The hidden threat: Unveiling the rise of antifungal drug resistance

Abstract

Fungal pathogens are increasingly recognized as a significant threat to global health, particularly for individuals with weakened immune systems, such as those with cancer or HIV/AIDS. Current antifungal treatments are limited and the development of new therapies has been slow due to the similarities between fungi and humans, limiting drug target options. The rise of drug-resistant strains, has led health organizations to classify antifungal resistance (AFR) as a critical global issue. AFR can develop through various mechanisms including change in drug target, enhanced activity of efflux pumps, and activation of cellular stress response, all of which reduce the effectiveness of standard antifungal therapies. This resistance develop either during antifungal treatment as a result of genetic mutations or through environmental exposure, especially in agriculture where azole based fungicides are extensively used. Despite its rising impact on global health, AFR has not received the same attention as bacterial resistance, highlighting the need for more effective surveillance and control measures. This review discusses the molecular and environmental factors contributing to AFR and highlights various strategies to combat it, such as use of combination therapies, targeting fungal virulence factors and advancements in diagnostic and surveillance system. In addition, the development of novel antifungal drugs, evaluation of immune-based therapies, better education, and training of healthcare professional are vital for effectively managing and mitigating AFR.