. Another is that fungal diseases are a problem mostly in low- and middle-income countries.”

Because the diagnosis options there are even worse than in richer countries. But here in Germany, for example, treatment is often given too late. What is also due to the symptoms of the fungal infections, says the microbiologist Hube: “These are not clear symptoms. The patients have a fever, then the doctor uses antibiotics and that could even make the problem worse.”

Because the antibiotics can then also kill helpful bacteria that contain the fungal infection. “And when the doctor then realizes: ‘Oh, that’s not a bacterium, that’s a fungus’, then it can often be too late.”

Fungi develop resistance

In addition to diagnostic problems, another problem has arisen in the last ten to twenty years. There are a growing number of fungal species that are resistant to all approved drugs, Warris said. “A fungus can be resistant to certain drugs simply because of its species. However, what is becoming more of a problem is the resistance that develops because fungi are exposed to anti-fungal drugs. Then, in turn, the fungus has the ability to fight against to become resistant to the antifungal drug.”

These so-called acquired resistances arise in two main places: in immunocompromised patients and in agriculture. In Germany, too, fields are sprayed with agents that are also used in humans as medicines against fungi. This is to prevent the harvest from rotting. At the same time, however, resistant species of fungi are emerging and are being spread all over the world, for example on tulip bulbs.

strengthen your immune system

Both researchers therefore advocate that agents against fungi in agriculture should only be used to a limited extent. This applies in particular to new active ingredients that are only just being developed.

Hube is also researching such new active ingredients. And other methods to deal with resistance. For example, to strengthen the patient’s immune system so that they can fight off the fungal infections themselves. “There would also be the possibility of not basically killing the fungus, but weakening it so that it becomes harmless. The risk of resistance developing would also be much lower.”