A recent study carried out by the Manchester Fungal Infection Group at the University of Manchester, and published in Lancet Infectious Diseases, has revealed that global deaths from fungal disease have nearly doubled in a decade and that approximately 3.8 million deaths annually may be attributed to fungal infections, compared to approximately 2 million deaths in 2012. This figure represents approximately 6.8% of total global deaths. In response to this public health threat, a greater emphasis on awareness, diagnostics and novel pipeline products for fungal infections is urgently needed.

The publication highlights the disease burden of two pathogens in particular, aspergillus and candida, which are responsible for millions of deaths each year. These fungi coincide with the World Health Organisation fungal priority pathogens list, which categorises candida auris, candida albicans, and aspergillus fumigatus as critical priority pathogens; candida glabrata, candida parapsilosis and candida tropicalis as high-priority pathogens; and candida krusei as a medium priority pathogen.

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Misdiagnoses or late diagnoses contribute to millions of deaths

Fungal infections are particularly opportunistic in individuals with asthma, tuberculosis, lung cancer, leukaemia and AIDS, as well as in those who have had an organ transplant or who are in intensive care. Misdiagnoses or untimely diagnoses of fungal infections contribute to millions of deaths each year, fuelled by a lack of awareness from healthcare professionals and the absence of widespread diagnostic testing. Currently available tests that rely on fungal cultures can only identify about one-third of people who have a fungal infection. Current blood culture tests only identify approximately 40% of life-threatening candida infections.

The major obstacles in the disease management of fungal infections include insufficient awareness, inadequate diagnostic measures and a lack of effective antifungal drugs. This is then compounded by antifungal resistance, which is a growing concern that is due, in part, to the use of fungicides in the environment. This is particularly the case for aspergillus infections. As aspergillus becomes exposed to azole fungicides in the environment, resistant microbes can survive, multiply and infect vulnerable individuals. Similarly, aspergillus can become resistant if a patient with a chronic fungal infection takes an azole antifungal over a long period. As aspergillus becomes exposed to azole antibiotics in the body, the fungus can become resistant to the medication and multiply.

Top priority to decrease global deaths

Antifungal-resistant infections are difficult to treat and can be life-threatening. According to the US Centers for Disease Control and Prevention, individuals infected with azole-resistant aspergillus fumigatus infections are up to 33% more likely to die from the infection compared to patients who can be treated with azoles.

According to GlobalData, there are 18 products in active clinical development against candida infections and 14 products in active clinical development against aspergillus infections. Of these 32 products, one is a prophylactic vaccine: LimmaTech Biologics’s Candi-5V. Candi-5V is a pentavalent biconjugate vaccine candidate in Phase I/II testing (NCT06190509) for women with recurrent vulvovaginal candidiasis, an infection typically caused by the critical priority pathogen, candida albicans. Currently, there are no approved vaccines on the market for any fungal infections. Despite this and the high level of unmet need surrounding fungal infections, the product development pipeline displays limited novel therapies. This should remain a top priority to decrease global deaths from fungal disease, in addition to increased awareness and widespread diagnostic tools.