David W Denning, FRCP FRCPath FMedSci, professor of infectious diseases and global health at the University of Manchester, and a key figure in GAFFI, discussed the ongoing challenges in diagnosing and treating fungal infections. He also highlighted the goals and successes of the “95-95 by 2025” campaign, which seeks to address global care gaps for fungal infections.
“When we started asking our colleagues, the GAFFI ambassadors, and others about which drugs they had available, we found that many countries didn’t have them (testing),” Denning explained. “One of the things GAFFI did was to register a number of diagnostics and antifungal drugs as essential for the WHO. Once these drugs are listed, it becomes incumbent on the governments to make them available to their populations. Uzbekistan took immediate action, applied, and within six months, they had all the generic antifungal drugs approved, something that hadn’t happened before.”
Denning gave another example, “In Nigeria we’ve been working with late-stage HIV patients. Our ambassador there has trained hundreds of clinicians across the country on how to diagnose cryptococcal meningitis and histoplasmosis. These tests have now been rolled out, and as a result, more diagnoses are being made, allowing doctors to give the correct treatment earlier,” Denning explained. “Although the survival benefit isn’t yet formally demonstrated, these diagnostic efforts have been integrated into national AIDS treatment guidelines, ensuring broader access to life-saving treatments.”
Indonesia and India are also witnessing shifts in how fungal infections are diagnosed. In both countries, where tuberculosis (TB) is highly prevalent, many patients with chronic chest diseases are being misdiagnosed with TB when, in fact, they are suffering from fungal infections. Denning noted that this misdiagnosis is common in areas where fungal diseases are not part of the standard diagnostic thinking. “We are starting to see more fungal infections being diagnosed instead of TB, especially in patients with chronic chest disease. The key here is awareness—awareness from both lab professionals and clinicians,” he said.
The project’s success in Guatemala, with the country now seeing an increase in correct fungal diagnoses and a reduction in mortality rates for late-stage HIV patients. Denning emphasized that the results are clear: “The number of fungal diagnoses has increased, and this is leading to better treatment and survival outcomes for patients.”
Denning noted that there are various clinical scenarios where fungal infections are still overlooked, resulting in poor patient outcomes. “A common scenario is a patient who presents with symptoms that could be TB, such as a cough or chest pain,” Denning explained. “They’re often sent to a TB clinic, where they undergo TB tests, and even if those tests are negative, they are still treated for TB. This is because the clinicians aren’t considering fungal infections, which leads to unnecessary treatments and contributes to AMR.”
Denning emphasized “To really make a difference, clinicians need to be aware of the differential diagnosis for infections. Is it a fungus? Is it bacteria? Is it a virus? Is it cancer? Accurate diagnostics and timely treatments are critical,” Denning said.
Part 1 of our interview with Denning: Fungal Infections: Invisible Until It’s Too Late
Stay tuned for more updates on GAFFI’s progress and other initiatives focused on improving global health in the next part of our conversation.
