Image courtesy of Norbert Nagel; CC-BY-SA 3.0.
In a world grappling with the impact of the COVID-19 pandemic, public health experts are raising concerns about another potential threat lurking on the horizon. This time, it’s not a virus but fungi that scientists are concerned might be the cause of the next pandemic.1
Fungi are a diverse group of organisms that includes molds, yeasts, and mushrooms. From athlete’s foot to serious lung infections, fungal infections are already a significant health concern.1 The Center for Disease Control and Prevention (CDC) has reported that fungal infections cause over 75,000 hospitalizations in the U.S. every year, and almost 9 million outpatient visits.2 Fungal infections are most threatening to individuals with compromised immune systems. However, recent research indicates that certain fungal strains possess the potential to become highly contagious and pose a threat to global health security.3
One such fungal pathogen, Candida auris, has been causing alarm among healthcare professionals in recent years. This multidrug-resistant fungus has proven deadly in numerous countries, spreading rapidly within healthcare facilities and causing severe infections. Candida auris is able to persist on surfaces and resist common disinfectants, making it difficult to eradicate and raising concerns of a larger outbreak.2 There are a number of other fungi that may pose a threat to public health. Some fungi, such as Aspergillus fumigatus, can cause severe lung infections. Others, like Cryptococcus neoformans, have the ability to cause deadly meningitis in both immunocompromised and healthy individuals.4
Recently an outbreak of Fungal meningitis in Mexico was caused by Fusarium solani. The CDC is currently monitoring the condition of 161 people across the U.S. who got surgeries involving epidural anesthesia at a surgical center in Mexico.5 Since June 29, 2023 there have been 9 confirmed cases, 7 deaths, 10 probable cases, and 15 suspected cases. Symptoms include fever, headache, stiff neck, nausea, and vomiting. Fortunately, fungal meningitis is not contagious.5
Disease-causing fungi have unique characteristics that make them difficult to control. Unlike viruses, which require a host to reproduce, fungi can survive and multiply in various environments, including soil, water, and air.6 The majority of fungi produce spores and release them into the air which allows them to spread quickly, making containment and control challenging. Fungal pathogens can also be spread by direct skin contact with infected humans and animals or indirectly from contaminated fomites or soil. Fungi can also adapt to a wide range of temperatures, making them resistant to extreme heat or cold.7 Their adaptability to temperature combined with global warming is concerning to scientists. Researchers at Duke University School of Medicine have found that increasing temperatures can cause pathogenic fungi to go into overdrive, increasing their disease-causing potential. As a result, fungal infections are expected to become more harmful as the planet warms.8 Travel also poses a threat because fungi or spores can attach themselves to travelers or items which facilitates the rapid spread of potentially harmful strains.9
To mitigate the looming threat, scientists and public health authorities emphasize the importance of surveillance, early detection, and enhanced infection control measures. Increased funding and research into antifungal medications, as well as the development of rapid diagnostic tools, are crucial steps in preventing a future fungal pandemic.10 Furthermore, education and awareness campaigns need to be launched to inform healthcare professionals, policymakers, and the public about the potential risks associated with fungal infections. Promoting proper hygiene practices, implementing effective disinfection protocols, and enhancing infection prevention and control measures in healthcare settings will be vital to reducing the transmission of fungal pathogens.11
The rise of fungal infections as a potential pandemic threat is a reminder of the importance of remaining vigilant and prepared. By investing in research, strengthening healthcare systems, and prioritizing global collaboration, we can strive to stay one step ahead of nature’s next surprise, ensuring the health and well-being of future generations.
Resources
1. Fungal Infections – Protect Your Health. Centers for Disease Control and Prevention https://www.cdc.gov/fungal/features/fungal-infections.html (2023).
2. Increasing Threat of Spread of Antimicrobial-resistant Fungus in Healthcare Facilities. CDC https://www.cdc.gov/media/releases/2023/p0320-cauris.html (2016).
3. Low, C.-Y. & Rotstein, C. Emerging fungal infections in immunocompromised patients. F1000 Med. Rep. 3, 14 (2011).
4. Li, Z., Lu, G. & Meng, G. Pathogenic Fungal Infection in the Lung. Front. Immunol. 10, 1524 (2019).
5. Fungal Meningitis Outbreak Associated with Procedures Performed under Epidural Anesthesia in Matamoros, Mexico | HAI | CDC. https://www.cdc.gov/hai/outbreaks/meningitis-epidural-anesthesia.html (2023).
6. Fungi | What is microbiology? | Microbiology Society. https://microbiologysociety.org/why-microbiology-matters/what-is-microbiology/fungi.html.
7. Kobayashi, G. S. Disease Mechanisms of Fungi. in Medical Microbiology (ed. Baron, S.) (University of Texas Medical Branch at Galveston, 1996).
8. Warmer Climate May Drive Fungi to Be More Dangerous to Our Health | Duke Today. https://today.duke.edu/2023/01/warmer-climate-may-drive-fungi-be-more-dangerous-our-health.
9. Ericsson, C. D. et al. Fungal Infections among Returning Travelers. Clin. Infect. Dis. 35, 1088–1095 (2002).
10. PREVENTING THE NEXT PANDEMIC: Zoonotic diseases and how to break the chain of transmission.11. Infection Prevention and Control for Candida auris | Candida auris | Fungal Diseases | CDC. https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html (2023).
