5: The Rising Threat of Fungal Infections and the Urgent Need for New Treatments

Infectious diseases have long been a major concern for global health. While much attention is given to bacterial and viral infections, fungal diseases remain an underappreciated and growing threat. With limited treatment options and rising resistance to existing antifungal drugs, the world is facing a silent crisis that could have devastating consequences. David Angulo, MD, an infectious disease specialist and the president and CEO of SCYNEXIS, sheds light on the urgent need for new antifungal treatments and the challenges in combating fungal resistance in this interview with Infection Control Today® (ICT®). Understanding the Scope of Fungal Infections In this interview, Angulo explains that when most people think of fungal infections, they often imagine superficial conditions like toenail or yeast infections. While these are common and generally treatable, a far more dangerous category of fungal diseases exists—one that attacks the lungs, bloodstream, brain, and other vital organs. These invasive fungal infections are often life-threatening, with mortality rates ranging from 20% to 80%, particularly among immunocompromised individuals. Angulo explains that patients undergoing chemotherapy, organ transplant recipients, and those in intensive care units are at the highest risk. In these situations, “You have multiple catheters placed in your body because of that reason, and then the fungi had the opportunity to get into your body and to cause these very severe infections,” Angulo said. Angulo discusses the most common invasive fungal infections, which include: Invasive Candidiasis: A bloodstream infection caused by Candida species, which can spread to organs and cause severe complications. Aspergillosis: An infection caused by Aspergillus, a mold commonly found in the environment. It can destroy lung tissue and lead to fatal respiratory failure. Mucormycosis: A rare but aggressive fungal infection with a mortality rate as high as 80%, affecting the sinuses, lungs, and brain. Coccidioidomycosis (Valley Fever): A fungal pneumonia endemic to certain regions, such as the southwestern United States, that is expanding due to climate change. Why Antifungal Resistance is a Growing Concern The fight against fungal infections is growing more challenging because of rising antifungal resistance. In contrast to bacterial infections, which benefit from numerous groups of antibiotics, antifungal therapies consist of only three primary drug classes, as Angulo clarifies in the interview: Polyenes (eg, Amphotericin B) – One of the first antifungal treatments, effective but highly toxic and limited to intravenous use. Azoles (eg, Fluconazole, Voriconazole, Posaconazole) – The most commonly used antifungals, but resistance to azoles is growing at an alarming rate. Echinocandins (eg, Caspofungin, Micafungin, Anidulafungin) – Newer antifungals with a better safety profile but limited to intravenous administration. Angulo emphasizes the critical need for innovation: “Over the years, fungi have developed resistance against many of them, and at this point, that's really the biggest concern,” he said His company, SCYNEXIS, is at the forefront of this fight, developing a new class of antifungal drugs called triterpenoids. "Our focus has been in trying to address the problem of antimicrobial resistance in the antifungal space, and really how to tackle those very difficult to treat diseases. That has been really the focus and the passion of this organization for the past 10 years," he explains. As Angulo told ICT, "The antibacterial space was developed much earlier and faster, but right now, with a better understanding of the impact of fungal diseases and the development of resistance of fungal pathogens that has been evolving in the US, the CDC runs the primary surveillance program regarding the development of antimicrobial and antifungal resistance.” By raising awareness and pushing for policy changes, the fight against deadly fungal infections remains a global priority. Listen to ICT’s interview with Angulo to learn more about the history and treatment of fungal diseases.