Invasive Candidiasis in Contexts of Armed Conflict, High Violence, and Forced Displacement in Latin America and the Caribbean (2005–2025)
Abstract
1. Introduction
2. Historical Context of Armed Conflict and High Levels of Violence in Latin America and the Caribbean (LA&C) (Last 25 Years)
2.1. Conflicts in North America and the Caribbean
2.1.1. Conflicts in Central America
2.1.2. Conflicts in South America
3. Epidemiology and Burden of IC Disease in LA&C
- Delay in diagnosis: the speed with which candidemia is detected varies depending on the fungal species. While C. albicans can be detected in an average of 35 h, N. glabratus requires up to 80 h, which significantly delays the start of effective antifungal treatment [74].
- Age and clinical status at admission: a high APACHE II score and a diagnosis of septic shock are negative prognostic factors. On average, patients who die from candidemia are around 60 years old [79].
Epidemiology, Disease Burden in the Context of Armed Conflict and High Violence
4. Risk Factors for IC in the General Population and in Contexts of Forced Displacement in LA&C
4.1. Health Conditions and Risk of Fungal Infection in Migrant and Displaced Populations
4.1.1. Socio-Environmental Conditions and Social Determinants
- Overcrowding and informal settlements: in contexts such as Venezuelan refugee camps in Colombia and Haitian migrant settlements in the Dominican Republic, it is common for families to live in extremely small spaces (less than 5 m2 per person). These overcrowded conditions not only make privacy and hygiene difficult but also increase body moisture and skin maceration, promoting the development of fungal infections. In a recent survey, 28% of adult women in these environments reported intertriginous or vulvovaginal candidiasis [156]. An institutional report (2019–2020) on Mexico’s southern border with Guatemala revealed that Central American migrants housed in shelters without adequate ventilation showed a high prevalence of skin infections. Microbiological field studies found that 33% of cases with interdigital rashes tested positive for Candida, mainly C. parapsilosis, highlighting how the tropical climate, combined with poor hygiene, increases susceptibility to these infections [157].
- Limited access to drinking water and sanitation: in the Northern Triangle of Central America (Honduras, El Salvador, and Guatemala), recent studies have shown that more than 40% of informal settlements do not have a continuous supply of chlorinated water. This limitation prevents adequate hand and surface hygiene, creating conditions conducive to the proliferation of yeasts in the environment. Such microenvironments become potential reservoirs for infections such as cutaneous and vulvovaginal candidiasis [158]. In Bolivia, data collected between 2018 and 2019 in rural areas inhabited by returning migrants showed that only 35% of homes had adequate latrines. This deficiency in basic sanitation increases the environmental microbial load and favors fungal colonization of the skin and moist areas of the body, especially in crowded conditions and hot climates [159].
- Malnutrition and immune deficiency: an internal epidemiological surveillance report conducted between 2018 and 2019 among the displaced population in the department of Arauca, Colombia, revealed that 42% of children and 28% of pregnant women suffered from acute or chronic malnutrition. In this context, 30% of children with oral candidiasis showed signs of malnutrition, and within this group, 18% developed candidemia within less than ten days [160,161]. The lack of essential micronutrients—such as vitamins A and D and zinc—impairs both cellular and humoral immunity, promoting the transition of Candida from superficial colonization to systemic infection. This risk is exacerbated in displaced adults with irregular access to basic nutritional supplements [160].
4.1.2. Prevalent Comorbidities in Migrants and Displaced Persons
- HIV/AIDS: according to an institutional report for the period 2018–2019, the prevalence of HIV among Venezuelan migrants settled in Colombia was 3.2%, of whom 45% were not receiving antiretroviral treatment and had CD4 counts below 200 cells/µL. In this cohort, 38% developed oral candidiasis, and 12% developed esophageal candidiasis during the first year of follow-up [162]. A retrospective analysis conducted after the 2010 earthquake in Haitian displacement camps revealed that many people were living with HIV patients in advanced stages of the disease and without access to antiretroviral therapy. In this group, 55% were diagnosed with recurrent mucocutaneous candidiasis, and 12% had candidemia, which was associated with a 65% mortality rate due to the lack of timely diagnosis and effective antifungal drugs [163].
