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Immune defence to invasive fungal infections: A comprehensive review
Balaji Pathakumari1, Guanzhao Liang1, Weida Liu2
1Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, People's Republic of China.
Abstract:
The fungal infections are relatively common in humans that can range from common, mild superficial infections to life-threatening invasive infections. Most of the pathogenic fungi are opportunistic that cause disease under immunocompromised conditions such as HIV infection, cancer, chemotherapy, transplantation and immune suppressive drug users. Efficient detection and treatment of high-risk population remain the highest priority to avert most of the deaths. Majority of invasive infections are caused by Candida, Aspergillus and Cryptococcus species. Lack of effective vaccines, standardised diagnostic tools, efficient antifungal drugs and the emergence of drug-resistant species/strains pose a global threat to control Invasive fungal infections (IFI). A better understanding of the host immune response is one of the major approaches to developing new or improved antifungal strategies to control the IFIs. In this review, we have discussed pathogenesis of medically important fungi, fungal interaction with the host through pattern recognition receptors (PRRs) and the interplay of innate and adaptive immune cells in shaping host immunity to IFI. Further, we emphasized the role of memory cells by offering long-term protection in secondary or subsequent infections. Moreover, we depicted the role of unconventional innate-like immune cells in anti-fungal immunity. We also summarize the available information on the current vaccine strategies, genetic susceptibility to fungal infections, recent co-infections studies and the emergence of drug-resistance, a growing trend throughout the world. Finally, we emphasized the steps to be taken for the control of IFIs.
Insights
Invasive fungal infections (IFIs) are a major threat, especially in immunocompromised individuals. Understanding host immunity is key to developing new antifungal strategies and combating drug resistance.
Area of Science:
- Medical Mycology
- Immunology
- Infectious Diseases
Background:
- Fungal infections range from superficial to life-threatening invasive fungal infections (IFIs).
- Opportunistic fungal pathogens cause disease primarily in immunocompromised individuals (e.g., HIV, cancer patients, transplant recipients).
- Candida, Aspergillus, and Cryptococcus species are major causes of IFIs, posing a global health challenge due to limited effective treatments and emerging drug resistance.
Purpose of the Study:
- To review the pathogenesis of medically important fungi and their interaction with the host immune system.
- To explore the role of innate and adaptive immunity, including memory cells and unconventional immune cells, in controlling IFIs.
- To summarize current vaccine strategies, genetic susceptibility, co-infections, and the growing trend of antifungal drug resistance.
Main Methods:
- Literature review focusing on fungal pathogenesis, host-pathogen interactions, and immune responses.
- Analysis of the roles of pattern recognition receptors (PRRs), innate and adaptive immune cells, and memory cells in antifungal immunity.
- Synthesis of information on current therapeutic and preventative strategies, including vaccines and genetic factors.
Main Results:
- Host immune responses, involving pattern recognition receptors and various immune cells, are crucial in combating fungal infections.
- Memory cells and unconventional innate-like immune cells play significant roles in providing long-term protection against secondary fungal infections.
- Antifungal drug resistance, genetic susceptibility, and co-infections are significant challenges in managing IFIs.
Conclusions:
- A deeper understanding of host immune responses is essential for developing novel and improved antifungal strategies.
- Addressing challenges such as drug resistance, diagnostic limitations, and the need for effective vaccines is critical for controlling IFIs.
- Implementing comprehensive control measures, informed by immunological insights, is necessary to mitigate the global threat of invasive fungal infections.
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