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世衛(wèi)組織警告:真菌感染是對(duì)公共健康的“嚴(yán)重威脅”

ELEANOR PRINGLE
2023-02-16

專家估計(jì),每年約有200萬(wàn)人死于真菌感染。

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煙曲霉菌子實(shí)體的電腦示意圖,這種真菌可能降低人體免疫力,引發(fā)多種疾病。圖片來(lái)源:KATERYNA KON/SCIENCE PHOTO LIBRARY/GETTY IMAGES

HBO的熱門(mén)劇集《最后生還者》(The Last of Us)的觀眾人數(shù)以百萬(wàn)計(jì),人們反復(fù)觀看這部劇集,卻很少有人能想到,這部劇集是以現(xiàn)實(shí)為基礎(chǔ)。

這部劇的編劇表示,它的前提是一種真菌感染毀滅了整個(gè)世界,而事實(shí)上,世界衛(wèi)生組織(World Health Organization)同樣擔(dān)心真菌感染問(wèn)題。

2022年10月,世衛(wèi)組織發(fā)布了第一份真菌“重點(diǎn)病原體”清單,并發(fā)出了一系列可怕的警告。世衛(wèi)組織列出了變得更普遍和更難治療的真菌病原體,目前醫(yī)療專業(yè)人員只有四類藥物可用于治療這些病原體。

一系列真菌可能引發(fā)疾病,這些真菌無(wú)處不在,從寬敞的戶外,到室內(nèi)的表面,甚至人體內(nèi),都有真菌存在。真菌感染會(huì)引發(fā)各種健康問(wèn)題,包括皮膚感染、哮喘或肺炎等肺部疾病、血流感染、皮癬、腦膜炎或結(jié)核菌株等。

雖然許多真菌感染被認(rèn)為是微不足道的日常小問(wèn)題,例如腳氣或酵母菌感染等,但其他侵入性感染卻會(huì)給免疫力低下的患者或患有嚴(yán)重基礎(chǔ)病的患者帶來(lái)巨大風(fēng)險(xiǎn)。專家估計(jì),每年約有200萬(wàn)人死于真菌感染。

“從陰影中出現(xiàn)”

世衛(wèi)組織抗微生物藥物耐藥性(AMR)事務(wù)助理總干事哈南·巴爾基博士在去年10月的新聞稿中表示,當(dāng)全世界忙于應(yīng)對(duì)新冠的時(shí)候,真菌感染“從陰影中出現(xiàn)”,并且耐藥性更強(qiáng)。

因此,世衛(wèi)組織開(kāi)始列舉增加對(duì)這些病原體的開(kāi)發(fā)研究以確定它們的危險(xiǎn)性和抗藥性的理由。

世衛(wèi)組織在公布真菌“重點(diǎn)病原體”清單時(shí)強(qiáng)調(diào),目前對(duì)于這些病原體沒(méi)有足夠的證據(jù)或知識(shí),能夠充分了解這些病原體對(duì)公共健康帶來(lái)的“負(fù)擔(dān)”。

然而,聯(lián)合國(guó)官員表示,各國(guó)可以開(kāi)始采取措施,例如增強(qiáng)實(shí)驗(yàn)室能力,保證現(xiàn)有治療藥物的公平分配等,應(yīng)對(duì)可能危險(xiǎn)的真菌感染。

我們以前為何從未聽(tīng)說(shuō)過(guò)真菌感染的危險(xiǎn)?

專家對(duì)《財(cái)富》雜志表示,真菌感染長(zhǎng)期以來(lái)就在我們的眼皮底下,卻沒(méi)有引起公共健康部門(mén)的關(guān)注。

傳染病學(xué)專家、倫敦大學(xué)學(xué)院附屬醫(yī)院(University College London Hospitals)的真菌感染負(fù)責(zé)人尼爾·斯通博士在電話中表示:“一想到真菌感染,我們就會(huì)想起一些奇怪或令人尷尬的事情,這些都是繁瑣和膚淺的問(wèn)題。一直以來(lái),我們都忽視了這些疾病,人們可能要花數(shù)十年時(shí)間才能重視起來(lái)。”

曼徹斯特大學(xué)(University of Manchester)傳染病學(xué)教授大衛(wèi)·丹寧補(bǔ)充道,真菌感染不僅被一個(gè)單調(diào)的名稱所掩蓋,甚至不屬于任何特定公共部門(mén)的職權(quán)范圍。

他表示,這是因?yàn)檎婢腥炯膊】缭搅吮姸噌t(yī)療領(lǐng)域,而且經(jīng)常會(huì)被誤診。他指出,感染和死于真菌感染的人數(shù)在不斷增多。病例數(shù)增加有許多原因,包括:壽命延長(zhǎng)、氣候變化、旅行和抗藥性等。

倫敦大學(xué)學(xué)院的斯通表示,抗藥性是關(guān)鍵,因?yàn)獒t(yī)療專業(yè)人員用于治療真菌病的有限藥物,經(jīng)常在人類和動(dòng)物體內(nèi)被過(guò)度使用。

真菌感染多久會(huì)成為一個(gè)嚴(yán)重問(wèn)題?

