15 days ago

The emergence of drug resistance fungal infection

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Fungus is found almost everywhere in our environment. They are part of our bodies too. Many fungal species naturally reside in our lungs, skin, mouth, stomach, and urinary and reproductive tracts. They play a beneficial role in maintaining our health. 

Generally, fungi do not cause disease in human beings. However, if our immune system is compromised, this could open the door to a fungal infection that can spread to multiple organs. Such an invasive infection is difficult to treat and may even cause death. 

WHO recently expressed concern that fungal infections are increasing rapidly. According to WHO Assistant Director-General of Antimicrobial Resistance, Dr. Hanan Balkhy, fungal infections are rising and showing resistance to the available treatment. He called it a global public health issue. Bangladesh is also not free of this issue. 

According to a 2020 article published in Bangladesh Critical Care Journal, skin, hair, and nail infection by fungus is most commonly seen in the hospital outpatient department. Available antifungal treatments are sometimes ineffective, which may be related to the injudicious use of those drugs among the patients.

As mentioned, fungal infections, especially invasive ones, are more common in people with reduced immune function. Patients suffering from cancer, HIV/AIDs, tuberculosis, and some lung diseases are often at risk.

Organ transplanted patients receiving high doses of steroids and other drugs are also vulnerable. 

The recent COVID pandemic is also a reason for the growing fungal infection. WHO data shows a significant increase in such infections among patients treated in hospitals. 
There was even an epidemic of White Fungus infection during the pandemic in India.

Dr Om Srivastava, a Mumbai-based infectious diseases specialist, shared that he saw a lot of such patients in the ICU who were getting a high dose of steroids. In his mind, this could have precipitated the fungus to attack. 

Immunologist Dr. Arturo Casadevall from the famous Johns Hopkins University has proposed a more interesting theory of rising fungal infection. He linked this to global warming. Dr. Casadevall highlighted that fungus usually stays away from the heat. So as warm-blooded animals, humans have a natural protection against them. 

However, the gradual increase in the planet’s temperature is causing a natural selection among the fungal species, leading to the growth of species with heat tolerance. His theory proposes this as one of the factors promoting fungal infections. 

The diagnosis of fungal infections may be challenging. This is because rapid and sensitive diagnostic tools for them are not widely available. And due to the high cost involved may not be affordable to everyone. 

The treatment options are limited, too, as the doctors can use only three groups of antibiotics against them. 

However, recent experiences reveal that these drugs are gradually losing their effectiveness against common fungal infections. This increases the risk of more serious and widespread fungal infection in the population. 

But why is treatment so limited? It is because the pathogenic fungus is usually less well understood. 

Another problem is the high risk of severe side effects. It is because many antifungal drugs also rampantly kill human cells. Casedevall said that we have very little idea of how the fungal ecosystem works. If the current resistance trend persists, we may expect a more pathogenic and easily transmissible species in the future. 

To minimise resistance, the right drug should be chosen following susceptibility testing, and proper dosing has to be ensured. 

Patients must also follow the prescription and complete the course as indicated unless otherwise advised by the physician. Sometimes, the doctor may suggest a combination of antifungal treatments, which is another way of beating the resistance. 
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