Fungal Diseases in the 21st Century: The Near and Far Horizons

Main Article Content

Arturo Casadevall


Fungal diseases became a major medical problem in the second half of the
20th century when advances in modern medicine together with the HIV
epidemic resulted in large numbers of individuals with impaired immunity.
Fungal diseases are difficult to manage because they tend to be chronic,
hard to diagnose, and difficult to eradicate with antifungal drugs. This
essay considers the future of medical mycology in the 21st century,
extrapolating from current trends. In the near horizon, the prevalence of
fungal diseases is likely to increase, as there will be more hosts with
impaired immunity and drug resistance will inevitably increase after
selection by antifungal drug use. We can expect progress in the development
of new drugs, diagnostics, vaccines, and immunotherapies. In the far
horizon, humanity may face new fungal diseases in association with climate
change. Some current associations between chronic diseases and fungal
infections could lead to the establishment of fungi as causative agents,
which will greatly enhance their medical importance. All trends suggest
that the importance of fungal diseases will increase in the 21st century,
and enhanced human preparedness for this scourge will require more research
investment in this group of infectious diseases.


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