GAFFI meeting provides plan for integrating modern fungal diagnostic tools into routine care

September 09 2019

Culture and microscopy were traditionally the cornerstones of diagnosing fungal infections, but the past decade has seen an explosion of molecular and serological tests that can dramatically improve the speed and accuracy of diagnosis. However, access to these technologies is limited in some regions: only 9% of Latin American labs surveyed met the ECMM minimum standards of test provision (Falci and Pasqualotto, 2019).

A meeting in Lima (Peru) last week brought together >60 fungal experts from 24 countries across Latin America to formulate a plan for integrating new diagnostic tools into routine care. The meeting was organised by GAFFI in collaboration with the CDC and Pan-American Health Organization (PAHO) .

Dr Guillermo García-Effron presented a talk on the different options (and costs) for implementing modern diagnostics. PCR and MALDI-ToF are more complicated and expensive to set up, but lateral flow devices offer a cheaper and less technically demanding option (download the slide set).

Estimates of the burden of key fungal diseases in 18 Latin American countries were also presented (read the full document):

Disease	Incidence	Prevalence	Deaths
Cryptococcal meningitis	12,300	-	4,900
Pneumocystis pneumonia	66,100	-	27,800
Disseminated histoplasmosis	9,800	-	5,800
Invasive candidiasis	227,300	-	>100,000
Invasive aspergillosis	68,300	-	>30,000
Chronic pulmonary aspergillosis	-	33,600	>4,000
Fungal asthma	-	1,580,000	-

 

Key actions arising from the meetings include:

• Implement the WHO Essential Diagnostics List
• Implement the WHO Essential Medicines List - in particular, flucytosine and liposomal amphotericin B should be routinely available for histoplasmosis (view antifungal availability world maps)
• Implement WHO guidelines for advanced HIV/AIDS
• Develop a common curriculum for laboratory training
• Introduce a peer-support approach to clinical training (for both specialists and primary care staff), using modern video conferencing technology
• Candida spp. will soon be added to the WHO’s Global Antimicrobial Resistance Surveillance (GLASS) scheme, with Latin American countries being among the first users of the early implementation protocol.
• Introduce teleradiology*, and investigate the use of artificial intelligence for reading X-rays in LMICs
• A full report of the meeting will be prepared in due course with the help of PAHO

* Teleradiology is the digital sharing of encrypted X-ray/CT scan images with colleague at other sites, to obtain specialist expertise not available locally. Various companies and charitable organisations (e.g. via Téléradiologie Sans Frontières) recruit volunteer radiologists who are paired with radiologists in low-resource countries.