EMERGING FUNGAL PATHOGENS: CHALLENGES, MECHANISMS, AND NOVEL ANTIFUNGAL STRATEGIES

Md. Al Amin*, Moazzema Binta Bashar, Sree Karma Tigga, Arin Akther Purne, Md. Rezwan Hossain

Emerging fungal pathogens represent a growing global health threat, particularly affecting immunocompromised populations including individuals with HIV/AIDS, malignancies, organ transplants, and those receiving immunosuppressive therapies. The incidence of invasive and opportunistic mycoses has risen markedly due to clinical and environmental factors. Pathogens such as Candida auris, azole-resistant Aspergillus fumigatus, Cryptococcus spp., and Mucorales demonstrate multidrug resistance, high virulence, and the ability to cause severe, often fatal infections. This review was conducted through a structured literature survey of peer-reviewed articles, reviews, and authoritative sources retrieved from PubMed, Scopus, Web of Science, and Google Scholar over a decade from 2014 to 2026. Search terms included "emerging fungal pathogens," "antifungal resistance," "novel antifungals," and "fungal diagnostics." Data were extracted on pathogen identification, resistance mechanisms, host-pathogen interactions, virulence factors, novel therapeutic strategies, and diagnostic advances. Resistance mechanisms identified include drug target alterations, efflux pump overexpression, biofilm formation, stress response activation, genetic adaptability, metabolic rewiring, and cell wall remodeling—often acting synergistically to reduce antifungal efficacy. Virulence is enhanced through adhesion, tissue invasion, enzymatic degradation, immune evasion, and morphological plasticity. Current antifungal therapies remain limited to azoles, echinocandins, and polyenes, each with notable toxicity, resistance issues, and diagnostic challenges. To address these limitations, novel strategies under development include new antifungal agents targeting unique pathways (ibrexafungerp, fosmanogepix, olorofim), nanotechnology-based drug delivery, antifungal peptides, immunotherapy, combination therapies, natural product derivatives, and gene- or RNA-based interventions. Diagnostic advances including PCR, MALDI-TOF mass spectrometry, and biomarker detection enable earlier and more accurate identification. This review synthesizes current knowledge on emerging fungal pathogens, their resistance and virulence mechanisms, and innovative antifungal strategies, highlighting critical research gaps and emphasizing the urgent need for integrated surveillance, rapid diagnostics, and effective therapeutic interventions.