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  • Review Article
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Fungal biofilms in human health and disease

Nature Reviews Microbiology volume 23, pages 355–370 (2025)Cite this article

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Abstract

Increased use of implanted medical devices, use of immunosuppressants and an ageing population have driven the rising frequency of fungal biofilm-related diseases. Fungi are now recognized by the World Health Organization (WHO) as an emergent threat to human health, with most medically important species defined as critical or high-priority organisms capable of forming biofilms. Although we strive for a better understanding of diagnostic and therapeutic approaches to detect and treat these fungal diseases more generally, the issue of hard-to-treat biofilms is an ever-increasing problem. These are communities of interspersed cells that are attached to one another on a surface, such as a catheter, or trapped into a cavity such as a paranasal sinus. Biofilms are difficult to detect, difficult to remove and intrinsically tolerant to most antifungal agents. These factors can lead to devastating consequences for the patient, including unnecessary morbidity and mortality, need for reoperations and prolonged hospital stay. This Review describes the breadth and growing impact fungal biofilms have on patient management and explains the mechanisms promoting biofilm formation, focusing on how targeting these can improve therapeutic options.

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Fig. 1: Overview of the different anatomical sites for fungal biofilm-related infections associated with abiotic and biotic surfaces.
Fig. 2: Biofilm developmental phases for priority fungal pathogens of critical importance.
Fig. 3: Genetic overview of key proteins and regulators involved in fungal biofilm development.
Fig. 4: Overview of the antifungal tolerance mechanisms in fungal biofilms.

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Acknowledgements

The authors acknowledge M. Butcher and H. Abduljalil (Glasgow Caledonian University) for their helpful comments and feedback during the development of the figures within this Review.

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Authors and Affiliations

  1. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK

    Gordon Ramage & Ryan Kean

  2. European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Biofilms, Basel, Switzerland

    Gordon Ramage, Ryan Kean, Riina Rautemaa-Richardson, Craig Williams & Jose L. Lopez-Ribot

  3. Mycology Reference Centre Manchester, ECMM Centre of Excellence, and Department of Infectious Diseases, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK

    Riina Rautemaa-Richardson

  4. Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Riina Rautemaa-Richardson

  5. Department of Microbiology, Lancaster Royal Infirmary, University Hospitals of Morecambe Bay, Lancaster, UK

    Craig Williams

  6. Department of Molecular Microbiology and Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, USA

    Jose L. Lopez-Ribot

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Correspondence to Gordon Ramage.

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Competing interests

G.R. has received speaker fees from Gilead and Mundipharma. R.R.-R. has received speaker fees from Mundipharma, Astellas, Basilea, Gilead, Pfizer and Scynexis, and is the principal investigator for phase II clinical trials for Scynexis and F2G. The other authors do not declare any conflict of interest.

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Ramage, G., Kean, R., Rautemaa-Richardson, R. et al. Fungal biofilms in human health and disease. Nat Rev Microbiol 23, 355–370 (2025). https://doi.org/10.1038/s41579-025-01147-0

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