This is because fungal infections are often difficult to diagnose, and are particularly challenging to treat (Perlroth, Choi and Spellberg 2007 Brown et al. Mortality rates for those suffering systemic fungal infections are unacceptably high, reaching 50% in many cases. Estimates suggest that, at any given time, over a quarter of the world's population have a fungal infection of the skin, that 75% of women suffer at least one episode of vulvovaginal candidiasis during their lifetime, and that over a million people die each year from an invasive fungal infection (Brown et al. We argue that a detailed understanding of these variables, which underlie fungal-host-microbiota interactions, will present opportunities for directed antifungal therapies that benefit vulnerable patients.Ĭandida, Candida infections, antifungal immunity, microbiota, mycobiota, fungus-host-microbiota interactions, patient variability, fungal variability, microbiota variability INTRODUCTIONįungal pathogens have a major global impact upon human health. Also, we describe factors that influence the composition of gut, oral and vaginal microbiotas, and how these affect fungal colonisation and antifungal immunity. We discuss antifungal immunity, how this differs between mucosae, and how individual variation influences a person's susceptibility to infection. Therefore, we summarise the features of the fungus that promote infection, and how genetic variation between clinical isolates influences pathogenicity. However, the complexity of these interactions, and the significant impact of fungal, host and microbiota variability upon disease severity and outcome, are less well understood.
albicans commensalism to pathogenicity is widely appreciated. The importance of the interplay between fungus, host and microbiota in driving the transition from C. Their perturbation can lead to fungal outgrowth and the development of mucosal infections such as oropharyngeal or vulvovaginal candidiasis, and patients with compromised immunity are susceptible to life-threatening systemic infections. It exists as a commensal in the oral cavity, gut or genital tract of most individuals, constrained by the local microbiota, epithelial barriers and immune defences. Candida albicans is a major fungal pathogen of humans.
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