Improvement of fungal disease identification and management: combined health systems and public health approaches

Abstract

More than 1·6 million people are estimated to die of fungal diseases each year, and about a billion people have cutaneous fungal infections. Fungal disease diagnosis requires a high level of clinical suspicion and specialised laboratory testing, in addition to culture, histopathology, and imaging expertise. Physicians with varied specialist training might see patients with fungal disease, yet it might remain unrecognised. Antifungal treatment is more complex than treatment for bacterial or most viral infections, and drug interactions are particularly problematic. Health systems linking diagnostic facilities with therapeutic expertise are typically fragmented, with major elements missing in thousands of secondary care and hospital settings globally. In this paper, the last in a Series of eight papers, we describe these limitations and share responses involving a combined health systems and public health framework illustrated through country examples from Mozambique, Kenya, India, and South Africa. We suggest a mainstreaming approach including greater integration of fungal diseases into existing HIV infection, tuberculosis infection, diabetes, chronic respiratory disease, and blindness health programmes; provision of enhanced laboratory capacity to detect fungal diseases with associated surveillance systems; procurement and distribution of low-cost, high-quality antifungal medicines; and concomitant integration of fungal disease into training of the health workforce.

Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

“…In a multicenter study in the United States (US), the pooled 1‐year cumulative incidence of IFI in SOT recipients was 11.6% . These data were limited to SOT performed before 2005, and important risk factors for IFI such as immunosuppressive therapy, post‐transplant care, prophylactic strategies, and diagnostic tools have dramatically changed over the last decade . Thus, more recent and more broadly representative estimates of the incidence of IFI in SOT recipients are needed.…”

Screening for invasive fungal disease using non‐culture‐based assays among inpatients with advanced HIV disease at a large academic hospital in South Africa

“…Reasons for this may include a similar clinical presentation and a high prevalence of TB in the same population 16 . There is generally poor awareness of invasive mycoses among clinicians and thus relatively few requests for appropriate laboratory diagnostic tests 17 . Compounding this problem is the lack of availability and affordability of appropriate diagnostic tests, particularly for endemic mycoses.…”

A multicentre study of oral paracoccidioidomycosis: Analysis of 320 cases and literature review

“…More than 1.6 million people are estimated to die of fungal diseases worldwide each year, and about one billion people have cutaneous fungal infections (Cole, Govender, Chakrabarti, Sacarlal, & Denning, ). These lesions are on the list of neglected diseases in tropical and subtropical areas worldwide (Queiroz‐Telles et al, ; WHO Department of Control of Neglected Tropical Diseases, ).…”