- Type 2 diabetes mellitus: in agricultural export plantations in Central America, studies conducted among migrant workers showed a prevalence of undiagnosed diabetes of 16%. Of this group, 30% had candidal vulvovaginitis and 8% developed complicated forms of cutaneous candidiasis, including infected ulcers [119,120]. Similarly, an internal epidemiological surveillance report on displaced indigenous communities in Peru documented that 14% of older adults had uncontrolled diabetes (fasting glucose greater than 126 mg/dL). In these patients, interdigital candidiasis occurred in 27% of cases, and an RR of 2.8 (95% CI: 1.6–4.9) was estimated for the development of disseminated candidiasis after hospitalization [164].
- Tuberculosis and co-infections: in camps for displaced persons located in the border areas between Venezuela and Colombia, a prevalence of tuberculosis (TB) of 350 cases per 100,000 inhabitants has been documented, with a high frequency of HIV/TB co-infection. This combination increases the risk of IC. A retrospective study conducted in Bogotá revealed that 22% of patients with TB/HIV coinfection developed candidemia, with an associated mortality rate of 58% [165]. On the other hand, a descriptive study in Guatemala observed that, in co-infected individuals, the presence of extrapulmonary TB—particularly in its peritoneal or gastrointestinal forms—caused damage to the digestive mucosa, facilitating the translocation of Candida spp. into the body. As a result, 14% of these patients developed intra-abdominal candidiasis [166].
4.1.3. Exposure to Iatrogenic Factors
- Use of antibiotics in mobile clinics and shelters: between 2019 and 2020, in mobile clinics providing medical care to Nicaraguan migrants in Mexican territory, it was observed that 78% of patients with fever were treated with broad-spectrum antibiotics, such as ceftriaxone or carbapenems, without prior blood cultures. This practice was associated with the onset of mucocutaneous candidiasis in 26% of cases and candidemia in approximately 5%, although significant underreporting is presumed due to the lack of diagnostic laboratories in these settings [167]. The widespread empirical use of antibiotics without proper assessment of the risk of fungal infection has contributed to the disruption of normal microbiota, facilitating the overgrowth of Candida spp.
- Use of invasive devices in border hospitals: an internal surveillance report from 2020, based on data from migrant reception units in Tapachula (Mexico–Guatemala region), found that 42% of patients hospitalized for sepsis required CVC insertion. Among these patients, 12% developed candidemia, which corresponds to a significantly elevated risk (OR 3.5; 95% CI: 2.0–6.1). Furthermore, due to a lack of specialized personnel, protocols for early catheter removal are not properly implemented, prolonging exposure to fungal biofilm and increasing the likelihood of invasive infections [168].
4.1.4. Demographic and Vulnerability Factors
- Age and gender: an epidemiological surveillance study in Colombia (2018–2019), focusing on displaced children, revealed that 18% of newborns from temporary shelters developed oral candidiasis in their first week of life. This finding was related to low birth weight (less than 2500 g) and maternal malnutrition, conditions that are common in contexts of forced displacement [160]. On the other hand, a study on reproductive health in migrant women (2019) found that 34% of women living in border settlements experienced episodes of vulvovaginal candidiasis in the last year, mainly linked to malnutrition, pregnancy, and limited access to adequate gynecological services [169].
- Ethnicity and inequalities: in displaced Guaraní indigenous communities in Paraguay, the rate of cutaneous candidiasis was almost three times higher than that observed in nearby urban populations. This difference has been attributed to difficulties in accessing adequate health services and language barriers that limit timely care [170]. Similarly, an internal report on Haitian migrants in the Dominican Republic reported that 46% of adults with HIV developed oral candidiasis, compared to 28% of the non-migrant population. Language barriers and experiences of discrimination contribute significantly to delays in diagnosis and treatment [171].
4.1.5. Environmental and Occupational Conditions
- Agricultural work and environmental exposure: among Central American migrants employed on sugar cane plantations in Guatemala, a 15% prevalence of skin colonization by C. parapsilosis has been identified, which is associated with repeated contact with humid environments and contaminated surfaces, such as wet soil and stagnant water [172]. On the other hand, an epidemiological surveillance report conducted in fruit-growing areas in Peru found that 22% of migrant workers of Peruvian and Bolivian origin developed interdigital candidiasis. This condition could be related to repeated exposure to insecticides, which alter the normal microbial flora of the skin [173].
