Human fungal infections are a historically neglected area of disease research, yet they cause more than 1.5 million deaths every year. Our understanding of the pathophysiology of these infections has increased considerably over the past decade, through major insights into both the host and pathogen factors that contribute to the phenotype and severity of these diseases. Recent studies are revealing multiple mechanisms by which fungi modify and manipulate the host, escape immune surveillance and generate complex comorbidities. Although the emergence of fungal strains that are less susceptible to antifungal drugs or that rapidly evolve drug resistance is posing new threats, greater understanding of immune mechanisms and host susceptibility factors is beginning to offer novel immunotherapeutic options for the future. In this Review, we provide a broad and comprehensive overview of the pathobiology of human fungal infections, focusing specifically on pathogens that can cause invasive life-threatening infections, highlighting recent discoveries from the pathogen, host and clinical perspectives. We conclude by discussing key future challenges including antifungal drug resistance, the emergence of new pathogens and new developments in modern medicine that are promoting susceptibility to infection.

人类真菌感染历来是疾病研究中被忽视的领域，但每年却导致超过 150 万人死亡。在过去的十年中，通过对导致这些疾病的表型和严重程度的宿主和病原体因素的深入了解，我们对这些感染的病理生理学的了解大大增加。最近的研究揭示了真菌改变和操纵宿主、逃避免疫监视并产生复杂合并症的多种机制。尽管对抗真菌药物不太敏感或快速产生耐药性的真菌菌株的出现构成了新的威胁，但对免疫机制和宿主易感因素的更多了解开始为未来提供新的免疫治疗选择。在这篇综述中，我们对人类真菌感染的病理学进行了广泛而全面的概述，特别关注可能导致侵袭性危及生命的感染的病原体，强调了从病原体、宿主和临床角度的最新发现。最后，我们讨论了未来的主要挑战，包括抗真菌药物耐药性、新病原体的出现以及现代医学的新发展，这些挑战增加了感染的易感性。