Fungal Diseases in the 21st Century: The Near and Far Horizons.

Arturo Casadevall

doi:10.20411/pai.v3i2.249

Abstract

Fungal diseases became a major medical problem in the second half of the 20th century when advances in modern medicine together with the HIV epidemic resulted in large numbers of individuals with impaired immunity. Fungal diseases are difficult to manage because they tend to be chronic, hard to diagnose, and difficult to eradicate with antifungal drugs. This essay considers the future of medical mycology in the 21st century, extrapolating from current trends. In the near horizon, the prevalence of fungal diseases is likely to increase, as there will be more hosts with impaired immunity and drug resistance will inevitably increase after selection by antifungal drug use. We can expect progress in the development of new drugs, diagnostics, vaccines, and immunotherapies. In the far horizon, humanity may face new fungal diseases in association with climate change. Some current associations between chronic diseases and fungal infections could lead to the establishment of fungi as causative agents, which will greatly enhance their medical importance. All trends suggest that the importance of fungal diseases will increase in the 21st century, and enhanced human preparedness for this scourge will require more research investment in this group of infectious diseases.

Highlights

Fungal diseases became a major medical problem in the second half of the 20th century when advances in modern medicine together with the HIV epidemic resulted in large numbers of individuals with impaired immunity
This impression has arisen because fungal diseases became a major medical problem only in the second half of the 20th century with the confluence of the advances in medicine and the initiation of the HIV epidemic, which resulted in large numbers of human hosts with impaired immunity
Medical mycology can claim that it was the first discipline to establish that a microbe can cause human disease when David Gruby showed that favus was a fungal disease in mid-19th century France

Summary

AUTHOR Arturo Casadevall

AFFILIATED INSTITUTION Department of Molecular Microbiology and Immunology, The Johns Hopkins School of Public Health, Baltimore, Maryland. This essay was adapted from a lecture given in a symposium to honor the contributions of Dr Mahmoud Ghannoum at Case Western Reserve University in September 2017. Fungal Diseases in the 21st Century: The Near and Far Horizons.

THE NEAR HORIZON

Findings

THE FAR HORIZON