Fungal diagnostics and antifungal drug access in Latin America and the Caribbean: an ESCMID EFISG multinational survey

Abstract Invasive fungal diseases (IFD) pose a major health challenge in Latin America and the Caribbean (LAC), particularly in vulnerable populations. A cross-sectional, survey is distributed between April 2023 and May 2025 to institutions involved in IFD diagnosis or care across LAC. The questionnaire evaluates diagnostic tools, antifungal availability, and therapeutic drug monitoring (TDM). A total of 619 institutions from 23 countries across LAC participate. Candida spp. (92%) and Aspergillus spp. (54%) are most frequently reported as major fungal threats. Culture (90%) is widely available, whereas access to galactomannan (41%), β-D-glucan (29%), and molecular testing (23%) is considerably lower. Availability of antifungals, including liposomal amphotericin B (38%), echinocandins (51%), voriconazole (57%) or posaconazole (33%) is significantly higher in countries with GDP per capita >US$ 10,000, in transplant centres, and in institutions managing people living with HIV. Therapeutic drug monitoring is available in only 36% of centres. Major diagnostic and treatment gaps persist in low-income countries, particularly in access to tools for identifying endemic mycoses. Substantial disparities exist in IFD diagnostic and treatment capacity across LAC, primarily driven by national income and institutional complexity. Strengthening laboratory infrastructure, antifungal access, and integration of fungal disease management into public health systems is urgently needed.

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Publication Details

Journal
Nature Communications
Published
2026-07-28
DOI
https://doi.org/10.1038/s41467-026-73165-2
Primary Topic
Antifungal resistance and susceptibility
Type
article
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article

Fungal diagnostics and antifungal drug access in Latin America and the Caribbean: an ESCMID EFISG multinational survey

Indira Berrío, Maribel Dolande, Alexandro Bonifáz, Norma Fernández et al.
Nature Communications
Antifungal resistance and susceptibility
article

Fungal diagnostics and antifungal drug access in Latin America and the Caribbean: an ESCMID EFISG multinational survey

Indira Berrío, Maribel Dolande, Alexandro Bonifáz, Norma Fernández, Freddy Pérez, Jon Salmanton‐García, Julio Maquera-Afaray, Oliver A. Cornely, Alessandro C. Pasqualotto, Luis E. Cuéllar, Andrés Ceballos, Diana Varela, Bryan Ortiz, Diego R. Falci, Mayda Rosa Perurena Lancha, Tulio C. O. Magalhães, Diana Perales
article en

Abstract

Abstract Invasive fungal diseases (IFD) pose a major health challenge in Latin America and the Caribbean (LAC), particularly in vulnerable populations. A cross-sectional, survey is distributed between April 2023 and May 2025 to institutions involved in IFD diagnosis or care across LAC. The questionnaire evaluates diagnostic tools, antifungal availability, and therapeutic drug monitoring (TDM). A total of 619 institutions from 23 countries across LAC participate. Candida spp. (92%) and Aspergillus spp. (54%) are most frequently reported as major fungal threats. Culture (90%) is widely available, whereas access to galactomannan (41%), β-D-glucan (29%), and molecular testing (23%) is considerably lower. Availability of antifungals, including liposomal amphotericin B (38%), echinocandins (51%), voriconazole (57%) or posaconazole (33%) is significantly higher in countries with GDP per capita >US$ 10,000, in transplant centres, and in institutions managing people living with HIV. Therapeutic drug monitoring is available in only 36% of centres. Major diagnostic and treatment gaps persist in low-income countries, particularly in access to tools for identifying endemic mycoses. Substantial disparities exist in IFD diagnostic and treatment capacity across LAC, primarily driven by national income and institutional complexity. Strengthening laboratory infrastructure, antifungal access, and integration of fungal disease management into public health systems is urgently needed.

Nature CommunicationsVol. 17(1)
TH Köln - University of Applied Sciences (DE), Federico Villarreal National University (PE), Universidade Federal de Ciências da Saúde de Porto Alegre (BR), Rafael Advanced Defense Systems (Israel) (IL), University of Cologne (DE), Pontificia Universidad Javeriana (CO), Santa Casa Hospital (BR), Hospital General de México (MX), Polytechnic University of San Luis Potosí (MX), Daniel Alcides Carrión National University (PE), Universidad de Antioquia (CO), Düsseldorf University Hospital (DE), Integrated Oncology (United States) (US), Hospital de Clínicas de Porto Alegre (BR), Municipality of Medellín (CO), German Center for Infection Research (DE), Hospital de Clínicas "José de San Martín" (AR), Universidad Metropolitana de Honduras (HN), Instituto Nacional de Enfermedades Neoplásicas (PE), Corporación para Investigaciones Biológicas (CO), National Autonomous University of Honduras (HN), European Society of Clinical Microbiology and Infectious Diseases (CH), Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (DE), Honduras Foundation for Agricultural Research (HN), Instituto de Medicina Tropical “Pedro Kourí” (CU), University Hospital Cologne (DE), Heinrich Heine University Düsseldorf (DE)
No poverty
Openalex Percentile: Top 9%
Antifungal resistance and susceptibility
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