Invasive fungal disease in the immunocompromised host: changing epidemiology, new antifungal therapies, and management challenges

Maddalena Giannella; Fanny Lanternier; Sarah Dellière; Andreas H Groll; Nicolas J Mueller; Ana Alastruey-Izquierdo; Monica A Slavin; ECCMID study groups on Invasive Fungal Infection and Infection in Immunocompromised Hosts

doi:10.1016/j.cmi.2024.08.006

Invasive fungal disease in the immunocompromised host: changing epidemiology, new antifungal therapies, and management challenges

Clin Microbiol Infect. 2024 Aug 12:S1198-743X(24)00386-0. doi: 10.1016/j.cmi.2024.08.006. Online ahead of print.

Authors

Maddalena Giannella¹, Fanny Lanternier², Sarah Dellière³, Andreas H Groll⁴, Nicolas J Mueller⁵, Ana Alastruey-Izquierdo⁶, Monica A Slavin⁷; ECCMID study groups on Invasive Fungal Infection and Infection in Immunocompromised Hosts

Affiliations

¹ Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy; European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts (ESCICH/ESCMID), Basel, Switzerland.
² Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland; Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris Cité University, AP-HP, Paris, France; Mycology Department, Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Paris, France.
³ Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland; Laboratoire de Parasitologie-Mycologie, AP-HP, Hôpital Saint-Louis, Paris, France; Institut Pasteur, Université Paris Cité, Immunobiology of Aspergillus, Paris, France.
⁴ Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland; Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany.
⁵ European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts (ESCICH/ESCMID), Basel, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland.
⁶ Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland; Mycology Reference Laboratory, Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
⁷ European Society of Clinical Microbiology and Infectious Diseases Study Group for Infections in Compromised Hosts (ESCICH/ESCMID), Basel, Switzerland; Department of Oncology, National Centre for Infections in Cancer, Peter MacCallum Cancer Centre and Sir Peter MacCallum, University of Melbourne, Melbourne, Victoria, Australia; Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia. Electronic address: monica.slavin@petermac.org.

PMID: 39142631
DOI: 10.1016/j.cmi.2024.08.006

Abstract

Background: Invasive fungal disease (IFD) causes morbidity and mortality in immunocompromised hosts (ICHs). Based on increasing recognition of the impact of IFD on human disease, a recent WHO priority list identified key areas of need.

Objectives: This review examines changes in the epidemiology of IFD, in particular the emergence of antifungal-resistant pathogens and the current availability of rapid diagnostic tests and antifungal treatment options.

Sources: Literature between 2000 and January 2024 regarding fungal epidemiology, diagnostic tests, antifungal resistance, emerging fungal pathogens, and novel antifungal agents in both adult and paediatric ICH were reviewed.

Content: We describe the changing epidemiology and continued burden and mortality of IFD in ICH. Furthermore, we discuss the emergence of antifungal-resistant organisms driven by new immunosuppressed populations, climate change, and antifungal exposure in the individual and environment. We highlight novel antifungal agents and how they will address current unmet needs.

Implications: The changing epidemiology and increased population at risk for IFD, lack of recognition or quantification of risks for IFD with new therapies, current gaps in the availability of rapid diagnostic tests, and the imminent availability of novel antifungals with distinct spectra of activity argue for improved availability of and access to rapid diagnostics, antifungal stewardship programmes, and global access to antifungal agents.

Keywords: Antifungal resistance; Aspergillosis; Candidiasis; Epidemiology; Invasive fungal diseases.

Publication types

Review