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Review
. 2016 Mar 15:3:11.
doi: 10.3389/fmed.2016.00011. eCollection 2016.

Emerging Threats in Antifungal-Resistant Fungal Pathogens

Dominique Sanglard  1
Affiliations
Review

Emerging Threats in Antifungal-Resistant Fungal Pathogens

Dominique Sanglard. Front Med (Lausanne). .

Abstract

The use of antifungal drugs in the therapy of fungal diseases can lead to the development of antifungal resistance. Resistance has been described for virtually all antifungal agents in diverse pathogens, including Candida and Aspergillus species. The majority of resistance mechanisms have also been elucidated at the molecular level in these pathogens. Drug resistance genes and genome mutations have been identified. Therapeutic choices are limited for the control of fungal diseases, and it is tempting to combine several drugs to achieve better therapeutic efficacy. In the recent years, several novel resistance patterns have been observed, including antifungal resistance originating from environmental sources in Aspergillus fumigatus and the emergence of simultaneous resistance to different antifungal classes (multidrug resistance) in different Candida species. This review will summarize these current trends.

Keywords: Aspergillus; Candida; antifungals; drug resistance.

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Figures

Figure 1
Figure 1
The three basic resistance mechanisms to antifungal drugs. They include (as listed in the text) (1) decrease of effective drug concentration with specific mechanisms including increased drug efflux, increased number of targets, drug sequestration of extracellular and intracellular origins, and poor pro-drug conversion; (2) drug target alterations; and (3) metabolic bypasses. Genome mutations are generally responsible for these three basic principles. Drug sequestration can be mediated by the formation of matrix polymers in biofilms, a state of cells that is not dependent on the occurrence of genome mutations. Wild type proteins are represented by blue circles catalyzing cellular functions; blue-shaded circles represent proteins blocked by drugs in which cellular functions are blocked causing decreased growth or death. Mutant proteins are represented by red circles. Drugs are represented with different symbols. Symbols: WT, wild type; M, mutant.
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