- Climate and microenvironments: according to an epidemiological surveillance report, climatic conditions in coastal areas of Central America—characterized by humidity levels above 80% and constant temperatures around 28 °C—are favorable for the growth of yeast on the skin and mucous membranes. In Honduras, migrants traveling along routes near the coast were found to have intertriginous candidiasis in 31% of cases, a figure considerably higher than the 12% reported among those traveling along mountainous routes [174].
5. Diagnosis of IC in LA&C: Barriers and Diagnostic Methods in Resource-Limited Settings
5.1. Barriers and Limitations in the Diagnosis of Candidiasis
5.1.1. Infrastructure and Logistics
- Lack of local laboratories: mobile health centers and small shelters are not equipped with adequate biosafety facilities or protocols for mushroom cultivation. As a result, samples must be sent to reference laboratories, which are often located far away. This involves transportation without a cold chain, which increases the risk of contamination or decreases the viability of the fungi, reducing crop yields to less than 50% [9,12].
5.1.2. Human Resources and Training
- High turnover of volunteer staff: in NGOs operating in camps, constant staff turnover prevents continuity in the use of protocols and hinders the transfer of specialized knowledge. Although there are no exact figures, this recurring problem has been documented in border environments [111,190,191,192].
5.1.3. Costs and Availability of Reagents
- Scarce and expensive basic reagents: in many countries in the Andean region and the Caribbean, essential reagents such as KOH 10% solutions and Gram stains must be imported, which increases the cost of each test by approximately USD 5–10. This is a difficult expense for mobile clinics with limited resources to bear [111,176,180,189,193].
- Limited access to state-of-the-art testing: serological tests such as BDG or molecular methods such as qPCR are not covered by public health systems and are only offered in reference laboratories, usually located in capital cities. This situation forces patients to travel long distances to access these diagnostics [9,117,176,194].
5.1.4. Social and Cultural Limitations
- Distrust of the healthcare system: many displaced persons have been victims of violence or discrimination, which generates mistrust of medical services and reduces their willingness to participate in procedures such as blood tests. Although there are no specific data on candidiasis, reproductive health studies show that more than 40% of displaced populations avoid going to official centers for this reason [12,41,125,142,192].
- Language and communication barriers: in Haitian refugee shelters in the Dominican Republic and also in Venezuelan indigenous communities, a lack of fluency in Spanish hinders communication with healthcare personnel. Qualitative studies indicate that up to 30% of consultations are postponed or interrupted due to language problems or a lack of interpreters [11,131,192,195,196].
5.2. Recommendations for Strengthening Diagnosis in Areas of Forced Displacement
5.2.1. Optimization of Low-Cost Methods
- Technical training in KOH: it is recommended to train local staff through weekly workshops focused on the processing and interpretation of exudates using 10% potassium hydroxide (KOH 10%). The implementation of this strategy in areas with limited resources has been shown to improve diagnostic accuracy [106,180,189,195,197].
- Rotary direct microscopy with calcofluor: several studies have shown that calcofluor is consistently more sensitive than KOH and sometimes comparable to more sophisticated diagnostic methods. Its usefulness as a rapid diagnostic technique makes it especially valuable in resource-limited environments. In this context, the possibility of sharing UV equipment between nearby camps is suggested to facilitate the assessment of mucocutaneous lesions. This strategy could be applied in countries such as Haiti to reduce the false negative rate [180,189,198,199].
5.2.2. Implementation of Simplified Algorithms
- Adapted use of the “modified Candida Score” in primary care: in community settings where state-of-the-art testing is not available, a simplified version of the “Candida Score” is proposed for initiating empirical treatment. In patients with fever without apparent source and at least three of the following criteria—recent antibiotic use, presence of CVC, and malnutrition—it is recommended to initiate FCZ if the KOH test is positive. If BDG is available, consider echinocandins when this marker is positive. Studies in ICUs in Latin America show that a score equal to or greater than 3 predicts candidemia with a sensitivity of 70% [117,188].
- Creation of multilingual visual guides: designing and distributing illustrative materials on clinical signs of candidiasis, translated into Spanish, Haitian Creole, and indigenous languages, can be key to improving recognition of the infection. Experiences in community health programs have shown that incorporating these guides improves early detection by 18% [7,12,189,200].
