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

Area of Science:

• Medical Mycology
• Plant Pathology
• Antimicrobial Resistance

Background:

• Fusarium species are increasingly resistant to antifungal drugs, posing a significant threat to human health and global food security.
• These fungi are dual pathogens, affecting both humans and crops, leading to challenges in clinical treatment and agricultural management.
• Cross-azole resistance has been observed in clinical and plant-associated Fusarium strains, raising concerns about treatment efficacy.

Purpose of the Study:

• To review the spectrum of human diseases caused by Fusarium species.
• To explore the potential genetic basis of azole resistance in Fusarium.
• To discuss reasons for the underreporting of invasive fusariosis.

Main Methods:

• Drug profiling of clinical Fusarium isolates.
• Review of existing literature on Fusarium diseases and azole resistance.
• Analysis of clinical spectrum bias and potential genetic mechanisms.

Main Results:

• Clinical Fusarium isolates exhibit resistance to front-line antifungals, including cross-azole resistance.
• Genetic evidence for azole resistance mechanisms in clinical settings is limited.
• Invasive fusariosis is globally underreported compared to keratitis and onychomycosis.

Conclusions:

• Fusarium's high-priority status is driven by widespread antifungal resistance.
• Understanding the genetic basis of azole resistance is crucial for developing effective treatments.
• Further research is needed to accurately report and manage invasive fusariosis.