There is a rise in untreatable fungal infections, indicating that the pathogens are becoming resistant to known medicines. What are the common fungal infections in India and their causes? Dr Rakesh Gupta, senior consultant, internal medicine, Indraprastha Apollo Hospitals, says: “In India, frequent fungal infections include tinea (ringworm), onychomycosis (nail fungus), oral and vaginal candidiasis, aspergillosis, cryptococcosis, and mucormycosis. The hot and humid climate, overcrowding, and limited access to clean environments make fungal growth more likely. Superficial fungal infections are particularly common in people with excessive sweating, poor hygiene, or shared use of towels, clothes, or footwear. Deep fungal infections occur more often in people with weakened immunity due to conditions like diabetes, cancer, or long-term steroid or immunosuppressive drug use. Inhalation of fungal spores from soil, damp buildings, or decomposing plant material can lead to lung infections. The use of broad-spectrum antibiotics can also disrupt the body’s natural flora, encouraging fungal overgrowth. In rural areas, lack of footwear and contact with contaminated soil increase risk. These infections can be persistent, and timely medical treatment is crucial to prevent complications or systemic spread.”
Are fungi becoming resistant like bacteria?
Yes, fungi are increasingly developing resistance to antifungal medications, posing a serious challenge to treatment. Just like bacteria evolve to survive antibiotics, certain fungi are now adapting to resist drugs like azoles, echinocandins, and polyenes. A notable example is Candida auris, which is resistant to multiple antifungal agents and is difficult to eliminate from hospital environments. Overuse of antifungal drugs in both healthcare and agriculture contributes to this resistance. When antifungals are used without clear need, or when treatment courses are incomplete, fungi are more likely to evolve mechanisms to survive future exposures. The problem is compounded by a limited number of antifungal classes available, and the fact that fungi, unlike bacteria, are biologically closer to human cells, which makes drug development more difficult.
Antifungal resistance leads to longer hospital stays, increased treatment costs, and higher risk of complications or death, especially in immunocompromised individuals.
What are the stubborn fungal infections encountered in patients?
Some fungal infections are particularly difficult to treat due to their aggressive nature, location in the body, or resistance to treatment. Mucormycosis is one such infection, known for rapidly spreading through tissue and often requiring surgery in addition to antifungal therapy. Onychomycosis (fungal infection of the nails) is another stubborn form, treatment can take several months, and recurrence is common. In the lungs, chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis in asthma patients are notoriously persistent, often requiring long-term therapy. Systemic fungal infections like invasive candidiasis in ICU patients or those with medical devices (eg catheters or feeding tubes) are also difficult to manage due to resistance and delayed diagnosis. These infections often recur, and managing them requires a multidisciplinary approach, including both medical and sometimes surgical intervention. Resistance to standard drugs makes treatment longer and more expensive, especially in patients with compromised immunity or chronic illness.
How to avoid fungal infections — internal and external?
Preventing fungal infections involves both lifestyle hygiene and protection of the body’s natural defenses. For external fungal infections, it’s important to bathe regularly, keep skin folds dry, and wear loose, breathable clothing. Avoid walking barefoot in damp public areas, and don’t share personal items like towels, socks, or combs. Using antifungal powders in high-sweat areas like underarms or groin can help prevent tinea. Internally, people with diabetes or those on long-term steroids should monitor their sugar levels and avoid unnecessary immunosuppression. A healthy diet and gut flora support the body’s resistance to fungal overgrowth like Candida. Avoiding contact with construction dust, moldy environments, or decaying organic matter helps prevent inhalation of spores. Hospitals must maintain strict sterilisation and hygiene protocols, especially for invasive devices like catheters. Also, using antibiotics and antifungals only when necessary reduces the risk of disrupting the body’s microbial balance and helps prevent future resistance.
