Authors: Martha Powell, Future Science Group
Think Fungus: Fungal Awareness Week is an annual event from the Centers for Disease Control and Prevention (CDC; GA, USA), aiming to highlight the importance of recognizing serious fungal diseases for both patients and providers.
In line with this we hosted a Twitter chat (#TalkFungi) on 2 October where we questioned Ilan Schwartz (Assistant Professor at the University of Alberta, Edmonton, Canada), Andrej Spec (Assistant Professor of Medicine at the Washington University School of Medicine in St. Louis, MO, USA), Rebecca Drummond (Group Leader in Fungal Immunology, University of Birmingham, UK) and Jessie Uehling (Postdoctoral researcher, University of California at Berkley and UC San Francisco, CA, USA) about all things fungi.
The experts dedicated an hour of their time to answering questions and we were also joined by the CDC’s Mycotic Diseases Branch and several other contributors, hopefully making some noise about fungal infections. We take a look at some of the highlights below:
A neglected burden?
Many of our panelists highlighted the burden of fungal diseases, how many infections fungi cause globally and the concern this raises. They also highlighted that fungal disease are often overlooked, and posed some suggestions as to why this could be the case.
A3. Recent estimates suggest that more than 200 million people suffer from a fungal infection every year. Most of these are skin and mucosal infections including thrush, ringworm and dandruff. #TalkFungi https://t.co/SICyLzUU25
— Rebecca Drummond (@theRAD__lab) October 2, 2018
A3: The burden is huge. Cryptococcus alone kills over 200,000 people worldwide. Fungi now kill more people than malaria or tuberculosis. What is most concerning, is that unlike most other infections, the numbers do not seem to be declining. #TalkFungi https://t.co/fSSttE4nO6
— Andrej Spec, MD, MSCI (@FungalDoc) October 2, 2018
A3: Fungal diseases range from relatively minor to deadly and can be difficult to diagnose. CDC report shows they cost over $7 billion per year. https://t.co/bwbSuUnOK8 #FungalWeek #TalkFungi
— CDC Emerging Infections (@CDC_NCEZID) October 2, 2018
A3. A graph of the numbers of people who die from fungal diseases each year shows that nearly the same number of people die from fungal infection as for TB. Read the article by @BallouLab and see that stats here https://t.co/bDTrceW6I2 #TalkFungi https://t.co/SICyLzUU25
— Rebecca Drummond (@theRAD__lab) October 2, 2018
Candida auris – an emerging threat?
Candida auris was one topic that was highlighted a lot during the hour as an emerging threat, particularly in healthcare settings. The panel not only highlighted the issues surrounding this fungi but also offered some stark warnings.
A9: Candida auris is behaving like no other fungi ever has. Large scale, world wide emergence; difficulty in eradication; high mortality rates, all combined are truly scary.
This is the organism that keeps your hospital epidemiologist up at night. #TalkFungi https://t.co/HbLh2NeX4u
— Andrej Spec, MD, MSCI (@FungalDoc) October 2, 2018
A5 (cont): #CandidaAuris is a nightmare germ from an infection prevention and control perspective. It spreads from person 2 person in the hospital, persists in the hosp environment and is resistant to standard disinfectants, and is frequently resistant to antifungals #talkfungi
— Ilan Schwartz MD PhD ??? (@GermHunterMD) October 2, 2018
A5. Yes. Candida auris is a real threat that can be spread through contact. This is a real disaster for any hospital or healthcare facility. We need to be able to identify these cases rapidly and institute appropriate contact precautions when isolated. #TalkFungi
— Melissa Johnson (@IDPharmacist) October 2, 2018
A9: Report describes importance of strengthening infection control in healthcare facilities to stop the spread of outbreaks caused by emerging fungus Candida auris. #FungalWeek #TalkFungi https://t.co/HraHTSQ7A8
— CDC Emerging Infections (@CDC_NCEZID) October 2, 2018
Insects, animals and agriculture
Insects and animals were highlighted in the chat as the experts drew attention to many of the fungal diseases that can also affect other creatures – in some cases perhaps even leading to extinctions. Moving from animals to plants, we also discussed the use of antifungals in agriculture and how important responsible use is for preventing antifungal drug resistance.
A7. Yes, other mammals can become infected by Coccidioides; including dogs, cats, cattle, sheep, pigs, llamas, dolphins, rodents, and armadillos #TalkFungi for more details see https://t.co/FlchgWyG6A
— Jessie Uehling (@JessieUehling) October 2, 2018
A7: On a global ecological scale, the most important fungal diseases of animals are chytridiomycosis, which threatens to wipe out amphibian populations (see https://t.co/gsWUyW3m25 by @fisher_mat and @fisher_lab ) and the white-nose fungus threatening bat populations #TalkFungi https://t.co/FNLzqxIYku
— Ilan Schwartz MD PhD ??? (@GermHunterMD) October 2, 2018
A7. Insects are also susceptible to fungal infection. The cordyceps fungus takes over insect brains to move the insect to conditions that the fungus favours. Read more about the ‘zombie fungus’ in this article by @edyong209 https://t.co/lwyl9mtCzY. #TalkFungi https://t.co/Dy3TZXvAmo
— Rebecca Drummond (@theRAD__lab) October 2, 2018
A7: Ringworm is a common fungal infection that can spread between animals and people. Wash your hands after touching pets or other animals. #FungalWeek #TalkFungi pic.twitter.com/mf6PNM8qAR
— CDC Emerging Infections (@CDC_NCEZID) October 2, 2018
A7. Fungi may even have contributed towards the rise of mammals and the end of the dinosaur age – read more about this theory from @ACasadevall1 at this link: https://t.co/xVvzrOmb8K#TalkFungi https://t.co/Dy3TZXvAmo
— Rebecca Drummond (@theRAD__lab) October 2, 2018
A8. This is a pressing public health concern. The use of azole like antifungals in agriculture is driving up rates of azole resistance. We are seeing patients with resistant fungi at an unprecedented rate. #TalkFungi https://t.co/QXSpOyCOUJ
— Andrej Spec, MD, MSCI (@FungalDoc) October 2, 2018
A8. Its important to use antifungals responsibly in agricultural settings, since soil dwelling fungi like Coccidioides are present near crops, creating the potential for resistance to antifungals that are also used to treat humans (for instance to the azoles) #TalkFungi
— Jessie Uehling (@JessieUehling) October 2, 2018
A8: The agricultural use of triazole antifungals for crop production is at a tipping pt. ⬆️ use is linked to resistant #Aspergillus fumigatus disease in patients, best reported in Netherlands (see https://t.co/qA7Q9QtpP3), and now in the USA (https://t.co/VXhvyITsms) #TalkFungi https://t.co/7VDBaldrLN
— Ilan Schwartz MD PhD ??? (@GermHunterMD) October 2, 2018
Dispelling myths
The panel also took the opportunity to dispel some commonly held beliefs about fungal infections – from sugar consumption to contagion.
