Opportunistic fungal pathogens can cause a diverse range of diseases in humans. The increasing rate of fungal infections caused by strains that are resistant to commonly used antifungals results in difficulty to treat diseases, with accompanying high mortality rates. Existing and newly emerging molecular resistance mechanisms rapidly spread in fungal populations and need to be monitored. Fungi exhibit a diversity of mechanisms to maintain physiological resilience and create genetic variation; processes which eventually lead to the selection and spread of resistant fungal pathogens. To prevent and anticipate this dispersion, the role of evolutionary factors that drive fungal adaptation should be investigated. In this review, we provide an overview of resistance mechanisms against commonly used antifungal compounds in the clinic and for which fungal resistance has been reported. Furthermore, we aim to summarize and elucidate potent generators of genetic variability across the fungal kingdom that aid adaptation to stressful environments. This knowledge can lead to recognizing potential niches that facilitate fast resistance development and can provide leads for new management strategies to battle the emerging resistant populations in the clinic and the environment.

中文翻译：

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临床相关真菌中适应性和抗真菌抗性机制的促进剂。

机会性真菌病原体可以引起人类多种疾病。由对常用抗真菌剂有抗性的菌株引起的真菌感染率增加导致难以治疗疾病，并伴随着高死亡率。现有和新兴的分子抗性机制在真菌种群中迅速传播，需要对其进行监测。真菌表现出多种机制来维持生理弹性并产生遗传变异。最终导致抗性真菌病原体的选择和传播的过程。为防止和预期这种分散，应研究驱动真菌适应的进化因子的作用。在这篇评论中，我们提供了临床上针对常用抗真菌化合物的耐药机制的概述，并已报道了其对真菌的耐药性。此外，我们旨在总结和阐明真菌王国中遗传变异的有效生成器，这些遗传器有助于适应压力环境。这些知识可以导致识别有助于快速耐药性发展的潜在利基，并且可以为在诊所和环境中与新出现的耐药性种群作斗争的新管理策略提供线索。