DOI: 10.1128/spectrum.02020-24 ISSN: 2165-0497

Fungi under fire: diagnostic capacities and antifungal availability in Peruvian healthcare facilities

Julio Maquera-Afaray, Luis E. Cuéllar, Oliver A. Cornely, Jon Salmanton-García, , Adriana Montoya Reategui, Aida Miluska Delgado Flores, Alex Castañeda Sabogal, Arquímedes Martín Ramón Pinedo, Augusto Gavino Escalante Candia, Carlo Bazan, César Enrique Sanchez Alvarez, Christian Chiara Chilet, Claudia Quezada Osoria, David Gustavo Cerrón Olivas, Daynaluz Calderon, Debora Mananita Terrones, Elizabeth Castillo Rivera, Enrique Uless Zumaeta Saavedra, Félix Chávez Mercado, Fiorela Alvarez Romero, Franz Kovy Arteaga Livias, Gary Ramos, George Hernández, Giancarlo Pérez Lazo, Gustavo Adolfo Valencia Mesías, Israel Mamani Cutipa, Jimmy Christian Camargo Macurí, Jimmy Damián Mateo Pacora, Jorge Alonso Zegarra Cárdenas, Jorge Luis Chumbes Perez, Jose Antonio Vilca Aguado, Juan Carlos Celis, Juana Huamani Cordova, Katia Nikita López Mata, Lilian Marita Astocondor Salazar, Lizzet Martinez Dionisio, Luis Enrique López Peña, Luis Hercilla Vasquez, Marco Guerrero Angulo, Maria Medina Calcina, Mariano Alarcón Parra, Marlon Bejarano, Miguel Hueda Zavaleta, Neil Aron, Luis Miguel Toro Polo, Tatiana Avalos Cruz, Paul Sanchez Rodrigo, Pedro Alberto Sullon Zavaleta, Pierina Vilcapoma Balbin, Raquel Giovanna Felix Coca, Raúl Montalvo, Renzo Vargas Gonzales, Rómulo Rodríguez, Rosa Marina Margarita Guillermo Valdiviezo, Roxana Elizabet Sandoval Ahumada, Sabina Mendivil Tuchia De Tai, Víctor Llerena, Wilfredo Martel, Yackeline Yenny Ñaca Bailon
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ABSTRACT

Invasive fungal infections (IFI) are a significant global health issue, affecting an estimated 7 million people annually, with around 3 million deaths. In Peru, IFIs are estimated to affect about 2% of the population. Underdiagnosis due to the limited sensitivity of diagnostic tests underestimates the true burden. This study evaluates the diagnostic capabilities of mycology laboratories and the availability of antifungal treatments in Peruvian healthcare facilities to identify gaps and improve IFI management. An observational, cross-sectional study was conducted online targeting physicians involved in IFI management across multiple centers in Peru, from April 2023 to April 2024. The survey covered institutional profiles, incidence and perceived relevance of IFI, diagnostic tools, and access to antifungal drugs. Fifty-four centers from 21/24 departments (Peruvian term for regions) in Peru participated. All centers reported a low to moderate IFI incidence. Candida spp. was the most concerning pathogen (93%), followed by Aspergillus spp. and Cryptococcus spp. (57% each). Diagnostic methods like microscopy were universally used (100%), while culture-based diagnosis was available in 90% of centers. Access to advanced diagnostics for species identification varied, with better availability in the capital (91%) compared to regions (64%). Antibody detection tests were available in 30% of centers, mostly in the capital area. Antigen detection tests were available in 46% of institutions, with significant regional disparities. Imaging techniques were widely used, but surgical access varied. Triazoles were the most accessible antifungals (96%), while echinocandins and therapeutic drug monitoring (TDM) were significantly limited (37% and 2%, respectively). The study highlights disparities in the availability of advanced diagnostics and antifungals in Peru. Despite universal use of microscopy, access to species identification, antibody, and antigen detection tests is limited outside the capital. Ensuring equitable access to these resources and implementing therapeutic drug monitoring are crucial for improving IFI management in Peru.

IMPORTANCE

Invasive fungal infections are a critical yet often underrecognized public health issue, particularly in countries with diverse climates like Peru. Limited access to advanced diagnostic tools and antifungal treatments creates significant barriers to effective management, contributing to underdiagnosis and delayed care. Our study provides an in-depth evaluation of current diagnostic capabilities and drug availability for IFI across Peru, uncovering geographic disparities and resource gaps that affect patient outcomes. This research highlights the urgent need for policy reforms aimed at enhancing laboratory infrastructure and access to antifungal therapies, ultimately improving IFI management and reducing mortality in Peru and similar regions globally.

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