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

Arastehfar A., Lass-Floerl C., Garcia-Rubio R., Daneshnia F., Ilkit M. M., Boekhout T., ...More

JOURNAL OF FUNGI, vol.6, no.3, 2020 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 6 Issue: 3
  • Publication Date: 2020
  • Doi Number: 10.3390/jof6030138
  • Journal Name: JOURNAL OF FUNGI
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Directory of Open Access Journals
  • Keywords: Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida auris, Aspergillus terreus, Aspergillus fumigatus, antifungal resistance mechanisms, POPULATION-BASED SURVEILLANCE, INFECTIOUS-DISEASES SOCIETY, AZOLE ANTIFUNGAL RESISTANCE, OF-FUNCTION MUTATIONS, CANDIDA-GLABRATA, ASPERGILLUS-FUMIGATUS, ECHINOCANDIN RESISTANCE, FKS MUTATIONS, MULTIDRUG-RESISTANCE, CLINICAL ISOLATE
  • Çukurova University Affiliated: Yes

Abstract

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-resistantCandida aurisandCandida glabrataand acquiring invasive infections due to azole-resistantC. parapsilosis,C. tropicalis, andAspergillusspp. in azole-naive 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-albicansCandidaand clinically importantAspergillusspecies 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.