The silent invaders: Why invasive fungal infections are the next big threat

New Delhi: Invasive fungal infections (IFIs) are a serious global health threat, occurring in about 6.5 million individuals each year and an estimated 3.8 million deaths, about 2.5 million of whom die directly because of the infection. While, life-threatening systemic IFIs carry a huge burden, opportunistic fungal infections such as Candida, Aspergillus, and Cryptococcus often go unnoticed until it's too late. These infections are becoming more prominent due to factors such as climate change, increased usage of immunosuppressive treatment, and the onset of antifungal resistance.

Dr. Anivita Aggarwal, Associate Consultant, Infectious Diseases, Sir Ganga Ram Hospital, Delhi, answered this for TV9 English.

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India carries a high proportion of the world's serious fungal disease burden. A systematic review of 434 studies estimated that almost 60 million Indians (4.1% of all Indians) are suffering from serious fungal infections. This number includes a very wide range of conditions, including long-standing, recurrent, and severe superficial infection—such as recurrent vaginal candidiasis—whereas life-threatening invasive fungal infections (e.g., mucormycosis, aspergillosis, cryptococcosis, and candidemia) account for a very small fraction of these numbers.

One of the most feared IFIs is mucormycosis, a common term for "black fungus." The estimated cases of mucormycosis in India each year are approximately 195,000. This infection has also been notably widespread during the COVID-19 pandemic, particularly in diabetic patients and those receiving immunosuppressive therapy.

The Global Threat: Candida auris

Candida auris is a newly emerged fungal pathogen of serious concern in healthcare. Though it may colonize the skin or mucous membranes without producing disease, it is also responsible for causing life-threatening invasive infections, including bloodstream infections (candidemia), especially in immunocompromised persons. C. auris, which is indicated by the World Health Organization as an important pathogen frequently develops resistance to several antifungal agents and disinfectants, and, therefore, hospital and long-term care facility outbreaks are challenging to manage.

Climate Change: A major cause

Climate change is worsening fungal infections by supporting their onset and transmission. Candida auris has a climate-adapted evolution to increased heat. Allergenic factors such as dust, air pollution, agriculture, and increasing immunosuppression heighten exposure to spores, while underdiagnosed infections like aspergillosis kill an estimated 340,000 individuals each year.

The Human and Healthcare Impact

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Invasive fungal infections pose not just individual health risks, but also a burden to healthcare systems. Prolonged hospital stays, expensive antifungal treatment, and intensive care needs become an economic drain on patients and hospitals. Additionally, delayed or missed diagnoses can lead to systemic spread, respiratory failure, sepsis, and high mortality. High-risk groups, including diabetes, cancer, or immunocompromised patients, are disproportionately represented. Especially, solid organ or stem cell transplant patients experience greater risks of infections. To sustain tolerance and avoid rejection, recipients of transplants are treated long-term with immunosuppressant drugs such as corticosteroids, calcineurin inhibitors, or biologics. Although these medications are lifesaving, they also compromise the body's natural defense systems, leaving patients susceptible to opportunistic fungal infections, emphasising the need for increased surveillance in risk populations.

Invasive fungal infections are silent killers with risky consequences for public health and the healthcare system. Awareness of their increasing prevalence, knowledge of the risk factors, and enhanced clinical vigilance are critical measures towards deterring their effects before they become an epidemic crisis.