Global Action For Fungal Infections (GAFFI)

Muchas gracias a todos los que apoyaron para que este proyecto avance!!! Ahora a empezar a trabajar para reducir las muertes prevenibles por VIH!! https://lnkd.in/eW2f-kvD

👁 Risk Assessment of Advanced HIV Disease (AHD) Using CD4 Lateral Flow Assay (LFA) There is sufficient evidence demonstrating that patients with advanced HIV have an elevated risk of severe opportunistic infections. This risk is assessed through a rapid CD4 count. Currently, the only widely available test is the VISITECT CD4 Advanced Disease Lateral Flow Assay (CD4-LFA) (Accubio). Two recent articles (https://lnkd.in/dtEzT3M5 & https://lnkd.in/dJ45EqHx) show that while its sensitivity is high, its specificity falls far below acceptable levels for a test of this nature. In high-risk situations, a low specificity may be acceptable—if the sensitivity is very high, as is the case here—because all at-risk patients would be evaluated according to established recommendations. However, we cannot stop at this point since a test of this nature, without subsequent confirmation via flow cytometry of the CD4-LFA result, has collateral effects that must be carefully analyzed. Firstly, many patients are classified as having advanced disease when they do not. Secondly, the burden of opportunistic infections in advanced disease decreases, leading to a false sense of lower risk when including patients in the screening who do not have advanced disease but are classified as such by the test. Thirdly, operational costs increase, which can be unsustainable for LMICs, as some clinical and diagnostic interventions may be unnecessary. Fourthly, a useful risk assessment test may be abandoned due to not carefully analyzing how its specificity can be improved. In our experience, the visual comparison of the intensity of two bands comes with considerable variability, depending on many factors that are not controllable and primarily related to the observer, including their training, visual acuity, and fatigue, as well as the clinical context in which the test is conducted: a patient living with HIV seeking medical attention, with a need for rapid risk assessment to determine whether to undertake a series of diagnostic and treatment interventions. An equivocal result may lead to the recommended intervention not being carried out, putting the patient's life at risk. Therefore, it is understandable that there is a confirmation bias and that patients are more frequently classified with AHD. In this complex context, which involves personal aptitudes, workload, and empathy, the development of automatic reading systems seems reasonable to aid in interpreting the test, minimizing inherent variability and the difficulties of global standardization due to the interaction of hundreds or thousands of different people with the execution, reading, and interpretation of the test. It is not about the presence or absence of a band but about comparing their intensity, which, in our opinion, is a subjective exercise subject to too many uncontrollable factors. #FungalDisease #FungalAI #ThinkFungalPatients #UnburdenFungalImpact #GlobalFungalCare

Five attendees of a California music festival contracted Valley fever after inhaling *Coccidioides fungal spores*. Given the attendance of over 20,000 people, more cases may emerge. This respiratory illness can be severe 🫁🍄 🌵🏜️⚠️ #ValleyFever #HealthAlert #fungi #festival https://lnkd.in/dZa7dHEJ

To improve patient survival, early detection is crucial. Access to diagnosis is essential—clinicians must accurately identify the patient's condition to tailor treatments, save lives, and reduce antibiotic misuse. While the publication data is vital for understanding the situation, our priority should be diagnosing the patient while they are still alive.

👀 Has the Epidemic of Populism Reached Fungal Disease? I return to a topic that concerns me because I hear it with increasing frequency. Perhaps it is a “confirmation bias,” making its discussion even more important. Diagnosis is the primary activity of medicine. While we might remember "Dr. House" using therapeutic empiricism to uncover the cause of the unknown disease of the week, the reality is that today, complementary tests play a crucial role in finding the cause of the condition that brought the person to the hospital. However, until we have the "Tricorder" —a portable, multifunctional device used in the "Star Trek" universe (Star Trek IV: The Voyage Home) to scan, diagnose, and treat patients, as well as to analyze environments and collect scientific data— we must make do with current diagnostic technology which, unfortunately, is expensive, requires prolonged training for proper use, and, in most cases, is multifaceted. We do not have a "Tricorder" that can find the cause and treat through a harmless, superficial, and non-invasive examination. Therefore, to ensure everyone plays by the same rules, the only solution is the transfer of technology from those fortunate places that enjoy it to those that, for various reasons not worth discussing here, do not have it. The sublime decision to develop "Tricorders" should focus on human beings rather than territories, as illness does not acknowledge the artificial division of a planet rotating around a blazing helium core into isolated compartments. The "Tricorder" will be welcomed and blessed, but meanwhile, the current technology that accurately identifies the cause of a person’s malfunction should be available wherever these failures appear. Waiting for the advent of the "Tricorder" with real but ineffective arguments such as: limited resources, complex facilities, prolonged training, and complicated logistics, does not help patients. #FungalDisease has been recognized as a global public health problem. There is a chasm between the diagnostic and treatment capacities for #FungalDisease in HICs and LMICs. However, there is no global strategy to ensure that patients with severe #FungalDisease have access to diagnosis and treatment under similar conditions. Its design and implementation are urgent. It will be a long and tortuous journey, but the sooner we begin, the sooner we will be pleased with the results. “We cannot keep waiting for the Tricorder.” #FungalDisease #FungalAI #FundFungalSolutions #ThinkFungalPatients #UnburdenFungalImpact #GlobalFungalCare 🌐 GAFFI supports the global access to diagnosis, management, and treatment of #FungalDisease. 🗣️ Please, disseminate GAFFI's post among your contacts. We need to step out of our comfort zone and convince the world that #FungalDisease causes significant mortality, and together we can save many lives.

