Abstract

Fungal pathogens cause over 1.7 million deaths annually, comparable to tuberculosis and
malaria, yet they remain critically neglected in public health priorities, research funding, and
surveillance systems. This comprehensive review synthesizes evidence from 130 studies
(2010- 2025) examining the global burden, emerging threats, and systemic neglect of fungal
diseases. Major fungal pathogens
including Candida, Aspergillus, Cryptococcus, Pneumocystis, and emerging fungi such
as Candida auris and drug resistant dermatophytes cause life threatening infections, particularly among immunocompromised populations (HIV, cancer, transplant, ICU patients). Climate change is driving geographic expansion and novel emergence, including Coccidioides (Valley fever) and Histoplasma. Antifungal resistance is rising, with
multidrug resistant C. auris spreading globally and azole resistant Aspergillus
fumigatus linked to agricultural fungicide use. Despite the burden, fungal diseases receive less
than 1.5% of infectious disease research funding, are absent from many national disease
surveillance systems, and lack rapid diagnostics and affordable treatments in low resource
settings. The COVID- 19 pandemic exacerbated fungal threats, with COVID- 19 associated
aspergillosis and candidiasis contributing to excess mortality. We recommend integrating
fungal pathogens into WHO priority pathogen lists, establishing global surveillance networks, investing in diagnostics and antifungal development, and including fungal threats in pandemic
preparedness frameworks. Fungal neglect is a preventable public health failure.