Over the past few days, reports have been gathered from hospitals in Israel about soldiers who were infected with a dangerous fungus while fighting in the Gaza Strip. Medint researcher Rotem Sisso explains what those dangerous fungi are, where they are found, who is at risk of infection and what is the new medicine that gives hope to infected patients.

On the walls of our houses and deep in the woods - what are fungi?

Fungi are actually a group of organisms, and one of the most common life forms on Earth. Some fungi, or mushrooms, are common products in the home kitchen, and others have an important role in the breakdown and removal of pollutants from the environment, helping to maintain a proper environmental balance.

Molds are a subfamily of fungi that form branching patterns, similar to webs. Molds feed on various food sources, including plants, walls and household foods. While many fungi and molds are harmless, some are capable of causing superficial, cutaneous, and subcutaneous infections, and even disseminated and significant diseases in humans.

While some infections can develop in healthy people, most severe infections develop in patients with underlying diseases associated with the weakening of the immune system, and in patients in whom the body’s various defense systems are damaged.

The harmful mold from Gaza - Fusarium

Recently, reports of soldiers infected with a harmful mold called Fusarium during the fighting in the Gaza Strip have been accumulating in Israeli hospitals. The mold, most species of which are not dangerous to humans, is found mainly in plants and soil, and it seems that the soldiers who were infected with the harmful strain were injured, such that the skin barrier, which is considered one of the most important in the body’s defense systems, was damaged.

Fusarium can cause a wide variety of diseases in humans: from superficial infections such as corneal infections (keratitis) and nail infections (onychomycosis) to diseases such as sinusitis, and even disseminated and severe infections. The main issue in dealing with violent strains of fungi and molds, including Fusarium, is that of prevention – i.e., trying to ensure that seriously ill or injured patients remain in sterile environments and are not accidentally exposed to the fungus. In case of infection, there are several antifungal drugs that should help, as well as surgical treatments, in which the tissue infected with the fungus is removed in order to prevent it from spreading.

Resistance: The major challenge facing the medical world

One of the main issues today in the treatment of harmful fungi is the development of fungi resistant to existing drugs. The primary reason for the development of resistant strains is the exposure of fungi to drugs that are administered in an uncontrolled or inappropriate manner, as well as the use of antifungal preparations in the agriculture industry to protect crops from the spread of harmful fungi and molds.

This is a significant challenge for the treating physicians, since sometimes, despite optimal treatment with the available drugs, the infection cannot be controlled.

Pfizer's new treatment

In March 2023, the results of a clinical trial on a new anti-inflammatory drug from Pfizer, Fosmanogepix, were published. The drug damages an important structure in the fungus called the cell wall. In the absence of a normal cell wall, the fungus cannot function, and dies. The published study included 151 young patients aged 23 – 35 years old, and proved that the drug is safe to use and has only minor side effects.

Last June, a report was also published about the successful use of the drug in a 14 year old boy with an immune deficiency disorder who was infected with a treatment-resistant strain of Fusarium that caused a severe skin infection.

The new treatment represents hope for the treatment of resistant fungi and molds, and can help many patients. In Israel, there are calls from doctors to import the new medication to the country for the treatment of difficult cases, such as the reported cases of soldiers who contracted the fungus during the fighting.

As noted, fungi and molds are an integral and important part of our environment, and are critical to our continued existence on Earth. However, we must be aware of the dangers they may present and try to maintain our body’s natural defense systems. In case of injury, dressing the exposed area and maintaining proper hygiene may help reduce the risk of infection. We hope that raising awareness will help reduce infections, and we wish all of our soldiers a safe and healthy return to civilian life.