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Defining the frontiers between antifungal resistance, tolerance and the concept of persistence

Eric Delarze1, Dominique Sanglard1

  • 1Institute of Microbiology, University Hospital Lausanne and University Hospital Center, Rue de Bugnon 48, CH-1011 Lausanne, Switzerland.

Drug Resistance Updates : Reviews and Commentaries in Antimicrobial and Anticancer Chemotherapy
|December 23, 2015
PubMed

Insights

Antifungal tolerance, distinct from resistance, allows fungal pathogens to survive treatment by forming persister cells, potentially leading to relapses. Understanding tolerance mechanisms is crucial for effective antifungal therapy.

Area of Science:

  • Medical Mycology
  • Antimicrobial Resistance
  • Pharmacology

Background:

  • Limited antifungal agents necessitate understanding drug resistance and tolerance.
  • Epidemiological cut-off values aid in distinguishing wild-type from drug-resistant fungal populations.
  • Molecular mechanisms of antifungal resistance are increasingly understood.

Purpose of the Study:

  • To review current knowledge on antifungal tolerance.
  • To explore potential mechanisms driving antifungal tolerance.
  • To evaluate the role of antifungal tolerance in treatment efficacy.

Main Methods:

  • Literature review of antifungal tolerance studies.
  • Analysis of mechanisms underlying fungal tolerance.
  • Evaluation of clinical implications of antifungal tolerance.

Main Results:

  • Antifungal tolerance, occurring at drug concentrations above inhibitory levels, promotes the survival of persister cells.
  • Persister cells can survive antifungal therapy, leading to potential treatment failure and relapse.
  • Mechanisms of antifungal tolerance are less understood than resistance but are critical.

Conclusions:

  • Antifungal tolerance is an under-recognized challenge in treating fungal infections.
  • Further research into tolerance mechanisms is essential for developing more effective antifungal strategies.
  • Addressing tolerance may improve outcomes and prevent relapses in patients with fungal diseases.
Keywords:
Antifungal resistancePersistenceTolerance

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