INDIA FACES RISING THREAT OF RESISTANT FUNGAL INFECTIONS

Why in the news?

The emergence of drug-resistant fungal infections, especially Trichophyton indotineae, is causing widespread treatment challenges in India, linked to steroid misuse and diagnostic delays.

INDIA FACES RISING THREAT OF RESISTANT FUNGAL INFECTIONS - UPSCsource:researchgate

Emergence of Resistant Fungal Infections

  • Rising Threat: Drug-resistant fungal infections, particularly Trichophyton indotineae, are becoming a significant health issue in India. This dermatophyte, linked to excessive use of topical steroids, is challenging to treat.
  • Clinical Challenges:
    • Persistent, treatment-resistant rashes are often misdiagnosed as eczema, delaying correct treatment.
    • Accurate diagnosis requires both clinical examination and advanced laboratory tests, including fungal cultures and molecular diagnostics.
    • Misdiagnosis and delayed treatment can lead to infection spread and increased community risk.

Treatment Difficulties

  • Resistance Issues:
    • Trichophyton indotineae, identified in 2019, shows resistance to common antifungals like terbinafine and itraconazole.
    • Suboptimal drug quality and misuse of steroid creams contribute to resistance and treatment complications.
  • Treatment Options:
    • Alternatives like itraconazole are necessary but come with side effects such as gastrointestinal issues and liver toxicity.
    • Comprehensive skin care, including hydration and barrier creams, is essential to support treatment.
WHO’s Fungal Priority Pathogen List (FPPL):

Overview:

  • FPPL includes 19 fungi posing significant threats to human health.
  • Follows the precedent set by the Bacterial Priority Pathogens List (BPPL) established in 2017.

Aim:

  • Drive research and policy interventions to enhance the global response to fungal infections and antifungal resistance.

Categories:

Critical Priority Group:

  • Candida auris: Highly drug-resistant.
  • Cryptococcus neoformans: Causes severe infections.
  • Aspergillus fumigatus: Common cause of invasive aspergillosis.
  • Candida albicans: Major cause of candidiasis.

High Priority Group:

  • Includes various Candida species and Mucorales (black fungus), notably affecting seriously ill patients, especially in India during COVID-19.

Medium Priority Group:

  • Includes Coccidioides spp and Cryptococcus gattii.

About Types of Fungal Diseases:

Common Infections:

  • Fungal nail infections
  • Vaginal candidiasis (yeast infection)
  • Ringworm
  • Candida infections (mouth, throat, esophagus)

Geographic-Based Infections:

  • Blastomycosis: Moist soil fungus (US, Canada)
  • Cryptococcus gattii: Tropical and sub-tropical areas
  • Paracoccidioidomycosis: Central and South America
  • Coccidioidomycosis (Valley Fever): Southwestern US, Mexico, Central and South America
  • Histoplasmosis: Bird or bat droppings