More and more people are affected
When fungal infections become fatal
By Hedviga Nyarsik
January 24, 2024, 4:38 p.m
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They live around us, on us and also in us: mushrooms. For healthy people, the unpleasant inhabitants of the body are usually not a problem. However, once the immune system is weakened, an infection can become life-threatening. A new study shows that more and more patients are dying from fungal diseases.
Fungi live in the air, soil, water and even in the human body. With every breath we ingest hundreds of spores – in addition to the large number of fungi on the skin, mucous membranes and even in the intestines. This can hardly be avoided: it is estimated that a quarter of the earth’s total biomass consists of fungi, from foot fungus to mold. This is usually harmless for healthy people because the immune system fights off the unpleasant inhabitants of the body. However, if this is weakened, a fungal infection can become life-threatening. And this danger has so far been massively underestimated, according to a new study.
How many people are affected by a fungal disease is poorly documented. Even in wealthy countries, testing options are usually lacking, are not used or do not reliably detect an infection. To shed light on the matter, infectious disease doctor and mycologist David Denning from the University of Manchester analyzed the numbers of officially diagnosed fungal infections from 2010 to 2023 from 120 countries and compared them with death rates and survival rates of treated and untreated infected people. His study was published in the journal Lancet Infectious Diseases.
The result: Around 6.5 million people worldwide become infected with a pathogenic fungus every year. Around 3.8 million people die as a result of a fungal disease. Eleven years earlier, according to Denning, there were still around two million deaths. The number of fatal fungal infections has almost doubled within a decade. “According to the data, fungi are now responsible for 6.8 percent of all deaths worldwide,” writes the study author. This means they kill six times more people than malaria and three times more than tuberculosis.
Danger from resistant fungi
Fungi are not necessarily the cause of disease, writes Denning. But according to his results, they contribute to the death of previously ill patients. Undetected fungal infections in people with lung disease are particularly critical. One of the most dangerous fungi that infect the lungs is mold Aspergillus fumigatus and Aspergillus flavus. Denning calculated that about 30 percent of those have tuberculosis or smoking-related disease Lung disease deceased are also infected with a fungus. He estimates that 1.8 million people die every year as a result of an Aspergillus infection.
Other potentially fatal pathogens include fungi of the genus Candida. “About a million people worldwide die from a Candida infection every year,” says Denning. In the bodies of seriously ill people, these common intestinal fungi overcome the intestinal wall and enter the bloodstream, where they can cause blood poisoning. “Patients with diabetes and kidney failure as well as people after major surgery are particularly often affected.”
Especially the yeast fungus, which was only discovered in 2009 Candida auris is a concern for health authorities worldwide as it has been spreading rapidly for some time. It is usually harmless to healthy people, but in immunocompromised patients, “Candida auris can cause invasive candidiasis in the blood, heart, central nervous system, eyes, bones and internal organs,” wrote the World Health Organization (WHO) in an appeal a year ago. to give the pathogen top priority. The mortality rate for the disease, in which the fungus affects internal organs, is between 29 and 53 percent. Particularly treacherous: C. auris can spread from person to person and is transmitted via smear infections and surfaces. This was previously only known from multi-resistant germs.
“Fungal infections have historically been neglected”
“We have to take mushrooms very seriously,” warns Denning in his study. It will not be possible to avoid infections in the future. “There are no vaccines against fungi and in some cases there are no effective medications,” said the expert. Similar to bacteria, fungi are also becoming increasingly resistant to common active ingredients. The use of fungicides in agriculture, among other things, contributes to this. It is therefore all the more important to provide treatment where effective medicines are available. In order to prevent spread, an accurate and timely diagnosis is urgently needed.
Tihana Bicanic, professor of infectious diseases and mycology at the St. Georges Institute at the University of London, was not surprised by Denning’s results. “Fungal infections have historically been neglected compared to the focus on bacterial infections and antibiotics,” she told the British “Telegraph”. Bicanic was not involved in the study.
At the same time, the expert warns against the excessive use of antifungals that hospitals use preventatively, for example in bone marrow transplants or to treat skin infections such as athlete’s foot. They could also contribute to the increase in resistant fungi. “Unlike antibiotics, we have about three classes of antifungals that we commonly use in patients,” she said. “All this usage puts pressure on the fungi, allowing them to adapt and become resistant – and that’s actually what’s happening now.”