Eukaryotic microbial pathogens are major contributors to illness and death globally. Although much of their impact can be controlled by drug therapy as with prokaryotic microorganisms, the emergence of drug resistance has threatened these treatment efforts. Here, we discuss the challenges posed by eukaryotic microbial pathogens and how these are similar to, or differ from, the challenges of prokaryotic antibiotic resistance. The therapies used for several major eukaryotic microorganisms are then detailed, and the mechanisms that they have evolved to overcome these therapies are described. The rapid emergence of resistance and the restricted pipeline of new drug therapies pose considerable risks to global health and are particularly acute in the developing world. Nonetheless, we detail how the integration of new technology, biological understanding, epidemiology and evolutionary analysis can help sustain existing therapies, anticipate the emergence of resistance or optimize the deployment of new therapies.The identification and use of antibiotics are some of the great medical achievements of the twentieth century, saving count-less lives by controlling the risk of infection from contagion, after injury, surgery or in immunosuppressed individuals. However, in only 80 years since the introduction of penicillin, resistance to a broad range of antibiotic drugs has become widespread, with the compounded risk from multidrug-resistant bacterial infections severely limiting treatment options. This has created justified concern and global attention, not only * keith.matthews@ed.ac.uk.
Author contributionsAll authors contributed equally to the preparation of the manuscript.
Additional informationReprints and permissions information is available online at www.nature.com/reprints. Correspondence should be addressed to K.R.M.
Competing interestsThe authors declare no competing financial interests.
Europe PMC Funders GroupAuthor Manuscript Nat Microbiol. Author manuscript; available in PMC 2017 January 05.Published in final edited form as: Nat Microbiol. ; 1(7): 16092. doi:10.1038/nmicrobiol.2016.92.
Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts in the medical community but also at government level, in the media and the general public1.While predominantly applied to control prokaryotic microbial infections, the threat of disease from eukaryotic microorganisms has also been contained by therapeutic drugspreventing or controlling disease caused by eukaryotic parasites and fungi in both a human and animal health setting. These represent some of the most important disease-causing agents (Table 1), particularly in the tropics, where the distribution of a pathogen is frequently linked to the distribution of the arthropods that act as disease vectors. Such vector-borne parasites include malaria (Plasmodium spp.) and kineto-plastid parasites (Trypanosoma cruzi, which causes Chagas disease; Trypanosoma brucei gambiense and T. b. rhodesiense, which cause human African trypanosomiasis (HAT); and 17 Le...