5.2.3. Surveillance and Reference Networks
- Development of collaborative networks for sample processing: it is proposed to implement a referral system between camps and laboratories located in nearby urban areas, ensuring the transport of samples under appropriate cold chain conditions. This measure, accompanied by regular exchanges of volunteer microbiologists, has proven effective: in Latin America, agreements between mobile units and universities reduced the analysis time for mycological samples from seven to three days [6,12,111,175,176,187].
- Strengthening tele-mycology networks: the use of technology to share diagnostic images (cultures, smears, lesions) in real-time via mobile networks or satellite connections can significantly improve diagnostic accuracy. Creating virtual links with regional mycology experts would enable constant supervision and technical support, with at least one specialist recommended for every 5000 displaced persons [178,197,201,202,203].
5.2.4. Funding and Strategic Alliances
- Ensure donations of basic supplies: we propose coordinating with organizations such as GAFFI and PAHO to deliver essential supplies (KOH, dyes, culture media) to mobile clinics in border areas and hard-to-reach camps. Since 2019, these initiatives have made it possible to supply resources to more than 20 mobile units in Colombia and Peru, strengthening their diagnostic capacity [6,7,106,176,189,200,204].
- Formalize agreements with regional universities: emphasis is placed on the need to integrate essential diagnostics and strengthen national and hospital diagnostic networks. It is also proposed to establish biannual agreements with local universities for the provision of diagnostic supplies to reduce and lower transportation expenses and expand diagnostic coverage in remote areas [7,12,106,175,176,187,200].
6. Antifungal Treatment of IC in LA&C: Availability of Antifungals and Antifungal Resistance
- Restricted availability of essential antifungals: in most LA&C countries, access to antifungals is limited mainly to generic FCZ, due to its low cost and early inclusion in national essential medicines lists [10,193,206]. Although this drug is available, it is not the ideal option for candidemia in critically ill patients, as up to 50% of non-albicans isolates—such as N. glabratus, P. kudriavzevii, and C. auris—have reduced sensitivity or intrinsic resistance to FCZ.
- Suboptimal administration of D-AmB: in the absence of echinocandins, D-AmB is frequently used as an alternative. However, to ensure its safe use, constant monitoring of renal function and electrolyte balance is required, as well as continuous administration of intravenous fluids and potassium salts [207]. In hospitals with limited resources, such conditions are often inadequate. This has led many professionals to reduce doses as a precaution, especially when there is no access to ICUs or adequate laboratories. Additionally, D-AmB depends on a cold chain, which is challenging in hot environments with unstable power supplies.
- Increase in antifungal-resistant strains: during the C. auris outbreak in Venezuela, all isolates showed resistance to FCZ and VCZ, and 50% had high minimum inhibitory concentrations (MIC) against AmB [208]. Although echinocandins are considered the almost exclusive therapeutic resource in these cases, strains with reduced sensitivity to these drugs are beginning to be detected [65,216]. At the same time, N. glabratus shows increased resistance to azoles, and C. parapsilosis shows mutations associated with prolonged treatment with echinocandins [214,219,220,221]. In Brazil, clusters of FCZ-resistant C. parapsilosis have been documented [8,220,221,222], and in areas of armed conflict, the absence of surveillance and infection control facilitates their unnoticed spread.
- Incomplete treatments: the minimum duration of treatment for candidemia should be 14 days from the last negative blood culture, extending in the presence of metastatic foci [112,117,185]. In displacement settings, it is common for patients to discontinue treatment after one week due to continuous displacement or depletion of medications in centers, which increases the risk of relapse and promotes the development of resistance.
- Inequality in costs and access: while FCZ is relatively affordable, echinocandins and L-AmB are too expensive for most centers and are only available in private clinics. In countries such as Haiti and Venezuela, public systems lack these drugs, and NGOs rarely include them in their emergency supplies due to budget constraints [121,193,194,206]. This means that, in many refugee camps, optimal treatment for candidemia remains inaccessible.
- Lack of complementary critical support: effective management of IC goes beyond the provision of antifungal agents. It requires intensive care, surgical interventions to control foci (such as valve replacement in endocarditis or abscess drainage), as well as life support—dialysis in cases of renal failure or MV [106,176,185]. In conflict-affected areas, these resources are often lacking [194], meaning that even with adequate antifungal treatment, the outcome can be fatal due to the lack of comprehensive clinical support or access to interventions that remove the source of infection.
