review · Medical Mycology
A systematic review evaluating invasive candidiasis caused by Candida tropicalis across thirty studies from twenty-five countries highlights a severe global health concern. The analysis found all-cause mortality associated with invasive infections to be between 55% and 60%. Resistance to common azole antifungals, including fluconazole, itraconazole, voriconazole, and posaconazole, reached between 40% and 80%. Conversely, resistance remained minimal for echinocandins (0% to 1%), amphotericin B (0%), and flucytosine (0% to 4%). Underlying conditions such as leukaemia and chronic lung disease were identified as significant risk factors for developing invasive disease. Due to the marked geographical variability in incidence and high resistance to standard triazoles, there is a clear demand for novel antifungal drugs, tailored therapeutic strategies, and expanded global surveillance programmes to track and mitigate the impact of this pathogen.
Fungal infections present a growing global health risk, with Candida tropicalis causing fatal outcomes in over half of invasive cases. High resistance to widely used triazole medications narrows treatment options for vulnerable individuals, notably those with leukaemia or lung disease. Establishing these clinical patterns aids international public health bodies in directing research funding and prioritising therapeutic interventions where they are most urgently required.
The findings highlight an urgent need for pharmaceutical developers to create novel antifungal therapies tailored to Candida tropicalis, particularly given widespread resistance to existing triazoles. The abstract points to early-stage priorities, noting the requirement for new agent discovery and coordinated global surveillance systems. Commercial applications remain at an early, exploratory stage, focusing on directing drug development pipelines and epidemiological tracking tools rather than near-market products.
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In response to the growing global burden of fungal infections with uncertain impact, the World Health Organization (WHO) established an Expert Group to identify priority fungal pathogens and establish the WHO Fungal Priority Pathogens List for future research. This systematic review aimed to evaluate the features and global impact of invasive candidiasis caused by Candida tropicalis. PubMed and Web of Science were searched for studies reporting on criteria of mortality, morbidity (defined as hospitalization and disability), drug resistance, preventability, yearly incidence, diagnostics, treatability, and distribution/emergence from 2011 to 2021. Thirty studies, encompassing 436 patients from 25 countries were included in the analysis. All-cause mortality due to invasive C. tropicalis infections was 55%-60%. Resistance rates to fluconazole, itraconazole, voriconazole and posaconazole up to 40%-80% were observed but C. tropicalis isolates showed low resistance rates to the echinocandins (0%-1%), amphotericin B (0%), and flucytosine (0%-4%). Leukaemia (odds ratio (OR) = 4.77) and chronic lung disease (OR = 2.62) were identified as risk factors for invasive infections. Incidence rates highlight the geographic variability and provide valuable context for understanding the global burden of C. tropicalis infections. C. tropicalis candidiasis is associated with high mortality rates and high rates of resistance to triazoles. To address this emerging threat, concerted efforts are needed to develop novel antifungal agents and therapeutic approaches tailored to C. tropicalis infections. Global surveillance studies could better inform the annual incidence rates, distribution and trends and allow informed evaluation of the global impact of C. tropicalis infections.
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DOI: 10.1093/mmy/myae040
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