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Article

The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report

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The International Foundation for Dermatology, London W1T 5HQ, UK
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The Global Fund for Fungal Infections, 1208 Geneva, Switzerland, and the University of Manchester, Manchester M13 9PL, UK
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Hospital General de México, “Dr. Eduardo Liceaga”, CP 06720, Mexico
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Department of Public Health, Hospital de Clinicas, Federal University of Parana, 80060-900 Curriba, Parana, Brazil
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Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Tropical Medicine, Infectious Diseases and Dermatology Department at the Hospital Cayetano Heredia, Lima 15102, Peru
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Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Hospital General de Acapulco, Secretaria de Salud Guerrero, C.P. 39901, Mexico
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Laboratoire de Parasitologie-Mycologie, Grenoble Alpes University, CNRS, Grenoble INP, CHU Grenoble Alpes, F-38000, France
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Community Dermatology Mexico C.A., Acapulco 39850, Guerrero, Mexico
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The Mycetoma Research Centre, Khartoum, Soba University Hospital, P.O. Box 102, Sudan
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School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111211, Colombia
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Peking University First Hospital, Research Centre for Medical Mycology, Peking University, Beijing 100034, China
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Department of Medical Microbiology, National Health Laboratory Services and School of Laboratory Medicine and Medical Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Berea, Durban 4001, South Africa
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Nelson R Mandela School of Medicine, University of Kwazulu Natal, Berea, Durban 4001, South Africa
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Faculty of Médicine, Antananarivo B.P 375 - 101, Madagascar
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Centre d’Infectiologie Charles Mérieux, Université d’Antananarivo, Antananarivo BP 4299, Madagascar
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Erasmus MC, Department of Medical Microbiology and Infectious Diseases, 3000 CA Rotterdam, The Netherlands
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Drugs for Neglected Disease Initiative, 1202 Geneva, Switzerland
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Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2019, 4(4), 122; https://doi.org/10.3390/tropicalmed4040122
Received: 25 July 2019 / Revised: 18 August 2019 / Accepted: 6 September 2019 / Published: 24 September 2019
The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs. View Full-Text
Keywords: fungal NTDs; laboratory diagnosis; mycetoma; sporotrichosis; chromoblastomycosis; integrated approaches fungal NTDs; laboratory diagnosis; mycetoma; sporotrichosis; chromoblastomycosis; integrated approaches
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MDPI and ACS Style

Hay, R.; Denning, D.W.; Bonifaz, A.; Queiroz-Telles, F.; Beer, K.; Bustamante, B.; Chakrabarti, A.; Chavez-Lopez, M.d.G.; Chiller, T.; Cornet, M.; Estrada, R.; Estrada-Chavez, G.; Fahal, A.; Gomez, B.L.; Li, R.; Mahabeer, Y.; Mosam, A.; Soavina Ramarozatovo, L.; Rakoto Andrianarivelo, M.; Rapelanoro Rabenja, F.; van de Sande, W.; Zijlstra, E.E. The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report. Trop. Med. Infect. Dis. 2019, 4, 122. https://doi.org/10.3390/tropicalmed4040122

AMA Style

Hay R, Denning DW, Bonifaz A, Queiroz-Telles F, Beer K, Bustamante B, Chakrabarti A, Chavez-Lopez MdG, Chiller T, Cornet M, Estrada R, Estrada-Chavez G, Fahal A, Gomez BL, Li R, Mahabeer Y, Mosam A, Soavina Ramarozatovo L, Rakoto Andrianarivelo M, Rapelanoro Rabenja F, van de Sande W, Zijlstra EE. The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report. Tropical Medicine and Infectious Disease. 2019; 4(4):122. https://doi.org/10.3390/tropicalmed4040122

Chicago/Turabian Style

Hay, Roderick, David W. Denning, Alexandro Bonifaz, Flavio Queiroz-Telles, Karlyn Beer, Beatriz Bustamante, Arunaloke Chakrabarti, Maria d.G. Chavez-Lopez, Tom Chiller, Muriel Cornet, Roberto Estrada, Guadalupe Estrada-Chavez, Ahmed Fahal, Beatriz L. Gomez, Ruoyu Li, Yesholata Mahabeer, Anisa Mosam, Lala Soavina Ramarozatovo, Mala Rakoto Andrianarivelo, Fahafahantsoa Rapelanoro Rabenja, Wendy van de Sande, and Eduard E. Zijlstra. 2019. "The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report" Tropical Medicine and Infectious Disease 4, no. 4: 122. https://doi.org/10.3390/tropicalmed4040122

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