7. Access to Health Services and Antifungal Treatment in Areas of Conflict and High Violence in LA&C
- Forced internal migration and informal settlements: internally displaced persons and refugees living in temporary camps often have limited or no access to adequate healthcare services. In these contexts, cases of candidemia are rarely diagnosed or treated with antifungal medication, and deaths are often not officially reported [38,142,228].
- Risks for patients and healthcare personnel: in areas of active violence, transfer to a medical center can pose a life-threatening risk (bombing, snipers, checkpoints). In conflicts such as the one in Syria, attacks on hospitals and healthcare personnel have been documented, interrupting essential treatments for severe mycoses [229].
8. Regional Perspective
8.1. Mexico
8.2. Haiti
8.3. North Triangle (El Salvador, Guatemala, Honduras)
8.4. Colombia
8.5. Venezuela
8.6. Brazil
8.7. Peru
9. Recommendations for Future Research
- Quantify the prevalence of candidiasis (mucocutaneous and invasive) and its distribution by species, including resistance profiles.
- Identify specific risk factors of displacement, such as hygiene conditions, sanitary access barriers, and psychological stress.
- Evaluate interventions such as improved sanitation, educational programs, and the use of broad-spectrum antifungals in vulnerable populations [125].
- Multicenter prevalence studies
- Conduct cross-sectional studies in camps and shelters to quantify the prevalence of oral and vulvovaginal candidiasis, itemized by sociodemographic factors, nutritional status, and HIV co-infection [227].
- Species identification and antifungal profile
- Establish mobile laboratory units or partner with regional diagnostic centers (e.g., hospitals in host cities) to accurately identify Candida species and perform MIC determinations using broth microdilution [255].
- Establish a regional registry of isolates from migrants and displaced persons in LA&C, including genetic typing using MLST (multilocus sequence typing) [256].
- Study of risk factors associated with displacement
- Design clinical trials to evaluate preventive and therapeutic interventions
- Conduct a randomized study in patients with recurrent vulvovaginal candidiasis to compare short treatment regimens with FCZ versus topical therapy with azoles (miconazole), evaluating adherence and tolerance [259].
- Systematic monitoring in camp healthcare centers
- Integration of a One Health approach
- Establish partnerships with veterinarians and local bioresource centers to identify environmental reservoirs of Candida in temporary settlement sites [106].
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Country | Type of Conflict/Violence | Key Period | Internally Displaced Persons/Migrants-Refugees (Estimates) | Key Findings |
---|---|---|---|---|
Mexico | Drug trafficking and violence by criminal groups | 2006–2020 | –/127,796 1 |
|
Haiti | Political instability, gang violence, and natural disasters | 2004–2020 | 702,973/350,000 2 |
|
El Salvador | Gang violence (MS-13, Barrio 18) | 2000–2020 | 513,000/234,000 3 |
|
Guatemala | Civil war (1960–1996) and post-conflict violence | 1960–1996/2000–2020 |
| |
Honduras | Gang violence and organized crime | 2000–2020 |
| |
Colombia | Internal armed conflict (FARC, paramilitaries) | 2000–2020 | 6,900,000/3,000,000 + 2,900,000 4 |
|
Venezuela | Sociopolitical crisis and high levels of street violence | 2014–2020 | –/7,770,000 5 |
|
Brazil | Urban violence and organized crime (favelas, militias) | 2000–2020 | –/790,000 6 |
|
Peru | Internal conflict (Sendero Luminoso (Shining Path) and State response) | 1980–2000 | –/Not available |
|
Country | Main Risk Factors for IC | Common Conditions and Fungal Risk General Population | Common Conditions and Fungal Risk Displaced/Migrant Population * | Comments |
---|---|---|---|---|
