The impact of COVID-19 pandemic on AIDS-related mycoses and fungal neglected tropical diseases: Why should we worry?

Abstract

The World Health Organization (WHO) considers mycetoma, chromoblastomycosis, and paracoccidioidomycosis to be fungal neglected tropical diseases (FNTDs). Depending on climatic, cultural, and economic contexts, these diseases have a similar geographical distribution as many other diseases, particularly tuberculosis (TB) and malaria, but are often less targeted by the national and many international healthcare systems. Another subgroup of fungal infections, such as candidiasis, cryptococcosis, pneumocystosis, histoplasmosis, and to a lesser extent, aspergillosis, are known as AIDS-related mycoses. Although antiretroviral therapy (ART) has been able to decrease the mortality rate of these diseases, particularly cryptococcosis, the disproportionately low distribution of funds to their diagnosis and treatment remains an obstacle in saving and improving the lives of patients affected. A new wave of viral diseases dubbed the Coronavirus Disease 2019 (COVID-19) hit the world at the end of 2019. Due to progressive symptoms and high mortality rates of COVID-19 compared to fungal infections, particularly the FNTDs, funding is currently allocated predominantly for diagnostic and therapeutic research on COVID-19. As a result, advances in FNTDs and AIDS-related mycosis care are considerably reduced. This paper explores the association between COVID-19, FNTDs, and AIDS-related mycoses with a predictive perspective.

Fig 1. Proposed negative effects.

(A) Negative effects of AIDS, malaria, and TB on FNTDs: In endemic areas, people are at risk for AIDS, TB, malaria, and FNTDs. But for reasons such as lower diagnostic focus and inadequate allocated budgets and longer common periods, FNTDs have not received the attention they need, despite their high prevalence. (B1) Negative effects of COVID-19 on FNTDs: On the other hand, with the global prevalence of COVID-19, with the high potential for morbidity and mortality, all the focus of healthcare is on that. Therefore, FNTDs will have other negative effects due to not receiving diagnostic and control requirements, and because they have previously been negatively affected by other diseases such as AIDS, TB, etc., the addition of COVID-19 will cause them to have double negative effects. So with the current situation, it is not unreasonable to call them “Re-Neglected Fungal Tropical Diseases.” (B2) Negative effects of COVID-19 on AIDS, malaria, and TB. COVID-19, Coronavirus Disease 2019; FNTD, fungal neglected tropical disease; TB, tuberculosis.