A review study on the epidemiology of fungal infections in France opens new avenues for research to tackle these diseases more effectively.
At the Institut Pasteur, the National Reference Center (CNR) for Invasive Mycoses & Antifungals is responsible for epidemiological surveillance on severe fungal infections in France. In a recent publication in the journal mBio, the CNR team summarized several years of surveillance to provide an overview of infections (septicemia, pneumonia, meningitis, etc.) caused by microscopic pathogenic fungi. The infections can be divided into candidiasis (caused by yeast of the Candida genus), aspergillosis and mucormycosis (caused by environmental mold) and Pneumocystis pneumonia.
Between 2012 and 2018, the CNR gathered epidemiological and microbiological data on these major fungal infections. Drawing on a network of 21 university hospital centers covering the whole of France, it compiled data on nearly 10,000 infectious episodes. These were mainly infections in immunocompromised patients or associated with complications during treatment, such as hospital-acquired infections or iatrogenic infections (resulting from treatment for another condition).
The mortality rate from fungal infections remains high
The study shows a degree of stability in the number of infections – with the exception of concurrent infections caused by several molds, which increased – and a relative fall in specific infections, such as aspergillosis. There was only a small rise in candidiasis, primarily associated with an aging population. An analysis of in vitro antifungal susceptibility did not show an increase in resistance to treatments in the fungi responsible for these infections. More worryingly, the overall mortality of patients with invasive fungal diseases remains desperately high, reaching 59% for infections such as mucormycosis.
These epidemiological trends – generally relatively stable and still associated with a high mortality rate – were observed despite the fact that new antifungal treatments have become widely available, especially for candidiasis, and many recommendations are available to guide health care providers in treating fungal infections. The results suggest that some of the arguments put forward to explain the very high mortality associated with fungal infections should be reassessed so that research can be redirected to other avenues for improvement.
This study is part of the priority scientific area Antimicrobial Resistance of the Institut Pasteur's strategic plan for 2019-2023.
Source:
Active Surveillance Program to Increase Awareness on Invasive Fungal Diseases: the French RESSIF Network (2012 to 2018), mBio, May 2, 2022
Stéphane Bretagne1,2, Karine Sitbon1, Marie Desnos-Ollivier1, Dea Garcia-Hermoso1, Valérie Letscher-Bru3, Sophie Cassaing4, Laurence Millon5, Florent Morio6, Jean-Pierre Gangneux7, Lilia Hasseine8, LoïcFavennec9, Estelle Cateau10, Eric Bailly11, MaximeMoniot12, Julie Bonhomme13, Nicole Desbois-Nogard14, Taieb Chouaki15, André Paugam16, Bernard Bouteille17, Marc Pihet18, Frédéric Dalle19,20,
Odile Eloy21, Milène Sasso22, Magalie Demar23, Patricia Mariani-Kurkdjian24, Vincent Robert25, Olivier Lortholary1,26, Françoise Dromer1
1 - Institut Pasteur, Université Paris Cité, CNRS, Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, UMR 2000, Paris, France
2 - Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux De Paris (AP-HP), Paris, France
3 - Laboratory of Parasitology and Medical Mycology, Strasbourg University Hospital, Institute of Parasitology and Tropical Diseases, UR7292 Dynamics of Host-Pathogen Interactions, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
4 - Sophie Cassaing: Department of Parasitology and Mycology, CHU Toulouse, Restore Institute, Toulouse, France
5 - Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Besançon, UMR 6249 CNRS Chrono-Environnement, University Bourgogne Franche-Comté, Besançon, France
6 - Nantes Université, CHU Nantes, Cibles et Médicaments des Infections et du Cancer, IICiMed, UR 1155, Nantes, France
7 - Univ Rennes, CHU, INSERM, Irset: Institut de Recherche en Santé, Environnement et Travail, UMR_S 1085, Rennes, France
8 - Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, Nice, France
9 - EA 7510, Centre Hospitalier UC. Nicolle, Rouen, France
10 - Laboratoire de Mycologie, CHU de Poitiers, UMR CNRS 7267, Poitiers, France
11 - Laboratoire de Parasitologie-Mycologie-Médecine Tropicale, CHRU Tours, France
12 - Service de Parasitologie-Mycologie, CHU Clermont-Ferrand, 3iHP, Clermont-Ferrand, France
13 - Department of Microbiology, University Hospital of Caen, ToxEMAC-ABTE, Unicaen Normandie University, Caen, France
14 - Laboratoire de Parasitologie-Mycologie, CHU de la Martinique, Fort de France, France
15 - Mycologie-Parasitologie, CHU d'Amiens, Amiens, France
16 - Laboratoire de Mycologie, Hôpital Cochin, Paris, France
17 - Department of Parasitology and Mycology, University Hospital, Limoges, France
18 - Laboratoire de Parasitologie-Mycologie, CHU d’Angers, University Angers, University Brest, GEIHP, SFR ICAT, Angers, France
19 - University Bourgogne Franche-Comté, Agrosup Dijon, UMR PAM A 02.102, Dijon, France
20 - Laboratoire de Parasitologie-Mycologie, Plateforme de Biologie Hospitalo-Universitaire Gérard Mack, Dijon, France
21 - Centre Hospitalier de Versailles, Le Chesnay, France
22 - Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, CNRS, IRD, UMR MiVEGEC, Montpellier, France
23 - Laboratoire Hospitalo-Universitaire de Parasito-Mycologie, centre hospitalier de Cayenne Guyane, Cayenne, France
24 - CHU Robert Debré, Paris, France
25 - Bioinformatics Group, Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
26 - Centre for Infectious Diseases and Tropical Medicine, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Cité, Paris, France
