Overcoming clinical challenges in the management of invasive fungal infections in low- and middle-income countries (LMIC)

ABSTRACT

Introduction

The management of invasive fungal infections (IFIs) in low- and middle-income countries (LMIC) is a serious challenge due to limited epidemiology studies, sub-optimal laboratory facilities, gap in antifungal management training and resources. Limited studies highlighted distinctive epidemiology of IFIs in those countries, and difficulty in distinguishing from closely related infections. To overcome the gaps for appropriate management of IFIs, innovative approaches are required.

Areas covered

Extensive literature search and discussion with experts have helped us to summarize the epidemiology, diagnostic and management difficulties in managing IFIs in LMIC, and recommend certain solutions to overcome the challenges.

Expert opinion

The strategies to overcome the challenges in diagnosis may include local epidemiology study, training of healthcare workers, association of fungal infections with already existing budgeted national programs, development and incorporation of point-of-care test (POCT) for prompt diagnosis, simplifying clinical diagnostic criteria suitable for LMIC, judicious use of available expertise, and diagnostic stewardship. For management strategies judicious use of antifungal, partnering with industry for inexpensive antifungal agents, development of LMIC specific guidelines for cost-effective management of IFIs and fungal outbreaks, improvement of infection control practices, advocacy for implementation of WHO recommended antifungal use, and integration of IFIs with public health.

KEYWORDS:

• Invasive fungal infections
• resource limited setting
• antifungal treatment
• point-of-care testing
• Antifungal Treatment

Article highlights

• Challenges in management of invasive fungal infections in low and middle-income countries include deficiencies in awareness, epidemiological study, laboratory manpower, diagnostic mycology laboratories, antifungal drugs availability and affordability, and investment of fund.

• To overcome the challenges, we require innovative approaches and research for development and incorporation of low-cost point-of-care tests (lateral flow assay), and new class of broad-spectrum and affordable antifungal agents.

• Integration of fungal management with already existing public health disease programs like with HIV and tuberculosis control programs, as none of those control programs will succeed without control of invasive fungal diseases in those patients.

• Judicious use of available expertise and diagnostic stewardship will improve optimal management and save expenditure.

• Advocacy for implementation of WHO recommended actions in priority fungal pathogens – strengthening laboratory capacity and surveillance; investment in research, development and innovation; public health intervention in the field of fungal diseases.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.