Emerging Antifungal Resistance in Tropical Mycoses: A Genomic and Clinical Perspective From Endemic Zones.

Antifungal resistance in tropical mycoses is an increasingly important component of the global antimicrobial resistance crisis, particularly in endemic regions where diagnostic capacity, therapeutic options, and surveillance systems are limited. This review synthesizes clinical, environmental, and genomic evidence on resistance in major endemic and tropical fungal pathogens, including Histoplasma capsulatum, the Sporothrix schenckii complex, Talaromyces marneffei, the Paracoccidioides brasiliensis complex, and tropical Aspergillus fumigatus isolates. Reported mechanisms include target alteration involving ERG11/CYP51A and FKS1, overexpression of efflux transporters, altered ergosterol biosynthesis, stress response pathways, and biofilm-associated tolerance. Environmental and agricultural selection pressures, especially azole fungicide exposure, may promote the emergence of resistant strains before human infection occurs. The revised synthesis treats prevalence estimates as descriptive aggregations rather than a formal meta-analysis because included studies used heterogeneous antifungal susceptibility testing methods, breakpoints, and reporting formats. The evidence supports integrated surveillance that links clinical isolates, environmental sampling, antifungal stewardship, and genomic monitoring. Whole-genome sequencing and targeted molecular assays can shorten time to resistance detection, but genotype-phenotype discordance and incomplete resistance databases require cautious interpretation. Strengthening laboratory networks, improving access to validated diagnostics, and developing region-specific treatment guidance are essential to limit the clinical impact of antifungal resistance in endemic tropical settings.