The World Health Organization (WHO) has issued a comprehensive guide to help nations combat the escalating threat of fungal infections and the growing problem of antifungal resistance. This newly released document offers a strategic framework for bolstering both national and regional efforts against fungal diseases, which impact over 300 million individuals annually but often go unrecognized, misdiagnosed, and inadequately managed.
While common fungal infections like ringworm are generally treatable, the primary concern lies with invasive fungal infections. These are caused by fungal strains that have developed significant resistance to the limited available antifungal medications, leading to high mortality rates.
This guide is part of the WHO’s continuing commitment to address a threat that is amplified by factors such as climate change, increased international travel, and the widespread application of antifungal pesticides in agriculture. In 2022, the organization first identified 19 fungal "priority pathogens" that pose significant public health risks and warrant focused research for new treatments and diagnostic tools.
The framework emphasizes four key areas for countries to concentrate on: enhancing awareness, preparedness, and response to fungal diseases; improving equitable access to antifungal medicines and diagnostic tools, alongside advancing research for new solutions; establishing laboratory networks and surveillance systems to monitor and detect fungal infections; and addressing the broader social, agricultural, and environmental influences contributing to fungal diseases and resistance.
The WHO intends for policymakers to integrate this blueprint into their national health strategies and their approaches to tackling antimicrobial resistance (AMR).
"Fungal disease and antifungal resistance remain under-addressed priorities across national health plans, AMR strategies, and surveillance systems. This Blueprint provides countries with a practical framework to strengthen their response," stated Hatim Sati, a technical officer in the Department of Antimicrobial Resistance at WHO.
CDC Report Highlights Rise in Candida auris Cases
Candida auris, a yeast that exhibits multidrug resistance, is a particular focus of concern for the WHO. First detected in 2009, it has since spread globally, particularly within healthcare settings. Invasive C. auris infections are highly challenging to treat, with resistance to all major antifungal drug classes observed in some instances. These infections carry a high fatality rate, ranging from 29% to 62%, and often affect critically ill patients with weakened immune systems who require complex medical care.
While C. auris can colonize the skin of severely ill hospital patients without always causing symptoms, it can lead to severe and potentially fatal illness when it enters the bloodstream or urinary tract.
A recent surveillance study by the US Centers for Disease Control and Prevention (CDC) and state public health departments, published in the Morbidity and Mortality Weekly Report, has documented a significant increase in C. auris cases in US hospitals. The study reported over 13,500 clinical C. auris cases over a three-year period, with a steady rise from 2,882 in 2022 to 4,428 in 2023 and 6,197 in 2024.
The majority of these cases (87.8%) occurred in patients aged 45 and older, primarily in acute care hospitals (76.6%) and long-term acute care facilities (17.8%), which tend to serve the most vulnerable patients. Urine (31.5%) and blood (30.2%) were the most common specimen types.
The initial C. auris case in the US was identified in 2016, with early instances linked to healthcare exposures abroad. However, recent cases are increasingly being acquired within US hospitals. Authors of the study noted that C. auris has become endemic in certain regions, leading to persistent high transmission rates and growing prevalence across healthcare facilities. They emphasized the ongoing transmission within healthcare settings and the critical importance of infection prevention and control measures, supported by federal, state, and local public health partners to curb further spread.
Broader Fungal Threats and Consequences
Beyond C. auris, other fungi of global concern include additional Candida species (Candida albicans and Candida glabrata), Aspergillus fumigatus (an environmental mold that can cause severe lung infections, posing a particular risk to individuals with cystic fibrosis), and Cryptococcus neoformans (a fungus found in the environment that can cause serious lung and brain infections upon inhalation).
The WHO highlights that even non-fatal fungal infections can result in chronic, debilitating illnesses with long-term social and economic repercussions. These burdens disproportionately affect individuals with compromised immune systems, such as those with HIV, cancer patients, transplant recipients, and individuals with chronic lung disease or trauma. However, the impact extends beyond these groups.
Even in individuals with healthy immune systems, fungal diseases can lead to severe outcomes due to delayed diagnoses, limited access to antifungal treatments, the rise of antifungal resistance (AFR), and the increased use of therapies that suppress or alter immune function, the WHO report indicates.
Low- and middle-income countries (LMICs) face heightened risks, as factors like poverty, overcrowding, and inadequate housing exacerbate vulnerability and facilitate the spread of pathogenic fungi. Patients in LMICs also experience greater challenges in accessing appropriate diagnostics and treatments.