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Antifungal persistence: Clinical relevance and mechanisms

Rui Wang1, Jingnan Lv1,2, Liang Chen3

  • 1Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China.

Plos Pathogens
|September 11, 2025
PubMed

Insights

Antifungal persistence, a dormant cell state, allows fungi to survive high drug doses, potentially causing treatment failure. Understanding this phenomenon is crucial for combating persistent fungal infections.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Pharmacology

Background:

  • Antifungal persistence is a survival strategy where a subpopulation of fungal cells endures high antifungal drug concentrations.
  • Persisters are phenotypic variants, not mutants, entering a dormant, low-metabolism state, distinct from resistance or tolerance.
  • This survival mechanism is linked to therapeutic failure and recurrent fungal infections.

Purpose of the Study:

  • To provide a comprehensive review of antifungal persistence.
  • To clarify its definition and differentiate it from resistance and tolerance.
  • To explore its detection, mechanisms, and clinical relevance.

Main Methods:

  • Literature review and synthesis of existing research on antifungal persistence.
  • Analysis of studies defining and characterizing fungal persisters.
  • Examination of in vivo experiments and clinical data.

Main Results:

  • Antifungal persistence is a distinct biological phenomenon characterized by reversible dormancy.
  • Molecular mechanisms underlying persister formation are complex and multifactorial.
  • Evidence suggests a significant role for antifungal persistence in clinical treatment failures.

Conclusions:

  • Antifungal persistence poses a significant challenge in treating fungal infections.
  • Further research into persister cell biology is needed to develop targeted therapeutic strategies.
  • Understanding and targeting antifungal persistence is critical for improving patient outcomes.

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