Mexico | - CVC—Broad-spectrum antibiotics—TPN—Colonization by Candida | - Infant malnutrition (13%)—HIV/AIDS (0.3%)—TB (22/100,000) - Fungal risk: 1.19‰ (regional mean). Associated with CVC and TPN | - Malnutrition and anemia in Central American migrants—COPD in rural displaced - Fungal risk: probable aspergillosis and candidemia in detention centers | The high rotation in shelters and the presence of wet soils increase the exposure to fungal spores. |
Haiti | - Broad-spectrum antibiotics—CVC—TPN | - Severe malnutrition (22%)—Epidemics of cholera and diarrhea - Fungal risk: post-breakout mucocutaneous mycoses; limited data on IC | - Critical post-disaster malnutrition—Cholera outbreaks in camps - Fungal risk: probable increase in mucocutaneous and systemic candidiasis | Sanitary collapse and lack of available antifungals limit the management of deep infections. |
Central America Northern Triangle (El Salvador. Guatemala. Honduras) | - Broad-spectrum antibiotics—CVC—TPN—Invasive procedures | - Chronic malnutrition (25–30%)—TB (≈100/100,000)—Trauma and violence - Fungal risk: skin cysts and candidemia in municipal ICUs | - Malnutrition in rural displaced persons—TB in informal camps - Fungal risk: IC in burns and associated with CVC | The insecurity and dispersion of the population make prevention and timely treatment interventions difficult. |
Colombia | - Broad-spectrum antibiotics (OR 5.6)—CVC (OR 4.7)—TPN (OR 4.6)—Colonization by Candida | - Chronic malnutrition (10.5%)—HIV/AIDS (0.4%)—TB (21/100,000) - Fungal risk: candidemia associated with CVC. TPN. and antibiotics (OR 5.6) | - Acute and chronic malnutrition—HIV/AIDS (~0.5%)—Elevated risk for pulmonary and extrapulmonary TB - Fungal risk: similar to the general hospitalized. aggravated by overcrowding and malnutrition | The combination of malnutrition and overcrowding enhances immunosuppression. increasing susceptibility to HF. |
Venezuela | Same as Colombia. but with scarce local data | - Infant malnutrition (11.3%)—Diabetes (8%)—TB (17/100,000) - Fungal risk: similar to Latin America, with local under-registration | - Malnutrition due to food crisis—Chronic diseases (diabetes, HTN)—TB in returnees - Fungal risk: possible delay in diagnosis, with poor surveillance | The humanitarian crisis hinders timely access to antifungal diagnosis and treatment. |
Brazil | - CVC—Broad-spectrum antibiotics—TPN—Recent surgery | - Infant malnutrition (7.4%)—HIV/AIDS (0.4%)—TB (32/100,000) - Fungal risk: outbreaks of candidemia in the ICU; increased isolates of N. glabratus | - Moderate malnutrition in Haitian refugees—HIV/AIDS in urban displaced persons—CKD (dialysis) in Haitian refugees—Chronic kidney disease (dialysis) in Haitian refugees - Fungal risk: elevated in dialysis and ICU patients | Migration from Haiti generates social stress and hinders the continuity of antifungal treatments. |
Peru | - Broad-spectrum antibiotics—CVC—Recent surgery—MV—TPN | - Infant malnutrition (12%)—TB (119/100 000)—HIV/AIDS (0.3%) - Fungal risk: incidence of 2.04‰ in ICU; mortality 39.6% | - Malnutrition in rural displaced persons—Extrapulmonary TB—TB-HIV co-infection in migrants - Fungal risk: similar to general inpatients | Internal-urban displacement delays seeking care, increasing fungal complications. |
Country | IC Burden (Incidence; Mortality) | Diagnosis and Treatment General Population | Diagnosis and Treatment Displaced/Migrant Population | Comments |
---|---|---|---|---|
Mexico | 1.19‰; 30–76% (regional mean) | Diagnosis:—Cultures and stains (48–72 h)-BDG/AGA (3 national institutes)-MALDI-TOF (5 high-complexity hospitals) Treatment:—FCZ-Standard AmB—L-AmB (limited)-Echinocandins (available, irregular distribution) | Diagnosis:—Cultures and stains in large hospitals—BDG and MALDI-TOF almost absent at the second level Treatment:—FCZ-D-AmB-Echinocandins (very limited access) | Existing national protocol, but uneven distribution of reagents and drugs delays the management of migrants and displaced persons. |
