Difficulties Faced in Asian Countries for the Diagnosis of Fungal Infections and Possible Solutions

Abstract

Life-threatening fungal diseases occur frequently in immunocompromised and hospitalized critically ill patients in Asian countries. However, Asian health system is not ready to face this ever increasing formidable challenge. The awareness of the fungal disease is limited to specialized medical units only, and gross inadequacies exist in diagnostic mycology laboratory services in those countries. In a recent laboratory survey of seven Asian countries, it was noted that the access to non-culture based diagnostic tests like galactomannan and beta-d-glucan tests almost does not exist in Indonesia, Philippines and Thailand; availability is limited in other countries. The surveillance studies on fungal diseases are also very few in Asian countries, and the health administrators are not aware of the burden of fungal diseases. Though the exact magnitude of the problem is not known, the disease burden is estimated to be high in Asian countries due to tropical environment where fungi thrive easily, compromise in healthcare due to over-capacity patient population in public sector hospitals and misuse of steroid and broad-spectrum antibiotics. The situation is further complicated with fungal outbreaks, new agents and susceptible hosts. Not only the super-bug Candida auris is causing havoc in those countries, but also many rare fungi have been reported to cause outbreaks in large number of patients. The diagnosis, identification and antifungal susceptibility testing of those rare fungi are difficult without advanced laboratory facilities. The delay in identifying the outbreaks causes spread of the disease across hospital and difficulty in containment. To overcome this challenge, fungal diseases are required to be recognized as public health concerns. A pyramidal structure with laboratory facilities should be planned in each country. Until the system is developed, integration of diagnosis of fungal disease with existing HIV, tuberculosis, diabetes, respiratory diseases and blindness control programmes would improve the laboratory services. The training of laboratory personnel on fungal diseases may also be integrated with those health programmes. Recently World Health Organization has declared many fungal diagnostics under essential diagnostics lists. This would help in advocacy with government for the development of mycology laboratories.