Elevating fungal care: bridging Brazil's healthcare practices to global standards

Abstract

Brazil faces unique challenges in managing invasive fungal infections (IFIs) due to diverse ecosystems, a rural workforce, and prevalent health conditions. In Europe, IFIs are primarily associated with transplantation, intensive care, and chronic diseases. Inspired by initiatives in the Caribbean and Latin America in 2019, efforts to map global diagnostic and treatment resources expanded to Africa, Europe, and Asia/Pacific. This study conducts a comparative analysis, mainly drawing data from Brazil and Europe, to investigate IFI epidemiology and management. Data were collected through online surveys distributed to Brazilian and European institutions, with collaborations from scientific organizations. Surveys covered institutional profiles, IFI diagnoses, accessibility to diagnostic techniques, and antifungal drugs. A comparative survey involving 96 Brazilian and 388 European institutions revealed variations in the perception and practices related to fungal pathogens. Differences in ranking and prevalence were observed, along with variations in diagnostic procedures, fluorescence dye usage, culture practices, antifungal medication availability, and technological approaches. Europe exhibited higher utilization rates for molecular diagnostic approaches, including PCR tests, and therapeutic drug monitoring (TDM) was more widespread in Europe compared with Brazil, indicating substantial differences in understanding and managing fungal infections. Customized IFI management is crucial, considering regional differences and addressing technological gaps like underutilized PCR. The study advocates for increased international collaboration, targeted training, and enhanced resources to foster a unified global approach in preventing, diagnosing, and treating IFI.

Importance: This work is significant as it highlights the unique challenges Brazil faces in managing invasive fungal infections (IFIs) due to its diverse ecosystems and public health landscape. By comparing Brazil's situation with Europe-where IFIs are mainly linked to transplantation and intensive care-this study identifies key disparities in diagnostic and treatment practices. The findings reveal substantial differences in the availability and use of molecular diagnostics, antifungal drugs, and therapeutic drug monitoring, with Europe demonstrating more advanced practices. By mapping these variations, the study underscores the importance of tailored approaches to IFI management that consider regional differences and technological gaps. Ultimately, it calls for enhanced international collaboration, targeted training, and resource allocation to improve IFI outcomes globally, particularly in regions with limited access to advanced diagnostic tools and treatments.

Keywords: Brazil; Europe; MALDI-TOF-MS; PCR; antifungals; diagnosis; invasive fungal infections.

Fig 1

Fungal pathogens described as having the most relevance in Brazil and Europe. *, P < 0.05 - χ test based; spp., species. Data from Brazil were previously included in a collective publication alongside data from other Caribbean and Latin American countries (26). The European data, in its present format, have been published separately elsewhere (29).

Fig 2

Access to antifungal treatments in participating institutions in Brazil and Europe. No information regarding the access to flucytosine, isavuconazole, and terbinafine from Brazil due to lack of inclusion of these antifungals in the survey. *, P < 0.05 - χ test based; full details and comparisons are presented in Table S1. Data from Brazil were previously included in a collective publication alongside data from other Caribbean and Latin American countries (26). The European data, in its present format, have been published separately elsewhere. (29)