然而,有一些好消息。斯通表示,真菌感染人數(shù)不會(huì)像新冠疫情一樣“爆炸性”增長(zhǎng)。

他還表示,新冠疫情已經(jīng)證明,在必要的時(shí)候,醫(yī)學(xué)界能迅速團(tuán)結(jié)起來(lái)解決問(wèn)題,但他指出,開(kāi)發(fā)更好的診斷方法和擴(kuò)充“少得可憐的”藥物清單,必須是首要任務(wù)。

曼徹斯特大學(xué)的丹寧解釋稱,應(yīng)對(duì)真菌感染人數(shù)增加的措施,將以不同的速度展開(kāi)。丹寧同時(shí)擔(dān)任全球真菌感染行動(dòng)組織(Global Action for Fungal Infections,GAFFI)的首席執(zhí)行官。

他對(duì)《財(cái)富》雜志表示:“在有些方面,我們可以迅速行動(dòng),以產(chǎn)生巨大的影響??焖僭\斷就是其中之一。我們可以指導(dǎo)人們?nèi)绾魏?jiǎn)單地使用檢測(cè)試劑,其單價(jià)只有約4美元。”

他表示,從長(zhǎng)遠(yuǎn)來(lái)看,為了減少誤診和確定最容易真菌感染的患者群體,培訓(xùn)真菌感染領(lǐng)域的醫(yī)生和臨床與實(shí)驗(yàn)室參與是關(guān)鍵。之后,公共健康部門(mén)就可以更輕松地收集和分享相關(guān)數(shù)據(jù)。

公眾需要做些什么?

專家表示,首先人們要認(rèn)識(shí)到,真菌感染不只是腳氣。

除此之外,丹寧教授認(rèn)為,有一些群體可能需要向醫(yī)療專業(yè)人員討論自己的癥狀。

他說(shuō)道:“如果你免疫力低下,或許你有胸部或皮膚問(wèn)題,如果你是一名女性,經(jīng)常感染酵母菌,下一次看醫(yī)生的時(shí)候不要只是購(gòu)買類固醇藥膏或處方藥,而是問(wèn)問(wèn)醫(yī)生:‘這是真菌感染嗎?’真菌感染檢查沒(méi)有什么特別,只是這并不是常規(guī)檢查。公眾需要提高對(duì)于真菌感染疾病的認(rèn)識(shí)?!保ㄘ?cái)富中文網(wǎng))

翻譯:劉進(jìn)龍

審校:汪皓

HBO的熱門(mén)劇集《最后生還者》(The Last of Us)的觀眾人數(shù)以百萬(wàn)計(jì),人們反復(fù)觀看這部劇集,卻很少有人能想到,這部劇集是以現(xiàn)實(shí)為基礎(chǔ)。

這部劇的編劇表示,它的前提是一種真菌感染毀滅了整個(gè)世界,而事實(shí)上,世界衛(wèi)生組織(World Health Organization)同樣擔(dān)心真菌感染問(wèn)題。

2022年10月,世衛(wèi)組織發(fā)布了第一份真菌“重點(diǎn)病原體”清單,并發(fā)出了一系列可怕的警告。世衛(wèi)組織列出了變得更普遍和更難治療的真菌病原體,目前醫(yī)療專業(yè)人員只有四類藥物可用于治療這些病原體。

一系列真菌可能引發(fā)疾病,這些真菌無(wú)處不在,從寬敞的戶外,到室內(nèi)的表面,甚至人體內(nèi),都有真菌存在。真菌感染會(huì)引發(fā)各種健康問(wèn)題,包括皮膚感染、哮喘或肺炎等肺部疾病、血流感染、皮癬、腦膜炎或結(jié)核菌株等。

雖然許多真菌感染被認(rèn)為是微不足道的日常小問(wèn)題,例如腳氣或酵母菌感染等,但其他侵入性感染卻會(huì)給免疫力低下的患者或患有嚴(yán)重基礎(chǔ)病的患者帶來(lái)巨大風(fēng)險(xiǎn)。專家估計(jì),每年約有200萬(wàn)人死于真菌感染。

“從陰影中出現(xiàn)”

世衛(wèi)組織抗微生物藥物耐藥性(AMR)事務(wù)助理總干事哈南·巴爾基博士在去年10月的新聞稿中表示,當(dāng)全世界忙于應(yīng)對(duì)新冠的時(shí)候,真菌感染“從陰影中出現(xiàn)”,并且耐藥性更強(qiáng)。

