Improving fungal disease diagnostics could help battle against antimicrobial resistance

Jan 18 2017

Ignorance of fungal disease and lack of diagnostics across the world is causing doctors to unknowingly overprescribe antibiotics a new report warns.

Experts from GAFFI (the Global Action Fund for Fungal Infections) caution that we will lose the battle against antibiotic resistance unless doctors better understand how to suspect fungal disease and have proper access to the appropriate testing for it.

In a paper published today in the cutting edge US journal Emerging Infectious Diseases, several leading authors from GAFFI warn of the gross misuse of antibacterial antibiotics, because doctors treat without knowing what is wrong with their patients. The authors focus on scenarios, all common, where the lack of the best diagnostic tests prevent the correct antimicrobial being given.  

Lord Jim O’Neill of Gatley, lately Chairman of the UK’s Review on Antimicrobial Resistance declared:

Improving diagnostic capability and responsiveness is at the heart of better antimicrobial prescribing, everywhere. Major efforts to improve fungal disease diagnostics are obviously necessary to optimise and minimise the use of both antibiotics and antifungals.

Dr David Denning, President of GAAFI and also of The University of Manchester, decried the lack of fungal diagnostics in most of the world. He said:

Solving AMR is not possible without accurate and timely diagnosis. Fungal disease diagnostics are critical in the AMR fight, and will improve survival from fungal disease across the world. The close link between fungal diagnostics and antibacterial prescribing needs a great deal more attention.

The GAFFI team report some people diagnosed with TB of the lungs, don’t actually have TB (smear negative) but a fungal infection instead. A simple antibody test can pick up the fungus Aspergillus, and unnecessary anti-TB antibiotics stopped and antifungal drugs given. In 2013, over 2.7 million ‘smear negative TB’ cases were notified to the World Health Organization.

In intensive care units Candida yeast bloodstream and tissue infections are common, yet only 40 per cent of patient have blood growing the organism. In many cases after antibacterial is given, without success. There are over 750,000 such cases worldwide.

Many asthma and patients with emphysema (COPD) get exacerbations, which are treated with antibacterials and steroids. Some have fungal asthma or are admitted to hospital with COPD. There are over 200 million asthmatics and an estimated 6-15 million have fungal asthma, which is diagnosable with skin testing or blood tests, which would respond to antifungal agents, minimizing antibacterial use. COPD is common in the over 40’s, and in China alone nearly 12 million were hospitalized. A study there showed the severe fungal infection aspergillosis developed in 3.9% (`462,000), and 43% died (`200,000). Almost all will have been give antibacterials to no avail.

Pneumocystis pneumonia (PCP) is a common problem in AIDS. Molecular testing is best for diagnosis, but not available outside most of Europe. The only way of diagnosing Pneumocystis before death in children, without putting them to sleep for a bronchoscopy, is with the molecular test. So many of the 400,000 with PCP are not diagnosed and even more without PCP are treated unnecessarily. Probably over two million get noxious PCP therapy for no reason each year.