As the World Health Organization focuses on what universal health coverage means in 2019, we explore the global challenges and opportunities in the control of fungal infection.

Although we often think of fungal infection in a cosmetic context, only affecting aging populations and often in relation to fungal nail infection, fungal disease is a serious global public health concern.

Far from being merely cosmetic issue, fungal infection can be extremely serious and, particularly for those with compromised immune systems, life threatening. People living with HIV; cancer patients; people who are admitted to hospital; people who are critically ill after trauma or surgery; and premature babies are among those most at risk.
Fungal infections can affect anyone around the world but pose a serious threat to people with weakened immune systems, such as those who have cancer or HIV/AIDS, or who have suffered from poor diet, malnutrition or repeated illness. It is these at-risk people who often reside in economically-challenged settings, where diagnosis and treatment can be tough and fraught with complications is a global issue. Over 300 million people of all ages are estimated to suffer from a serious fungal infection. Every year over 1.66 million of these people are estimated to die.1  When compared to deaths from headline grabbing diseases such as malaria and tuberculosis, that are fatal to 0.6 million and 1.5 million respectively, it’s hard to understand why there isn’t more of a discussion surrounding fungal infection and its disproportionate burden on developing nations.1

But some fungal diseases can be extremely serious and, particularly for those with compromised immune systems, even life threatening. People living with HIV; cancer patients; people who are admitted to hospital; people who are critically ill after trauma or surgery; and premature babies are among those most at risk.

The advocacy group Global Action Fund for Fungal Infections estimates that fungal diseases cause between 1.5 million and 2 million deaths every year. Many of these occur among people with AIDS or among those who develop fungal sepsis in hospital and 25 milllion are at high risk of dying or losing their sight.

Some fungal diseases are acute and severe (i.e. cryptococcal meningitis and fungal eye infection (keratitis), other recurrent (i.e. Candida vaginitis or oral candidiasis in AIDS) and other chronic (i.e. chronic pulmonary aspergillosis or fungal hair infection (tinea capitis)

These settings often lack the education and infrastructure needed to properly diagnose fungal diseases, for example fungal infection experts are almost none existent in many developing countries and laboratory infrastructure is often poor.1

Agriculture is also often the backbone of the economic growth in developing regions. As a result, many rural workers are repeatedly exposed to a pathogenic soil-related fungus.2 Once diagnosed, attaining treatment is extremely difficult, as many of these countries do not have any antifungals, or they are priced beyond the reach of most citizens and healthcare systems.1

As all potentially life-threatening fungal infections require specialised testing for diagnosis, any delays or missed diagnosis often lead to death, or long-term illness including blindness, psychological problems and reduced work capacity.1

This presents a huge global market opportunity to provide patients in these developing countries with access to simple, affordable live-saving treatments and diagnostics, designed specifically for their infrastructure and which could ultimately improve patient outcomes.

However, fungal disease is not exclusive to either developing nations or the West. It takes the lives of many, and effective treatment is needed in all areas across the globe.

References
1. Why | Gaffi – Global Action Fund for Fungal Infections [Internet]. Gaffi.org. 2019 [cited 17 April 2019]. Available from: https://www.gaffi.org/why/
2. Herkert P, Hagen F, Pinheiro R, Muro M, Meis J, Queiroz-Telles F et al. Journal of Fungi [Internet]. Mdpi.com. 2019 [cited 17 April 2019]. Available from: https://www.mdpi.com/journal/jof/special_issues/fungal_infections