因此,世衛(wèi)組織開(kāi)始列舉增加對(duì)這些病原體的開(kāi)發(fā)研究以確定它們的危險(xiǎn)性和抗藥性的理由。

世衛(wèi)組織在公布真菌“重點(diǎn)病原體”清單時(shí)強(qiáng)調(diào),目前對(duì)于這些病原體沒(méi)有足夠的證據(jù)或知識(shí),能夠充分了解這些病原體對(duì)公共健康帶來(lái)的“負(fù)擔(dān)”。

然而,聯(lián)合國(guó)官員表示,各國(guó)可以開(kāi)始采取措施,例如增強(qiáng)實(shí)驗(yàn)室能力,保證現(xiàn)有治療藥物的公平分配等,應(yīng)對(duì)可能危險(xiǎn)的真菌感染。

我們以前為何從未聽(tīng)說(shuō)過(guò)真菌感染的危險(xiǎn)?

專家對(duì)《財(cái)富》雜志表示,真菌感染長(zhǎng)期以來(lái)就在我們的眼皮底下,卻沒(méi)有引起公共健康部門(mén)的關(guān)注。

傳染病學(xué)專家、倫敦大學(xué)學(xué)院附屬醫(yī)院(University College London Hospitals)的真菌感染負(fù)責(zé)人尼爾·斯通博士在電話中表示:“一想到真菌感染,我們就會(huì)想起一些奇怪或令人尷尬的事情,這些都是繁瑣和膚淺的問(wèn)題。一直以來(lái),我們都忽視了這些疾病,人們可能要花數(shù)十年時(shí)間才能重視起來(lái)?!?/p>

曼徹斯特大學(xué)(University of Manchester)傳染病學(xué)教授大衛(wèi)·丹寧補(bǔ)充道,真菌感染不僅被一個(gè)單調(diào)的名稱所掩蓋,甚至不屬于任何特定公共部門(mén)的職權(quán)范圍。

他表示,這是因?yàn)檎婢腥炯膊】缭搅吮姸噌t(yī)療領(lǐng)域,而且經(jīng)常會(huì)被誤診。他指出,感染和死于真菌感染的人數(shù)在不斷增多。病例數(shù)增加有許多原因,包括:壽命延長(zhǎng)、氣候變化、旅行和抗藥性等。

倫敦大學(xué)學(xué)院的斯通表示,抗藥性是關(guān)鍵,因?yàn)獒t(yī)療專業(yè)人員用于治療真菌病的有限藥物,經(jīng)常在人類和動(dòng)物體內(nèi)被過(guò)度使用。

真菌感染多久會(huì)成為一個(gè)嚴(yán)重問(wèn)題?

然而,有一些好消息。斯通表示,真菌感染人數(shù)不會(huì)像新冠疫情一樣“爆炸性”增長(zhǎng)。

他還表示,新冠疫情已經(jīng)證明,在必要的時(shí)候,醫(yī)學(xué)界能迅速團(tuán)結(jié)起來(lái)解決問(wèn)題,但他指出,開(kāi)發(fā)更好的診斷方法和擴(kuò)充“少得可憐的”藥物清單,必須是首要任務(wù)。

曼徹斯特大學(xué)的丹寧解釋稱,應(yīng)對(duì)真菌感染人數(shù)增加的措施,將以不同的速度展開(kāi)。丹寧同時(shí)擔(dān)任全球真菌感染行動(dòng)組織(Global Action for Fungal Infections,GAFFI)的首席執(zhí)行官。

他對(duì)《財(cái)富》雜志表示:“在有些方面,我們可以迅速行動(dòng),以產(chǎn)生巨大的影響??焖僭\斷就是其中之一。我們可以指導(dǎo)人們?nèi)绾魏?jiǎn)單地使用檢測(cè)試劑,其單價(jià)只有約4美元。”

他表示,從長(zhǎng)遠(yuǎn)來(lái)看,為了減少誤診和確定最容易真菌感染的患者群體,培訓(xùn)真菌感染領(lǐng)域的醫(yī)生和臨床與實(shí)驗(yàn)室參與是關(guān)鍵。之后,公共健康部門(mén)就可以更輕松地收集和分享相關(guān)數(shù)據(jù)。

公眾需要做些什么?

