Fungi such as molds, yeasts, and mushrooms can be counted among the first microorganisms that humans recognized the utility of and incorporated into daily life. In addition to helping maintain the Earth’s ecosystems by breaking down organic matter like dead plant and animal material, behind the scenes, fungi are also steadfast supporters of everyday living that drive the processes by which we brew alcohol or ferment foods such as miso and cheese. They also contribute to the production of penicillin and other pharmaceutical products.

However, some fungi can weaken the immune system. harm the body, or cause various diseases. Such diseases are referred to as “fungal infections” or “mycoses,” while harmful varieties of fungi are called “pathogenic fungi.” Fungal infections caused by pathogenic fungi are classified by the parts of the body they infect, and generally fall into one of two categories: superficial mycoses, which are skin conditions like athlete’s foot; or deep mycoses, which can cause symptoms that affect the organs and include infections like mucormycosis and candidiasis. In particular, deep mycoses are said to carry a high risk of resulting in serious, life-threatening medical conditions. Some people are highly vulnerable to deep mycoses, including those with weakened immune systems or in poor general condition, such as patients undergoing organ transplantation, chemotherapy, or immunosuppressive therapy for autoimmune diseases.

While deep mycoses can be treated with antifungals, in recent years, some fungi that have acquired antimicrobial resistance (AMR) have emerged, making such treatments less effective. Antifungal resistance is now becoming a global problem. One such fungi that has become the focus of a great amount of attention is Candida auris (C. auris).

C. auris was discovered in Japan in 2009 by Professor Koichi Makimura, who isolated it from the ear discharge of a patient with a chronic middle ear infection. This domestic strain is less pathogenic and was originally the only strain detected in Japan. Since 2009, many countries around the world have started to report the detection of highly pathogenic, antifungal-resistant strains of C. auris (hereafter, “non-Japanese strains”). In 2022, it was estimated that over 2,300 people were infected with non-Japanese strains of C. auris in the United States, with a crude mortality rate of up to 72% among those infected. Non-Japanese strains of C. auris have already developed resistance to many antifungals. In light of this urgent situation, the World Health Organization (WHO) published its first Fungal Priority Pathogens List that same year, in 2022.

Japan reported its first mortality caused by a strain of C. auris that originated overseas in May 2023, leading the Ministry of Health, Labour and Welfare (MHLW) to issue an alert. The appearance of highly-pathogenic strains originating overseas in Japan is believed to be the result of the widespread travel across international borders that occurs today. As the movement of people and goods grows more and more active, some are concerned that domestic outbreaks of strains originating abroad will grow more widespread in the near future.

In the context of growing demand for measures to combat antifungal resistance around the world, progress must be made on similar discussions in Japan, as well. Fungi are eukaryotes and have cellular structures that are more similar to humans than to bacteria or viruses, so there are unique challenges to developing pharmaceuticals or testing equipment with the capacity to specifically target or detect only fungi. Fungi can also survive in the environment for long periods of time, so focused efforts must be made to devise infection prevention measures. We must now reconsider the priority of issues that are specific to fungal infections within the broader context of AMR control and determine how to advance countermeasures.

HGPI first began holding discussions on AMR control in 2016 and continues to engage in activities that aim to promote policies against AMR. We hope this seminar will contribute to comprehensive discussions on future AMR countermeasures.

[Event Overview]

• Speakers:
  Prof. Koichi Makimura (Deputy Director, Institute of Medical Mycology Professor; Vice-Director, Teikyo University)
  Dr. Yoshitsugu Miyazaki (Director-General, Department of Fungal Infection, National Institute of Infectious Diseases; Director, Leprosy Research Center, National Institute of Infectious Diseases)
  Prof. Yuka Yamagishi (Professor, Department of Clinical Infectious Diseases, Kochi Medical School; Professor, Department of Infectious Diseases, Kochi Medical School Hospital; Director, Department of Infection Control and Prevention, Kochi Medical School Hospital)
• Date & Time: Friday, August 23,2024; from 18:00 to 19:30 JST
• Format: Online (Zoom webinar)
• Language: Japanese
• Participation Fee: Free
• Capacity: 500 participants

■Profiles:

Prof. Koichi Makimura (Deputy Director, Institute of Medical Mycology Professor; Vice-Director, Teikyo University)
Dr. Koichi Makimura MD PhD graduated from Tokyo Medical University (1990) and completed postgraduate studies at Teikyo University. After a fellowship at Tampa Bay Research Institute (1992), he joined Teikyo University Institute of Medical Mycology in 1994. He became a professor in 2011 and Vice Director of the Center in 2021. Notably, he served as the principal investigator for microbiology research in the Japanese Experiment Module of the International Space Station. His research focuses on fungi affecting human health, spanning environments from hospitals to zoos and ancient ruins. Dr. MAKIMURA continues to contribute to all aspects of medical mycology.

Dr. Yoshitsugu Miyazaki (Director-General, Department of Fungal Infection, National Institute of Infectious Diseases; Director, Leprosy Research Center, National Institute of Infectious Diseases)
Dr. Yoshitsugu Miyazaki is an expert in internal medicine, particularly infectious diseases, medical mycology, and respiratory medicine. He was appointed as the Director-General of the Department of Fungal Infection since its establishment at the National Institute of Infectious Diseases (NIID) in 2013. He has been concurrently serving as Director of the Leprosy Research Center at NIID since 2019. He also serves as a member of the Pharmaceutical Affairs Council of the Ministry of Health, Labour, and Welfare’s Medical Device and Regenerative Medicine Product Safety Committee.
Dr. Miyazaki joined NIID as Director-General of the Department of Chemotherapy and Mycosis in 2007. Before joining NIID, he was a lecturer in the Department of Laboratory Medicine and the Second Department of Internal Medicine at Nagasaki University Hospital. In 1995 he was a fellow in the National Institutes of Health (NIH) in the United States. In 1994 he worked at the Imari Municipal Hospital.
Dr. Miyazaki graduated from Nagasaki University School of Medicine in 1988. He also has a PhD in Medicine from Nagasaki University.

Prof. Yuka Yamagishi (Professor, Department of Clinical Infectious Diseases, Kochi Medical School; Professor, Department of Infectious Diseases, Kochi Medical School Hospital; Director, Department of Infection Control and Prevention, Kochi Medical School Hospital)
Prof. Yuka Yamagishi, MD, PhD, graduated from Juntendo University Faculty of Medicine and trained as a pediatrician at Gifu University Hospital and in the Department of Infection Control and Prevention at Aichi Medical University Hospital. Before joining Kochi University, she was an associate professor (2016) and a professor (April 2017) of the Clinical Infectious Diseases Program in the Graduate School of Medicine at Aichi Medical University. Dr. Yamagishi became a professor of Infectious Diseases and the Director of Infection Control, Kochi Medical School Hospital on July 2021, and has also served as a professor in the Department of Clinical Infectious Diseases at Kochi Medical School since 2022.
Dr. Yamagishi’s qualifications include certified clinical laboratory physician of the Japanese Society of Laboratory Medicine, board certified pediatrician and board certified supervisor of pediatrics. She is also an infectious disease specialist and consultant of the Japanese Association for Infectious Diseases. Dr. Yamagishi is active in several associations; she serves as a board member of the Japan Society of Chemotherapy, the Japanese Society for Medical Mycology, the Japanese Society for Sexually Transmitted Infections, and the Japan Society of Surgical Infection.