Fungi under fire: diagnostic capacities and antifungal availability in Peruvian healthcare facilities

Abstract

Invasive fungal infections (IFI) are a significant global health issue, affecting an estimated 7 million people annually, with around 3 million deaths. In Peru, IFIs are estimated to affect about 2% of the population. Underdiagnosis due to the limited sensitivity of diagnostic tests underestimates the true burden. This study evaluates the diagnostic capabilities of mycology laboratories and the availability of antifungal treatments in Peruvian healthcare facilities to identify gaps and improve IFI management. An observational, cross-sectional study was conducted online targeting physicians involved in IFI management across multiple centers in Peru, from April 2023 to April 2024. The survey covered institutional profiles, incidence and perceived relevance of IFI, diagnostic tools, and access to antifungal drugs. Fifty-four centers from 21/24 departments (Peruvian term for regions) in Peru participated. All centers reported a low to moderate IFI incidence. Candida spp. was the most concerning pathogen (93%), followed by Aspergillus spp. and Cryptococcus spp. (57% each). Diagnostic methods like microscopy were universally used (100%), while culture-based diagnosis was available in 90% of centers. Access to advanced diagnostics for species identification varied, with better availability in the capital (91%) compared to regions (64%). Antibody detection tests were available in 30% of centers, mostly in the capital area. Antigen detection tests were available in 46% of institutions, with significant regional disparities. Imaging techniques were widely used, but surgical access varied. Triazoles were the most accessible antifungals (96%), while echinocandins and therapeutic drug monitoring (TDM) were significantly limited (37% and 2%, respectively). The study highlights disparities in the availability of advanced diagnostics and antifungals in Peru. Despite universal use of microscopy, access to species identification, antibody, and antigen detection tests is limited outside the capital. Ensuring equitable access to these resources and implementing therapeutic drug monitoring are crucial for improving IFI management in Peru.IMPORTANCEInvasive fungal infections are a critical yet often underrecognized public health issue, particularly in countries with diverse climates like Peru. Limited access to advanced diagnostic tools and antifungal treatments creates significant barriers to effective management, contributing to underdiagnosis and delayed care. Our study provides an in-depth evaluation of current diagnostic capabilities and drug availability for IFI across Peru, uncovering geographic disparities and resource gaps that affect patient outcomes. This research highlights the urgent need for policy reforms aimed at enhancing laboratory infrastructure and access to antifungal therapies, ultimately improving IFI management and reducing mortality in Peru and similar regions globally.

Keywords: Peru; antibody detection; antifungal treatments; antigen detection; diagnostic capabilities; invasive fungal infections; microscopy; mycology laboratories; species identification; therapeutic drug monitoring.

Fig 1

Map of participating institutions per department (Peruvian term for regions). Departments (Peruvian term for regions) with participating institutions are colored in red. Departments (Peruvian term for regions) whose participating centers have not been included are colored in white. If more than one participating center is from the same location, a single circle is pictured. Participating institutions per department (Peruvian term for regions): Lima (n = 20/54, 37.0%); Callao and Junín (n = 4/54, 7.4% each); La Libertad and Piura (n = 3/54, 5.6%, each); Cusco, Huánuco, Loreto, and Pasco (n = 2/54, 3.7%, each); and Amazonas, Apurímac, Arequipa, Ayacucho, Huancavelica, Ica, Moquegua, Puno, San Martín, Tacna, Tumbes, and Ucayali (n = 1/54, 1.9%, each).

Fig 2

Fungal pathogens described as of most relevance in Peru.

Fig 3

Described access to antifungals in Peru.