PANDEMICSWill Invasive Fungal Infections Be the Last of Us?

“The Last of Us,” a post-apocalyptic drama television series based on the 2013 video game by the same name, is set twenty years into a pandemic caused by a mass fungal infection, which causes its hosts to transform into zombie-like creatures and collapses society.

Do the video game and TV series describe a completely fictional scenario? Experts say that, creative embellishments notwithstanding, “The Last of Us” describes a situation which is closer to reality than we would like to believe, or hope.

In a new article, Roxana Rodríguez Stewart and her co-authors discuss the growing threat of invasive fungal infections and the importance of antifungal stewardship. The article, “Will Invasive Fungal Infections be the Last of Us?” was published inthe Expert Review of Anti-infective Therapy:

Pandora Report writes:

“The video game-turned-HBO show ‘The Last of Us’ is a fanciful representation of a zombie apocalypse caused by a fungal infection. Although Ophiocordyceps, the ‘zombie fungi’ featured in the show, do not infect vertebrates, the show serves as a reminder that many fungi can cause life-threatening invasive fungal infections (IFIs). Candida and Aspergillus species are the most common and well-known causes of IFIs, but at least 300 species of opportunistic human pathogenic yeasts and molds exist.”

“Each year, IFIs are responsible for over 1.5 million deaths globally and, in the United States alone, impose health-care costs ranging from five to seven billion dollars [1,2]. During the COVID-19 pandemic, rates of death from fungal infections have increased [3], and the burden of IFIs is poised to grow given the expanding population of patients living with immunosuppressive conditions (e.g. solid organ and stem cell transplantation), increasing antifungal resistance, and potential climate-change related expansion of the geographic ranges in which pathogenic fungi live. Despite the morbidity and mortality associated with fungal infections and their growing public health importance, we still have much to learn about their diagnosis and management. In this review, we discuss gaps and global disparities in fungal laboratory capacity including antifungal susceptibility testing, the paucity of fungal surveillance, and the importance of antifungal stewardship, all against the backdrop of increasing antifungal resistance and a limited armamentarium of antifungal therapies.”