The Dual Pathogen Fusarium: Diseases, Incidence, Azole Resistance, and Biofilms

The increasing resistance of Fusarium species to nearly all first-line antifungal agents in clinical settings has led to its designation as a 'high-priority' human pathogen. As a dual pathogen, Fusarium spp. threaten both human health and crop production, impacting food security. Our recent drug profiling of clinical Fusarium isolates reveals resistance to several front-line antifungals, with notable cross-azole resistance observed in both clinical and plant-associated strains. While the overuse of agricultural azoles has been implicated in the selection of azole-resistant fungi such as Aspergillus, a similar mechanism has been assumed for Fusarium in clinical settings. However, direct genetic evidence supporting this hypothesis remains limited. In this review, part of our Special Interest (SI) series, we discuss the spectrum of human diseases caused by Fusarium. While incidence data are better established for human keratitis and onychomycosis, invasive fusariosis remains globally underreported. We propose reasons for this distinct clinical spectrum bias and explore the potential genetic basis of azole resistance.