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. 2022 Dec 8;8(12):1285.
doi: 10.3390/jof8121285.

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

Narda Medina  1 , Ana Alastruey-Izquierdo  2   3   4 , Danicela Mercado  5 , David W Denning  1   6 , Eduardo Arathoon  1   5 , Juan Luis Rodriguez-Tudela  2
Affiliations

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

Narda Medina et al. J Fungi (Basel). .

Abstract

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.

Keywords: HIV; Latin America; cryptococcosis; histoplasmosis; opportunistic infections; public health; tuberculosis.

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Conflict of interest statement

In the last three years, A.A-I. has received honoraria as a speaker from Gilead Sciences and Pfizer outside the submitted work. E.A. has received honoraria from Gilead for educational conferences and participation in advisory board meetings. DWD and family hold Founder shares in F2G Ltd., a University of Manchester spin-out antifungal discovery company, and share options in TFF Pharma. He acts or has recently acted as a consultant to Pulmatrix, Pulmocide, Biosergen, TFF Pharmaceuticals, Pfizer, Omega, Novacyt and Cipla. He sat on the DSMB for a SARS-CoV-2 vaccine trial. In the last 3 years, he has been paid for talks on behalf of Hikma, Gilead, BioRad, Basilea, Mylan and Pfizer. He is a longstanding member of the Infectious Disease Society of America Aspergillosis Guidelines group, the European Society for Clinical Microbiology and Infectious Diseases Aspergillosis Guidelines group and recently joined the One World Guideline for Aspergillosis. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Summary of the HIV units of the network, average number of screened patients in every location, and driving time to the diagnostic laboratory hub.
See this image and copyright information in PMC

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