India’s Growing Fungal Disease Burden

Why in News?

India is facing a rising burden of fungal diseases, with estimates suggesting that over 5 crore Indians suffer from fungal infections. Researchers are now working to identify priority fungal pathogens and map antifungal resistance.

The issue has gained global attention after the WHO released its first-ever priority fungal pathogens list in 2022.

Key facts about Fungi: 

• Fungi are eukaryotic organisms, i.e., their cells contain a well-defined nucleus and membrane-bound organelles. 
• Fungi constitute a separate biological kingdom distinct from plants, animals, and bacteria. Unlike plants, fungi do not contain chlorophyll.
• The fungal kingdom includes a wide range of organisms such as mushrooms, yeasts, and moulds. Lichens are also closely associated with fungi, as they represent a symbiotic relationship between fungi and algae or cyanobacteria.
• Fungi are heterotrophic organisms that obtain nutrients from external sources. Many fungi feed on dead and decaying organic matter, while others survive as parasites. 
• The cell walls of fungi are primarily composed of chitin, a strong structural material that is also present in the exoskeletons of insects and crustaceans.
• Fungi are highly adaptable organisms and are found in almost every habitat on Earth, ranging from tropical forests to Arctic regions, including acidic and alkaline habitats.
• Fungi reproduce through both asexual and sexual methods.
• Ecologically, fungi play a crucial role in the decomposition of organic matter. By breaking down dead plants and animals, they help recycle essential nutrients back into the environment and contribute significantly to soil formation and nutrient cycling.
• Fungi are used in various industries, including food (yeast for baking and brewing), medicine (antibiotics like penicillin), bioremediation and production of biofuels.

What are Fungal Diseases?

• Fungal diseases (mycoses) are infections caused by fungi that affect the skin, eyes, lungs, bloodstream, brain and reproductive organs. 
• Fungi thrive in hot and humid conditions, in poor sanitation environments and in immunocompromised populations. 

Major Fungal Diseases in India: 

• Aspergillosis is caused by Aspergillus fungi, primarily affecting the lungs. Often mistaken for tuberculosis. Aspergillus can also grow on various food crops and agricultural commodities such as peanuts, corn, cottonseed, and tree nuts. They produce Aflatoxins, which are a group of poisonous carcinogens and mutagens. 
• Mucormycosis, commonly known as “black fungus,” is a rare but highly aggressive fungal infection caused by a group of moulds. It primarily affects the sinuses, lungs, skin, and brain in people with weakened immune systems. The infection is not contagious and cannot spread between humans.
• Candida Infections: Candidiasis (a yeast infection) is caused by an overgrowth of Candida fungi, which naturally live on our bodies. When the balance of healthy bacteria and yeast is disrupted, it can cause localised infections in the mouth, skin, or vagina. 
• Athlete’s foot is a contagious fungal infection that causes an itchy, stinging, or burning rash on the feet, particularly between the toes.
• Ringworm is a highly contagious fungal infection. It typically causes an itchy, red, scaly, or raised circular rash.

Why is India Highly Vulnerable?

• Climatic Factors: Heat and humidity favour fungal growth, monsoon conditions increase exposure.
• High burden of Diabetes: Diabetes Mellitus weakens immunity.
• Antifungal Resistance: Overuse of antifungal medicines. Large-scale agricultural fungicide usage. 
• Weak Awareness: Delay in fungal diagnosis. Fungal diseases are often ignored compared to Tuberculosis, Viral diseases and other Bacterial infections.  

Associated Challenges: 

• Limited Treatment Options: Unlike bacteria, fungi are biologically closer to humans because both are eukaryotic organisms. Thus, antifungal drugs can also damage human cells, and drug development becomes difficult. 
• Inadequate Advanced Diagnostics: 
  • PCR-based tests require breaking tough fungal cell walls; not yet standardised for clinical use. 
  • MALDI-TOF mass spectrometry can identify fungi in ~30 min but costs ₹1.5 Cr+ per unit. MALDI-TOF databases lack many tropical fungal pathogens prevalent in India
• Research focus has been on Candida (yeast); filamentous moulds like Aspergillus and Fusarium are understudied in India. 
• Large-scale agricultural use of antifungals drives environmental resistance. 

Way Forward: 

• National Mycology Institute: Establish a dedicated apex body for fungal disease surveillance, research, and outbreak response.
• Mandatory Co-testing Protocol: Mandate simultaneous bacterial and fungal testing in all public-sector microbiology labs, especially for respiratory and eye infections.
• Diagnostic Indigenisation: Fund development of cost-effective PCR kits and India-specific MALDI-TOF databases covering tropical fungal pathogens.
• Antifungal Drugs Regulation: Regulate Over-the-counter (OTC) sales of antifungals, review agricultural fungicide use, and integrate antifungal resistance (AFR) into the AMR National Action Plan.
• Promote the One Health Approach by integrating human, animal, and environmental health. 

UPSC PYQ 2021

Q. Consider the following:

1. Bacteria

2. Fungi

3. Virus

Which of the above can be cultured in an artificial/ synthetic medium?

(a) 1 and 2 only

(b) 2 and 3 only

(c) 1 and 3 only

(d) 1,2 and 3

Answer: (a) 

UPSC PYQ 2013

Q. Improper handling and storage of cereal grains and oilseeds result in the production of toxins known as aflatoxins, which are not generally destroyed by normal cooking process. Affetoxins are produced by
(a) bacteria
(b) protozoa
(c) moulds
(d) viruses

Answer: (c)