A4. @theRAD__lab is right, for example, Coccidioides (Valley Fever) is not spread from person to person #TalkFungi
— Jessie Uehling (@JessieUehling) October 2, 2018
A4. Eating lots of sugar will not lead to a vaginal yeast infection, and treating it with yoghurt is unlikely to work. @DrJenGunter #TalkFungihttps://t.co/7tO4BedOC7 https://t.co/gI7T5SXX9D
— Rebecca Drummond (@theRAD__lab) October 2, 2018
Future research
We also asked what research would be necessary in the future to better understand fungal infections, the answers ranged from better diagnostics and therapies to vaccine development.
Fungal infections can look like those caused by bacteria and viruses. Healthcare providers often don’t consider fungal causes of infection. Many of the diagnostic tests are not widely available and take longer to get a result. Faster tests are needed. #ThinkFungus #TalkFungi
— CDC Emerging Infections (@CDC_NCEZID) October 2, 2018
A10. We need to understand more about how fungi respond to immune cells and how fungi evade detection so we can find holes in their defenses and design better therapies for these diseases. #TalkFungi https://t.co/vELvodQKAU
— Rebecca Drummond (@theRAD__lab) October 2, 2018
A10 The desperate need for Valley Fever is to develop a vaccine (efforts are underway) and identify targets for novel antifungals. In Coccidioides, this means research in a BioSafety Level 3 lab so that researchers do not become infected during study #TalkFungi
— Jessie Uehling (@JessieUehling) October 2, 2018
A10: Need to better understand where certain fungi live in the environment and how to reduce people’s contact with harmful fungi. #TalkFungi
— CDC Emerging Infections (@CDC_NCEZID) October 2, 2018
Accelerating awareness
Finally, the need for awareness of fungal diseases was highlighted. Both for practitioners to ‘think fungus’ on diagnosis, but also more broadly in terms of reducing burden in vulnerable populations and in ensuring funding for research.
Thank you again to our panelists for giving up their time to advocate for fungal diseases – we had some fantastic, varied perspectives highlighting the ubiquity of fungi and some of the challenges in the field. Hopefully #TalkFungi has been one step in raising much-needed awareness and we are hopeful for more action, funding and research for these diseases in the future.
A13. Better reporting on the incidence of fungal infections is needed to understand the impact of fungal diseases on human health and enhance awareness among clinicians and patients. #talkfungi https://t.co/byI1qPAxsV
— Rebecca Drummond (@theRAD__lab) October 2, 2018
A13: The fact that patients, doctors and public health officials think fungi are rare. They are common, and affect many people. Cocci is ~25% of the community acquired pneumonia in the endemic regions. We need more people to understand the seriousness and the impact. #TalkFungi https://t.co/7gmLNx7Hbn
— Andrej Spec, MD, MSCI (@FungalDoc) October 2, 2018
But we are shackled with the term “rare disease.” Funding is limited for research because people think they do not impact enough people. But that no longer true, and the patient doesn’t care how rare the disease is that they are dying of. #talkfungi https://t.co/OLZTsuADA7
— Andrej Spec, MD, MSCI (@FungalDoc) October 2, 2018
A13: Many people who suffer from fungal diseases live in areas with limited resources for diagnostic tests and treatment. Learn what CDC is doing to improve access around the world. https://t.co/R56ywHN2nO #TalkFungi pic.twitter.com/r7AwXZ61r3
— CDC Emerging Infections (@CDC_NCEZID) October 2, 2018
But without question the world’s most vulnerable, in resource limited settings often with high burdens of HIV and malnutrition etc, are most affected by fungal disease #TalkFungi
— Ilan Schwartz MD PhD ??? (@GermHunterMD) October 2, 2018
A13. Agreed! Training more mycologists and making funds for mycological research available will expedite progress to better understanding fungal diseases #TalkFungi
— Jessie Uehling (@JessieUehling) October 2, 2018
A13: We need buy in from a wide range of partners including academia, funders, and governments to ensure the most vulnerable people have access to life-saving diagnostics and treatments for fungal diseases, which r too often overlooked as causes of disability and death #talkfungi https://t.co/uQnZ2ZTvuy
— Ilan Schwartz MD PhD ??? (@GermHunterMD) October 2, 2018
#Truth. But we have started to organize through the @MSG_ERC and @eurconfmedmycol and we will continue to work hard to make lives of patients with these diseases better. #TalkFungi https://t.co/XW4JMFnCVZ
— Andrej Spec, MD, MSCI (@FungalDoc) October 2, 2018
