Fungal Infections: Silent Killers?

Lenias Hwenda
From a meeting organised by the Global Action Fund for Fungal Infections and Bioventures for Global Health.

Washington Seattle: Lenias Hwenda is a global health policy expert with a passion for improving access to quality affordable treatments. 

​I recently attended a meeting in Washington Seattle on the challenges to sustainable supply of anti-fungal treatments and access to affordable prices to promote better use of available treatments. The meeting highlighted the important, but often overlooked public health burden of human fungal diseases.  

Despite advances in anti-fungal therapy, the availability of treatments in African countries and poor diagnosis contribute to poor outcomes and high mortality rates. In many countries, fungal infection treatments are not registered. They are too expensive or completely not available. Often, diagnostics tests are not carried out for fungal infections. In African countries, diagnosis is rarely available. ​

The WHO recently added amphotericin B and flucytocine to the model list of essential medicines as a result of  advocacy efforts by organizations like GAFFI, its partners, the CDC, MSF and Clinton Health Access Initiative. This is an important step towards improving their availability in public sector facilities. Addition of these treatments by African countries to national essential medicines list would be an important step towards improving their availability. This is because national essential medicines list are the basis of procurement decisions in African countries.

​In African countries, potentially life-threatening fungal infections affect millions of immunocompromised people such as those with HIV/AIDS and those receiving chemotherapy. Existing clinical observations suggests that more people might be dying from fungal infections than is documented. A number of well-established treatments exists. However,  they are not available to many people who need them due to a variety of constraints. There is a great need for improving access to diagnosis, and treatment for fungal infections.

There are very few public health mycology laboratories in the world. It is believed that there are less than ten surveillance programs on fungal infections. In African countries, the relationship between the rate of opportunistic infections, susceptibility to opportunistic infections and survival is not clear. However, epidemiological studies on aspergillosis have been carried out in Uganda, Kenya and Nigeria. This is a start, but a greater understanding of the extent of the problem is needed.

Fungal meningitis and pneumonia are believed by scientists to  affect more than a million people living with HIV each year. Loss of sight as a result of fungal infections happens to more than a million adults and children globally. Fungal infections and allergies also contribute to cases of severe asthma.

Experts point out that there are less than 20 countries with reference laboratories capable of providing key diagnostic tests and expertise in fungal infections globally. There is therefore a need to train personnel in laboratories and collect better epidemiological data on the extent of the problem. 

Primary care is a source of comprehensive care that integrates and coordinates care for all health problems. It therefore provides a good opportunity for case finding. The WHO has developed clinical guidelines for fungal meningitis  in HIV/AIDS. Addressing opportunistic infections through an integrated approach to HIV care is likely to present a big opportunity to take advantage of the public health investment in HIV treatment and care infrastructure. An integrated approach similarly offers the opportunity to address gaps in the care of patients with HIV who are affected by opportunistic fungal infections.

There is a need to bring focus and new thinking to clinical practice, diagnosis, treatment and public health approach to the management of opportunistic fungal infections in HIV care. Symptoms of fungal infections are mostly hidden. Fungal infection experts believe that prophylaxis for opportunistic infections is an important concomitant step in preventing associated morbidity and mortality.