Haiti | 1.19‰; 30–76% (regional mean) | Diagnosis:—Cultures in 2 central laboratories (48–72 h)-No BDG, PCR, or MALDI-TOF. Treatment:—Generic AmB—FCZ (ONG) | Diagnosis:—Clinical (lack of specialized laboratories) Treatment:—AmB-FCZ-Echinocandins (not available) | Healthcare collapse and dependence on NGOs leave displaced persons without timely diagnosis and appropriate treatment. |
Central America Northern Triangle (El Salvador, Guatemala, Honduras) | 1.19‰; 30–76% (regional mean) | Diagnosis:—Local cultures—No BDG, PCR, or MALDI-TOF Treatment:—D-AmB-FCZ-ITZ-Echinocandins (not included in the public service) | Diagnosis:—Clinical and primary cultures—No immunological/molecular testing Treatment:—AmB-FCZ-Echinocandins (not accessible) | Lack of training and equipment in local laboratories; diagnostic delays increase mortality among displaced persons. |
Colombia | 1.19‰; 30–76% (regional mean) | Diagnosis:—Cultures and stains (48–72 h)-BDG (reference)-MALDI-TOF (large hospitals) Treatment:—D-AmB, L-AmB (limited)-FCZ, ITZ-Echinocandins (expensive, scarce) | Diagnosis: Cultures and stains (reference)—No BDG/MALDI-TOF in primary care Treatment:—AmB-FCZ-Echinocandins (not accessible) | Delays in diagnosis and lack of echinocandins in the public system increase mortality in displaced persons. |
Venezuela | 1.19‰; 30–76% (regional mean) | Diagnosis:—Cultures (very slow)—No BDG nor MALDI-TOF Treatment:—Generic AmB—FCZ (unstable stock) | Diagnosis:—Predominantly clinical—No immunological/molecular testing Treatment:—AmB-FCZ-Echinocandins (not available) | Chronic shortage of reagents and antifungals aggravates delays in displaced persons. |
Brazil | 2.49‰; 54% | Diagnosis:—Cultures and stains (48–72 h)—BDG (2–3 reference laboratories)—MALDI-TOF (large hospitals) Treatment:—AmB (including liposomal)—FCZ, VCZ, echinocandins | Diagnosis:—Cultures/stains in urban centers-Little BDG/MALDI-TOF outside of capitals—PCR almost null Treatment:—D-AmB-FCZ-Echinocandins (limited) | Large health centers offer adequate care, but rural refugees and displaced persons are almost completely lacking these options. |
Peru | 2.04‰; 39.6% (30 days) | Diagnosis:—Cultures (48–72 h)-BDG (2 laboratories in Lima)-MALDI-TOF (1 university center) Treatment:—D-AmB, L-AmB (limited stock)—FCZ, ITZ, echinocandins (irregular stock) | Diagnosis:—Cultures—Outside Lima without BDG/MALDI-TOF/PCR Treatment:—AmB-FCZ-Echinocandins (virtually inaccessible) | Concentration of resources in Lima leaves displaced persons from the interior of the country with almost insurmountable barriers to diagnosis and treatment. |
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Rivas-Pinedo, P.; Motta, J.C.; Gutierrez, J.M.O. Invasive Candidiasis in Contexts of Armed Conflict, High Violence, and Forced Displacement in Latin America and the Caribbean (2005–2025). J. Fungi 2025, 11, 583. https://doi.org/10.3390/jof11080583
Rivas-Pinedo P, Motta JC, Gutierrez JMO. Invasive Candidiasis in Contexts of Armed Conflict, High Violence, and Forced Displacement in Latin America and the Caribbean (2005–2025). Journal of Fungi. 2025; 11(8):583. https://doi.org/10.3390/jof11080583
Chicago/Turabian StyleRivas-Pinedo, Pilar, Juan Camilo Motta, and Jose Millan Onate Gutierrez. 2025. "Invasive Candidiasis in Contexts of Armed Conflict, High Violence, and Forced Displacement in Latin America and the Caribbean (2005–2025)" Journal of Fungi 11, no. 8: 583. https://doi.org/10.3390/jof11080583
APA StyleRivas-Pinedo, P., Motta, J. C., & Gutierrez, J. M. O. (2025). Invasive Candidiasis in Contexts of Armed Conflict, High Violence, and Forced Displacement in Latin America and the Caribbean (2005–2025). Journal of Fungi, 11(8), 583. https://doi.org/10.3390/jof11080583