Vaccines have been hailed as one of the greatest achievements in the public health during the past century. So far, the development of safe and efficacious vaccines has been a major barrier for other infectious agents including fungi, partly due to of our lack of knowledge about the mechanisms that underpin protective immunity. Although fungi are responsible for pulmonary manifestations and cutaneous lesions in apparently immunocompetent individuals, their impact is most relevant in patients with severe immunocompromised, in which they can cause severe, life-threatening forms of infection. As an increasing number of immunocompromised individuals resulting from intensive chemotherapy regimens, bone marrow or solid organ transplantation, and autoimmune diseases have been witnessed in the last decades, so has the incidence of fungal diseases.
Vaccine development is a priority for several fungal pathogens, including C. albicans, C. neoformans, A. fumigatus, and dimorphic fungi. Many challenges confront vaccine development for fungi, including different host risk factors and modes of fungal pathogenesis. No single antigen can be expected to be used in a "pan-fungal" vaccine; rather, specific tailored vaccines will be required for the major fungal pathogens.
Immunotherapy can be evaluated as preventive or as adjunctive therapy. Prevention should be targeted to patients at significant risk for the infection of interest and should focus on infections with significant morbidity or mortality that are inadequately covered by standard therapies. One challenge relates to accrual of adequate numbers of patients in trials involving uncommon infections.