PEARLS A Case for Two-Component Signaling Systems As Antifungal Drug Targets

The recent outbreak of fungal meningitis caused by Exserohilum rostratum in patients receiv-ing contaminated steroid injections resulted in 64 deaths, receiving a lot of press and briefly bringing into the public eye the difficulty of treating systemic fungal infections [1]. What is generally less well appreciated, however, is that there are several other, much more common fungal pathogens that pose a serious health threat. Indeed, currently more people die from these fungal diseases worldwide than from tuberculosis or malaria [2]. The fungal pathogens most frequently responsible for human mortality are: Aspergillus fumigatus, Candida spp. (pre-dominantly C. albicans), Cryptococcus neoformans, Pneumocystis carinii, and dimorphic fungi that cause endemic mycoses (Coccidioides immitis, Histoplasma capsulatum, Blastomyces der-matitides, and Paracoccidioides brasiliensis). Fungal pathogens pose an especially high risk to individuals with compromised immunity, and this population of susceptible hosts is growing [3,4]. There has been a steady increase in the incidence of fungal infections over recent decades, primarily due to the AIDS pandemic, an increase in patients receiving cancer chemotherapy and allogeneic bone marrow transplants, a higher incidence of seriously ill patients in intensive care units, and the aging of the human population [3–8]