Pappas Warns of the Increase of Fungal Infections in the Deep South

Nov 08, 2023 at 10:37 am by kbarrettalley

Peter Pappas MD
Peter Pappas MD

Ansley Franco 

“Southern states face a higher risk of acquiring certain fungal infections amid climate change,” said Peter Pappas, Md and professor in the Division of Infectious Diseases at the UAB Heersink School of Medicine. Consequently, he anticipates the development of more aggressive fungi.

Fungi, a complex microorganism that is more closely related to humans than bacteria or viruses, find an ideal habitat in Alabama due to its nutrient-rich soil and warm, moist climate.

“It's no accident that across the southeast we see more invasive fungal infections than in other parts of this country,” Pappas said. “If you take the hospital-acquired fungal infections and combine them with what is acquired naturally out in the community, you come up with a fair number of invasive fungal infections across the Deep South.”

Although fungi are vital for life on Earth, breaking down organic matter and returning it to its original state, a small amount of fungi cause significant diseases in humans. Pappas estimates that only 100 to 150 fungi out of millions pose problems for humans.

There are two types of fungal infections that humans are at risk of contracting. Dermatophytes, which are fungal infections that invade keratinized tissue such as hair, skin and nails. This type of infection thrives in ambient temperatures and rarely causes life-threatening issues. On the other hand, an invasive fungal infection can be considered almost as severe as a bacterial infection that can go uncontrolled and lead to sepsis and death. Deeply invasive or invasive infections can manifest in the bloodstream, brain, lung or deep tissue infections.

“There are several things that predispose you to fungal infection: if you’ve received a transplant; received

disease-modifying agents; have lupus, rheumatoid arthritis, any of the connective tissue disorders; HIV; or cancer,” Pappas said. “Like most regions, we have an abundance of those types of patients. We have a population across the state and the region living in an area of relative vulnerability. These numbers are going up everywhere.”

To combat this, industrial anti-fungicides are used in paints to keep mildew and mold down, and in agriculture sprays for crops. “Industrial agricultural anti-fungal sprays contribute to human resistance to fungal infections,” Pappas said. “The industrial use of fungicides is pretty significant worldwide, especially in Northern Europe where they use these sprays to keep tulips and flowers from getting ruined as a consequence of fungal infection.

“If people contract a fungal infection, some of these threatening fungi live on the skin and can become infected through hospital devices such as a ventilator, where the organism can enter the bloodstream. In rare instances, fungi that live on the skin can be contracted from person to person, like Candida auris ((C. auris.) C. auris is a germ that poses a threat to humans since its origin on five continents simultaneously and has arisen from climate change and environmental degradation. It’s particularly difficult because it is, by nature, resistant to one or more antifungals. It’s difficult to eradicate from the environment, and it’s difficult to eradicate from people. It colonizes and it’s hard to rid an individual of it once colonized. So it's difficult to treat because it's resistant and it leads to more death.”

Pappas, who is one of the leaders for the Mycoses Study Group (MSG), a world-renowned organization dedicated to providing evidence-based medicine for patients at risk for or afflicted with invasive fungal infections, said the group is working towards getting a protocol through to a study of C. auris. He is confident the group will have something within the next year.

MSG is located at UAB, and is the center of clinical research in mycology nationwide. The group organizes and conducts trials for new antifungals, diagnostics and therapeutics while collaborating with sites across the country to better understand the pathogenesis of some fungal infections.

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