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How to Improve Fungal Disease Management Worldwide

In an article published in The Lancet Infectious Diseases, Donald C. Cole, FRCP, from the University of Toronto, Ontario, Canada, and colleagues describe the current state of identification and management of fungal diseases and discuss potential approaches for improving their recognition and treatment.

According to the authors, estimates of the burden of fungal diseases in low-income and middle-income countries made by the Global Action Fund for Fungal Infections (GAFFI) exceed the capability of these countries to manage the burden.

This burden includes neglected tropical diseases such as mycetoma and chromoblastomycosis that cause progressive chronic disfiguring disease, opportunistic fungal infections such as pneumocystis pneumonia in HIV patients, and emerging diseases such as pythiosis.

However, the authors say that fungal disease often goes unrecognized for several reasons, including suboptimal patient and clinician awareness, high patient loads, inadequate clinician training, a low index of diagnostic suspicion, a lack of diagnostic tests to identify certain fungal diseases, poor access to diagnostic tools), and few treatment options. Public health responses to fungal disease are thus rare, they note and typically focus on disease outbreaks and cryptococcal meningitis in AIDS patients.

“These limitations in awareness, diagnosis, and management stem from deficits of the health system in education, provision, and infrastructure,” they stress.

As a consequence, to address these gaps, Dr. Cole and colleagues highlight potential ways to enhance healthcare and public health capabilities in national health systems with international support. In particular, they emphasize 4 core strategies to help accomplish this.

Healthcare providers need education about fungal diseases, they say, but governments, funding agencies, and the World Health Organization (WHO) are not yet ready to prioritize fungal diseases with separate programs for low-income and middle-income countries. The authors therefore suggest incorporating education about fungal diseases into those public health initiatives and programs already established in other important areas such as HIV infection, tuberculosis, antimicrobial resistance, diabetes, chronic respiratory disease, and blindness.

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