Changing Climate, Changing Candida: Environmental and Social Pressures on Invasive Candidiasis and Antifungal Resistance in Latin America

Summary

Invasive fungal infections caused by Candida species are becoming increasingly common and dangerous in Latin American hospitals, with newer strains showing resistance to multiple antifungal drugs. Rising temperatures from climate change and widespread use of fungicides in agriculture appear to be selecting for these resistant fungi. Most hospitals in the region lack advanced diagnostic tools to quickly identify which fungal strain is causing infection, leading to delayed and sometimes inappropriate treatment. Implementing better diagnostic access, stricter antifungal use policies, and coordinated surveillance programs across the region could help control this growing public health problem.

Background

Invasive candidiasis (IC) in Latin America is experiencing a significant epidemiological shift with increasing prevalence of non-albicans strains such as Candida tropicalis, Candida parapsilosis, and Candidozyma auris that exhibit multidrug resistance. Environmental pressures including climate change and agricultural azole use are selecting for resistant and thermotolerant strains, while diagnostic limitations and socioeconomic inequalities restrict access to appropriate testing and treatment.

Objective

To examine the epidemiology, risk factors, diagnostics, and antifungal resistance patterns of invasive candidiasis in Latin America, with emphasis on environmental and social drivers of non-albicans strain emergence.

Results

Latin America exhibits high IC incidence (1.18 cases per 1000 hospital admissions) with over 60% non-albicans strains. C. auris Clade IV predominates with high azole resistance (>90%) and variable amphotericin B resistance (30-60%). Diagnostic capabilities are severely limited with advanced techniques available in only 20% of centers, concentrated in major urban areas.

Conclusion

A One Health-oriented framework combining integrated environmental surveillance, antifungal stewardship programs, broader diagnostic access, and coordinated public health actions is essential to mitigate the emerging IC challenge and slow antifungal resistance advancement in the region.
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