How fungi kill millions globally

By Susie East, for CNN

Updated 1044 GMT (1844 HKT) September 27, 2016

Candida – The organism behind oral and vaginal thrush, Candida is a yeast-like fungus that
many of us carry on or inside our body without doing any harm. Overgrowth can cause
symptoms to develop, which are treatable for most people, but for those with weakened
immune systems the infection can become serious.

Histoplasma – Histoplasma can be found in soil that contains large amounts of bird or bat
droppings, and can infect people who breathe in its fungal spores from the air, resulting in
fever, cough and fatigue.
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Superficial fungi – While deadly fungal infections kill over a million people every year,
superficial ones such as ringworm (pictured), athlete's foot and dandruff can affect 1-2
billion people annually, as well as put stress on health care systems.
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8 of 9

Ringworm – This is an example of a patient who got a ringworm infection on their torso,
caused byTrichophyton verrucosum -- a fungal organism commonly associated with horses
and cattle.
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9 of 9

Fatal Fungi – Tiny fungal spores are found in soil, air and water, and whilst most species
are harmless to humans, some can be deadly, collectively killing 1.5 million people around
the world each year.
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1 of 9

Aspergillus – One such fungus is Aspergillus -- a common mold found both indoors and
outdoors. Most of us breathe in its spores everyday without getting sick, but for those with
weakened immune systems it can cause serious lung infections and allergic reactions.

Pnuemocystis jirovecii – The fungus Pnuemocystis jirovecii can also cause severe
infections, particularly in people with HIV/AIDS. It caused one of the main AIDS-defining
illnesses in the United States after the epidemic started in the 1980s.
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3 of 9
Cryptococcus – The fungus Cryptococcus can be found all around the world, and most of
us are likely to breathe it in at some point in our lives. But it also causes Cryptococcal
meningitis, a leading cause of death for HIV/AIDS patients in sub-Saharan Africa.
Hide Caption
4 of 9

Photos: Fungal diseases under the microscope

Cryptococcus – There are over 30 different species of Cryptococcus -- here's an example
of a skin lesioncaused by the fungus.
Hide Caption
5 of 9

Photos: Fungal diseases under the microscope

Candida – The organism behind oral and vaginal thrush, Candida is a yeast-like fungus that
many of us carry on or inside our body without doing any harm. Overgrowth can cause
symptoms to develop, which are treatable for most people, but for those with weakened
immune systems the infection can become serious.
Hide Caption
6 of 9

Photos: Fungal diseases under the microscope

Histoplasma – Histoplasma can be found in soil that contains large amounts of bird or bat
droppings, and can infect people who breathe in its fungal spores from the air, resulting in
fever, cough and fatigue.
Hide Caption
7 of 9

Photos: Fungal diseases under the microscope

Superficial fungi – While deadly fungal infections kill over a million people every year,
superficial ones such as ringworm (pictured), athlete's foot and dandruff can affect 1-2
billion people annually, as well as put stress on health care systems.
Hide Caption
8 of 9

Ringworm – This is an example of a patient who got a ringworm infection on their torso,
caused byTrichophyton verrucosum -- a fungal organism commonly associated with horses
and cattle.
Fatal Fungi – Tiny fungal spores are found in soil, air and water, and whilst most species
are harmless to humans, some can be deadly, collectively killing 1.5 million people around
the world each year.
Hide Caption
1 of 9
 Photos: Fungal diseases under the microscope
Aspergillus – One such fungus is Aspergillus -- a common mold found both indoors and
outdoors. Most of us breathe in its spores everyday without getting sick, but for those with
weakened immune systems it can cause serious lung infections and allergic reactions.
Hide Caption
2 of 9

Photos: Fungal diseases under the microscope

Pnuemocystis jirovecii – The fungus Pnuemocystis jirovecii can also cause severe
infections, particularly in people with HIV/AIDS. It caused one of the main AIDS-defining
illnesses in the United States after the epidemic started in the 1980s.
Hide Caption
3 of 9

Photos: Fungal diseases under the microscope

Cryptococcus – The fungus Cryptococcus can be found all around the world, and most of
us are likely to breathe it in at some point in our lives. But it also causes Cryptococcal
meningitis, a leading cause of death for HIV/AIDS patients in sub-Saharan Africa.
Hide Caption
4 of 9
Cryptococcus – There are over 30 different species of Cryptococcus -- here's an example
of a skin lesioncaused by the fungus.
Story highlights

 Fungal diseases kill 1.5 million people every year

 People with reduced immune systems are most vulnerable to serious infections

Vital Signs is a monthly program bringing viewers health stories from around the world.

