International Society for Human and Animal Mycology (ISHAM)—New Initiatives
Abstract
:1. Present Status
- Lack of awareness of fungal diseases, especially in developing countries where two thirds of the world population lives. A recent survey in seven Asian countries reported a lack of formal training in medical mycology in 37% of clinicians; each clinician handles only 2–4 invasive fungal infections a month due to lack of suspicion and the absence of diagnostic mycology facilities; 80% of patients could not afford appropriate antifungal drugs. Clinicians fail to follow the standard guidelines of management; 34.3% of clinicians noted that they could not treat patients with appropriate antifungals due to the non-availability of the drug in their country [8];
- It is estimated that two million serious fungal infections are present at any time in Latin American countries, 1.7 million serious fungal infections in 15 African countries and more than two million serious fungal infections in eight countries in Southeast Asia [9];
- Certain game changers in fungal disease patterns have been noted over the years. Three important events over the last decade may explain the change in the paradigm of fungal infections.
- An outbreak of cryptococcosis due to Cryptococcus gattii in the temperate climate of Vancouver Island and the North-Western part of the United States of America, although the fungus had been known to be prevalent only in tropical climates. It was postulated that the fungus spread from Brazil to the temperate region by adaptation over the years [10,11,12];
- Candida auris, a fungus which behaves like bacteria. It is a serious threat due to antifungal resistance and rapid spread in healthcare facilities [15].
- The limited number of diagnostic mycology laboratories in developing countries is the most important stumbling block in managing fungal infections;
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- A survey of eight countries in southeast Asia reported availability of non-culture-based diagnostics (beta-glucan, galactomannan, and Histoplasma antigen detection) in less than 25% of the laboratories [20];
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- A similar picture has been noted in Latin American and Caribbean countries in another survey [21];
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- Even in a developed country like the United Kingdom, a laboratory survey reported availability of β-glucan in 5%, galactomannan in 20%, and fungal PCR diagnosis in 6% laboratories only [22];
- Limited recognition of fungal diseases by international authorities is another barrier in the development of mycology;
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- Although after a prolonged advocacy, the World Health Organization (WHO) has agreed to include yeast antifungal resistance surveillance in the Global Antimicrobial Resistance Surveillance System (GLASS), the start of this surveillance is taking a long time due to inadequacies in diagnostic fungal laboratories and the evolving standard of antifungal resistance testing;
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- Mycetoma and chromoblastomycosis have been included in the WHO Neglected Tropical Disease (NTD) list, but many are still waiting to be included, like paracoccidioidomycosis, fungal keratitis and sporotrichosis;
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- Until the worldwide emergence of C. auris infections, fungal diseases were never included in public health challenge listings, though fungal keratitis, resistant dermatophyte infections, sporotrichosis, Candida vaginitis, etc., are major public health problems affecting large numbers of people. This requires concerted advocacy from organisations working in this field, including ISHAM;
- Antifungal drugs—Due to the limited scope of exploiting differences in metabolism between fungi and humans (both eukaryotes), few antifungal classes are in practice to treat human fungal infections. Both intrinsic resistance and emerging acquired resistance in antifungal drugs is further limiting the scope of antifungal management. Aggravating the problem, antifungal drugs are beyond the reach of the majority of the population in developing countries, either due to cost of the drugs or non-availability in certain countries. In a recent multi-centre study from India on mucormycosis, one quarter of the patients could not be treated with appropriate antifungal drugs despite timely diagnosis [23].
2. Targets of Mycology Societies
3. New Activities Initiated by ISHAM
To Achieve the Above Targets ISHAM Initiated the Following Activities
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Chakrabarti, A.; Meis, J.F.; Cornely, O.A. International Society for Human and Animal Mycology (ISHAM)—New Initiatives. J. Fungi 2020, 6, 97. https://doi.org/10.3390/jof6030097
Chakrabarti A, Meis JF, Cornely OA. International Society for Human and Animal Mycology (ISHAM)—New Initiatives. Journal of Fungi. 2020; 6(3):97. https://doi.org/10.3390/jof6030097
Chicago/Turabian StyleChakrabarti, Arunaloke, Jacques F. Meis, and Oliver A. Cornely. 2020. "International Society for Human and Animal Mycology (ISHAM)—New Initiatives" Journal of Fungi 6, no. 3: 97. https://doi.org/10.3390/jof6030097