Dr. Tom Chiller
MPHTM, Chief, Mycotic Diseases Branch; Associate Director for Global Health, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, USA
Rapid fungal diagnostics save lives and have a positive impact on antifungal resistance, says Dr Tom Chiller from the Centers for Disease Control and Prevention (CDC) in the US.
Dr Tom Chiller: As the climate and environment are changing, fungi are adapting. They’re ubiquitous opportunists that cause many different syndromes and diseases, which I’d put into three categories. The first and most superficial are skin diseases — although we’re seeing new emerging species that are highly resistant to treatment. Then, there’s subcutaneous disease and, lastly, deep, invasive internal diseases which can be life-threatening, particularly to patients with weakened immune systems.
Is antifungal resistance a growing issue?
We’re seeing more fungal infections that are resistant to drugs than a decade ago. For example, Candida auris can cause severe illness, is often resistant to medications and has ripped across the world in a short time. Then there are heavily resistant, very nasty skin infections originating from South Asia that are present in the UK and the US. Right now, we really only have three classes of antifungals to treat invasive infections.
Quicker diagnosis helps us curb resistance,
lowers hospitalisation costs and saves lives.
Why are rapid fungal diagnostics important? What part do they play in fighting antifungal resistance?
The longer it takes to get a patient on to the right therapy, the harder it is to treat them and — in serious cases — the higher their risk of mortality. Also, because many fungal syndromes resemble bacterial infections, many patients who are waiting a long time for a diagnosis may mistakenly be prescribed antibacterial medication when they really need antifungal medication. That’s not just bad for the patient — it also contributes to the problem of bacterial resistance. So, quicker diagnosis helps us curb resistance, lowers hospitalisation costs and saves lives.
How important is antifungal stewardship — and how can clinicians and diagnostic companies help?
It’s vital. I’m a big believer that accurate diagnostics help healthcare professionals be the best stewards of any medicine they’re using. Once we know what we’re dealing with, it’s a matter of using the right drug for the right bug at the right time.
I can’t emphasise enough the importance of employing diagnostics in our stewardship routines. We do need more rapid diagnostics, however, but I’m a ‘glass is half full’ guy and some promising small companies are now engaged in that field. Plus, the World Health Organization is finally getting more involved in the fungal space, which helps create awareness of the dangers of fungal infections and antifungal resistance.
