Antifungal persistence: Clinical relevance and mechanisms

Abstract

Antifungal persistence is the phenomenon that occurs when a subpopulation of fungal cells can survive in the presence of high concentrations of antifungal drugs, which is different from the concepts of antifungal resistance and tolerance. Fungal persisters are not mutants but phenotypic variants of normal cells, entering a dormant state with low metabolism and proliferation. Previous studies have shown that antifungal persistence may lead to therapeutic failure, as well as chronic or recurrent fungal infections in clinical settings. This review provides a comprehensive overview of antifungal persistence covering its definition, distinctions from other related concepts, detection methods, and molecular mechanisms of formation. Importantly, we discuss relevant in vivo experiments and clinical observations to assess clinical relevance of antifungal persistence.