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Endemic mycoses, or fungal pathogens that lead to a wide range of diseases in humans, are expected to become more common in the coming decade, partly due to climate change. The increasing spread of these pathogens increases the possibility that clinicians without familiarity of the mycoses may encounter them in daily practice. This is important because endemic mycoses may be erroneously diagnosed as bacterial infections, leading to inappropriate use of antibiotics and other prescriptions that provide no relief to the patient. The commentary is published in Annals of Internal Medicine.
Stopping the spread of fungal pathogens is a public health priority being increasingly recognized by international public health efforts. In October 2022, the World Health Organization (WHO) announced the creation of the WHO fungal priority pathogens list (WHO FPPL), a new effort to “systematically prioritize fungal pathogens, considering their unmet research and development (R&D) needs and perceived public health importance.”
Authors from the University of California-Davis and the Centers for Disease Control and Prevention highlight the increasing spread of blastomycosis, coccidioidomycosis, and histoplasmosis, the endemic mycoses that are most prevalent in North America. All three pathogens have been traced outside of their original endemic regions due to both climate change and more thorough identification. The authors highlight the current lack of guidelines for testing and treatment of mycoses, unlike when clinicians encounter infections like community-acquired pneumonia. Patients who have been infected with these pathogens may experience long periods of illness between initial infection and diagnosis, leading to increased healthcare costs and frequent antibiotic overprescription. The authors say that improvements in our epidemiologic understanding of disease and the ability to capture changes in disease incidence at the county level would enable directed educational efforts, public health campaigns, and quality improvement initiatives to reduce the time to diagnosis and receipt of appropriate antifungal therapy.