(CNN)What do you think of when you hear the word fungi? Mushrooms? Athlete's foot?
General mold?

Whatever comes to mind, the fact is that when most of us think of fungal infections, we think
of something mild and unpleasant at best.

But these tiny organisms can be fatal and kill an estimated 1.5 million people globally each
year. It's a shockingly high figure and is greater than the number of people who die from
malaria, more than twice the number of women who die from breast cancer, and an
equivalent number to those who die from tuberculosis, or HIV, each year, according to
professor Neil Gow, President of the Microbiology Society.

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Of course, it's not the superficial infections like athlete's foot that are killing millions. There
are certain kinds of fungal infections that can invade our blood, lungs and other organs
within the body -- and there are a lot of them out there.

Matching the number of deaths each year, there are around 1.5 million species of fungi --
tiny microbes found in soil, air and water -- and we interact with them every day. Three
hundred of these are known to make people sick, with some proving to be fatal.

Fatal fungi
"Almost nobody has heard of Cryptococcus, Candida, or Aspergillus, but the three of those
probably account for more than a million deaths every year," says Gow.

He estimates that the fungus Cryptococcus, which mainly affects people with HIV in sub
Saharan Africa, is killing between 200-600,000 people every year.

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When Pneumocystis is added to the mix, these four fungi account for more than 90% of
fatal fungal infections worldwide, says Gow.

And importantly, they aren't rare. In fact, most of us are in contact with them regularly.

"Somewhere between 100 to 300 spores of a fungus called Aspergillus get in our lungs
every day," says Gow, "We deal with it perfectly well because our lungs are full of immune
cells, which patrol around looking for these spores, and they swallow them up and kill
them."

But for people with weakened immune systems, Aspergillus can cause lung disease and
can kill after as little as 10-14 days, according to David Denning, professor of Infectious
Diseases in Global Health from the University of Manchester. "It's fairly uncommon, but still
life-threatening," he says.

People with asthma and cystic fibrosis -- a genetic condition that can lead to excess
mucous in the lungs -- are also more susceptible to lung disease from Aspergillus, which
can cause pneumonia-like symptoms for them, such as coughing up mucus and wheezing.

These fungi are also some of the most misdiagnosed infections in intensive care units in the
UK according to Denning, which, when coupled with late diagnosis and the presence of
severe underlying diseases, is what makes them deadly.
From mild to deadly
Not all infections are fatal. Treatable skin infections, or dermaticites, could be considered
the most common fungal infection of all, affecting as many as 1-2 billion people, and
resulting in ringworm, athlete's foot and even dandruff, says Gow.

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Many healthy people also naturally carry the species of yeast-like Candida fungi in, and on,
their bodies, without it being harmful. Candida can also cause superficial infections like
vaginal thrush and while this is treatable, it remains a burden for many, with 100 million
women suffering four or more episodes annually.

But even seemingly mild fungi like candida can prove deadly when immune systems are
weakened. People living with HIV/AIDS, organ transfer patients, or cancer patients
undergoing chemotherapy are vulnerable to this range of fungal infections that would
normally be harmless or treatable.

The burden on healthcare systems is equally huge, with hospitalization costs estimated to
range from $11,000 to $57,000 for a patient with an invasive fungal infection -- and experts
are warning that the issue needs more attention.

Preventing infection
"Prevention is better than a cure," says Gow. "One of the things about fungi is that they're
quite difficult to dislodge once they start to grow.

"There's not a single vaccine against any fungus at the moment."

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Without the option of a vaccine, hospitals have to work hard to avoid exposure: patients can
be given drugs to help prevent infection, some hospital wards may not allow flowers
because of the risk of fungal spores spreading, and they can also use air filtration barriers to
protect patients. But the public also need to be informed to avoid exposure.

"It's still the case that this information is not really even understood, and not fully
appreciated by all members of even the professional community of microbiologists, and
certainly not by the general public," says Gow.
The hope is that these little known infections will gain more recognition for what they really
are -- global killers.