專家表示,首先人們要認(rèn)識(shí)到,真菌感染不只是腳氣。

除此之外,丹寧教授認(rèn)為,有一些群體可能需要向醫(yī)療專業(yè)人員討論自己的癥狀。

他說(shuō)道:“如果你免疫力低下,或許你有胸部或皮膚問(wèn)題,如果你是一名女性,經(jīng)常感染酵母菌,下一次看醫(yī)生的時(shí)候不要只是購(gòu)買類固醇藥膏或處方藥,而是問(wèn)問(wèn)醫(yī)生:‘這是真菌感染嗎?’真菌感染檢查沒(méi)有什么特別,只是這并不是常規(guī)檢查。公眾需要提高對(duì)于真菌感染疾病的認(rèn)識(shí)?!保ㄘ?cái)富中文網(wǎng))

翻譯:劉進(jìn)龍

審校:汪皓

The millions of viewers who kicked back and watched HBO’s hit series The Last of Us are unlikely to think the show is grounded in much reality.

However, the drama’s writer has defended the premise?that the world could be brought to its knees by a mere fungal infection—and as it turns out, the World Health Organization is worried about it too.

In October 2022, the WHO released the first-ever list of fungal “priority pathogens,” as well as a series of stark warnings. The body outlined that fungal pathogens are becoming both more common and more resistant to treatment, with health professionals having just four classes of medicine available to combat them.

Diseases can be brought on by a range of fungi found everywhere?from the great outdoors to indoor surfaces to inside the human body. These can develop into a raft of health problems including skin infections, lung conditions such as asthma or pneumonia, bloodstream infections, ringworm, meningitis, or strains of tuberculosis.

And although many fungal infections are seen as minor everyday problems—such as athlete’s foot or yeast infections—other invasive forms pose a major risk to immunocompromised patients or those with severe underlying health conditions. Experts estimate that around 2 million people die of fungal infections every year.

‘Emerging from the shadows’

While the world was busy battling COVID, fungal infections began “emerging from the shadows” in more treatment-resistant forms, Dr. Hanan Balkhy, the WHO’s assistant director-general of antimicrobial resistance (AMR), said in an October news release.

As a result, the the organization has begun outlining the case for increasing research and development into these pathogens to establish how dangerous and drug-proof they are.

The WHO emphasized when it published its list of priority fungi that there currently isn’t enough evidence or knowledge of these pathogens to fully understand the “burden” they could have on public health.

However, officials at the U.N. agency said countries could get a head start against potentially dangerous fungal infections by taking steps like strengthening their laboratory capacities and ensuring equitable access to existing treatments.

Why haven’t we heard about this before?

Fungal infections have long been hiding in plain sight and slipping through the cracks of public health bodies, experts told Fortune.

“When we think of fungal infections we think of something a bit weird or embarrassing, something that’s trivial and superficial,” Dr. Neil Stone, a specialist in infectious diseases and University College London Hospitals’ fungal infections lead, said in a phone call. “There’s been a legacy of neglect in looking at these diseases, and it’s taken decades to get people to pay attention.”

As well as masquerading behind a humdrum title, these infections haven’t fallen under the remit of any specific public body to address, added David Denning, a professor of infectious diseases at the University of Manchester.

That’s because these diseases span a vast range of practices and are also often misdiagnosed, he said, noting that the number of people contracting and dying of fungal infections is only increasing. The case numbers are going up because of a range of factors: longer life spans, climate change, travel, and resistance to drugs.

Drug resistance is a key issue, added UCL’s Stone, because the limited arsenal medical professionals do have to fight fungal disease is often overused in both humans and animals.

How quickly will this be a problem?

However, there is some good news. Stone said it’s unlikely the rise in these infections will be anywhere near as “explosive” as the COVID pandemic.

He added that the coronavirus outbreak proved how quickly the medical community can come together to troubleshoot when needed, but noted that developing better diagnosis streams and expanding a “pitiful” repertoire of drugs must be top priorities.

Moves to combat the rise of fungal infections will proceed at varying paces, explained Manchester University’s Denning, who also serves as chief executive of Global Action for Fungal Infections (GAFFI).

“There are things we can do quickly which have a big impact,” he told Fortune. “Rapid diagnostics is one of them—we can teach someone how to use a test really easily, and they only cost about $4 each.”

In the long term, training doctors in the field and linking clinical and laboratory engagement is essential, in order to cut down on misdiagnosis and establish which groups of patients are most susceptible to which disease, he added. From there data can be more easily collected and shared by public health bodies.

What does the public need to do?

Being aware that fungal diseases are more than just athlete’s foot is a good place to start, the experts said.

On top of this, there are a few groups of people who might need to chat to a health professional about their symptoms, added Professor Denning.

“If you’re immunocompromised, maybe you have a bad chest or bad skin, or you’re a woman who suffers with recurring yeast infections, then next time you go to the doctor instead of getting a steroid cream or prescription, ask: ‘Is this a fungal infection?'” he said. “The tests are very similar, they’re just not done as routinely. There just needs to be a general awareness of these diseases.”

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