Diagnostic Mycology Laboratories Should Have a Central Role for the Management of Fungal Disease

• Published in: Journal of fungi (Basel) Vol. 8; no. 12; p. 1285
• Main Authors: Medina, Narda, Alastruey-Izquierdo, Ana, Mercado, Danicela, Denning, David W, Arathoon, Eduardo, Rodriguez-Tudela, Juan Luis
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.12.2022; MDPI
• Subjects: Antifungal agents; Bias; CD4 antigen; Control systems; Cryptococcosis; Decision making; Differential diagnosis; Disease; FDA approval; Fungal diseases; Fungal infections; Health aspects; Histoplasmosis; HIV; HIV (Viruses); HIV patients; HIV testing; Human immunodeficiency virus; Infection; Laboratories; Latin America; Medical practices; Medical screening; Microorganisms; Opinion; opportunistic infections; Pathogens; Patients; Public health; Tuberculosis; Guatemala; opportunistic infections; HIV; tuberculosis; histoplasmosis; cryptococcosis; public health; Latin America
• ISSN: 2309-608X; 2309-608X
• DOI: 10.3390/jof8121285

The absence of awareness of fungal diseases as part of the differential diagnosis in at-risk populations has severe consequences. Here, we show how the active role of laboratories can improve patients’ survival. Recently, major advances have been made in non-culture-based assays for fungal diseases, improving accuracy and turnaround time. Furthermore, with the introduction of proficiency control systems, laboratories are an easily monitored environment with good analytical accuracy. Diagnostic packages for opportunistic infections can overcome many deficiencies caused by the absence of awareness. In Guatemala, to make diagnosis accessible, we set up a diagnostic laboratory hub (DLH) providing screening for cryptococcosis, histoplasmosis and tuberculosis to a network of 13 healthcare facilities attending people living with HIV (PLWHIV). In two years, we screened 2127 newly HIV-diagnosed patients. The frequency of opportunistic infections was 21%, rising to 30.3% in patients with advanced HIV disease (<200 CD4); 8.1% of these patients had more than one infection. With the implementation of this diagnostic package, mortality decreased by 7%, a key goal of many public health interventions. Screening for serious infection in high-risk populations can partially overcome training or experiential deficiencies among clinicians for life-threatening fungal diseases.