High Prevalence of Terbinafine Resistance Among Trichophyton mentagrophytes/T. interdigitale Species Complex, a Cross-Sectional Study from 2021 to 2022 in Northern Parts of Iran https://lnkd.in/ec-EXRxw

👁 Ten Reasons to Urgently Equip Hospitals in LMICs with Proven Diagnostic Technologies for #FungalDisease 1.     Proven Efficacy: Current techniques are effective in diagnosing many severe fungal diseases in hospital settings, ensuring accurate and timely diagnoses, which is critical for effective treatment and improved health outcomes. 2.     Immediate Implementation: Existing diagnostic techniques are already developed and validated. This provides instant benefits. 3.     Rapid Capacity Building: Training healthcare professionals in LMICs improves their skills quickly and ensures the effective use of these tools. 4.     Uniform Diagnostic Standards: Using the same diagnostic technologies everywhere maintains uniform benchmarks, facilitating data comparisons, quality control, and ensuring high standards of patient care. 5.     Established Support and Maintenance: Proven diagnostic technologies come with well-developed support and maintenance networks, which are crucial for long-term operation and reliability. 6.     New Diagnostic Developments: Developing and validating new diagnostic tools can take 5 to 10 years or more. In contrast, transferring existing technologies can provide immediate impact and timely diagnostic capabilities. 7.     Easier Validation Studies: Transferring existing diagnostic technologies makes validation studies for new and improved techniques easier and faster. Hospitals are already equipped and trained, patients are accurately diagnosed, and established biobanks provide well-documented samples. With more identified cases worldwide, validation studies become more efficient and quicker, leveraging the existing infrastructure and data. 8.     Cost-Effective Resource Allocation: Utilizing and transferring existing proven technologies is more cost-effective for the Health System than wait for the development of similar, simpler, and more affordable new tools. 9.     Facilitation of International Collaboration: Agreements and collaborations between HICs and LMICs promote knowledge exchange, continuous support, and help bridge the healthcare gap. 10. Comprehensive Economic and Professional Benefits: Transferring advanced diagnostic technologies to LMICs can attract highly skilled healthcare professionals, stimulate local research and development, foster international business growth, and contribute to overall economic development. Transferring existing diagnostic technologies and negotiating with diagnostic companies to make advancements accessible to the largest number of patients is a more cost-effective and ethical approach than duplicating techniques looking only for simplicity and affordability. This strategy provides immediate benefits, saves lives, and promotes global health equity. The focus should be on maximising the impact of current technologies through strategic partnerships while continuing to develop new techniques as supplementary efforts to cover the existing gaps in the diagnosis of severe #FungalDisease.

What is a pathogen? The damage-response framework posits that the capacity for pathogenesis is not a microbial trait, as it is often defined, but an outcome of host-microbe interactions. In other words, pathogenesis doesn't simply exist—it emerges. https://brnw.ch/21wKokQ

👁 Attempting to Combat “UNTREATABLE FUNGAL DISEASE” 77th World Health Assembly. Resolution on Antimicrobial Resistance. The WHA approved a resolution to accelerate national and global responses to antimicrobial resistance (AMR), ahead of the second UN General Assembly High-Level Meeting on AMR to take place in September 2024. The Fungal Pathogen Priority List contains 19 human pathogenic fungi, some of which show high rates of resistance to antifungals, which implies higher mortality, prolonged hospital stays, and alternative antifungal treatments that are not available in many countries. In reality, some of the severe conditions caused by the pathogens included in the FPPL could be called “Untreatable Infections” since there are no antifungals with the necessary activity to guarantee the death of the causative fungus. There are only 4 classes of antifungals authorized for the treatment of infections caused by human pathogenic fungi. The existing antifungals have side effects and interact with many other drugs, making their management complicated. Furthermore, there are few new candidates in clinical trials. We hope this new resolution will help to establish, where none exist, and strengthen existing programs to contain resistance of human pathogenic fungi by: 1.     Access to the diagnosis of #FungalDisease. Without access to diagnosis, empiricism is the norm, which implies the administration of broad-spectrum antimicrobials to cover unknown etiological agents. This undoubtedly increases the pressure on the global microbiome, selecting those that are resistant and exponentially aggravating the problem, as it is not even known what the empirical antimicrobials are acting on due to the lack of diagnostic techniques. 2.     Surveillance of incidence/prevalence to establish the real disease burden and not rely on estimates (studies conducted by GAFFI have always found higher incidences than estimated). 3.     Expansion of antifungal resistance surveillance programs through technology transfer between HICs and LMICs. 4.     Development of new, simpler, and faster technologies for detecting resistance, validated against EUCAST and CLSI reference techniques. 5.     Global access to existing antifungals and the development of new antifungals. The mortality and morbidity of severe Fungal Disease are very high even when the infection is caused by a fungus considered susceptible to antifungals, so they increase exponentially when dealing with a resistant one. The term “#UntreatableDisease” is indeed very accurate. #FungalDisease #FungalAI #FundFungalSolutions #ThinkFungalPatients #UnburdenFungalImpact #GlobalFungalCare 🌐 GAFFI supports the global access to diagnosis, management, and treatment of #FungalDisease. 🗣️ Please, disseminate GAFFI's post among your contacts. We need to step out of our comfort zone and convince the world that #FungalDisease causes significant mortality, and together we can save many lives.

👁 Medical Mycology Diagnostic Laboratory For some time now, I have been hearing and reading about the urgent need to develop more POCTs, with which I absolutely agree. However, alongside this demand, I sense that a sector of the healthcare system believes that these instruments will resolve the diagnosis of #FungalDisease entirely. Therefore, I want to put my opinion in writing, with no other intention than to encourage a balanced reflection between expectations and the stubborn reality. POCT diagnostic techniques are very useful, but they are only part of the solution. First, there are difficulties in validating them in all contexts where their use is necessary, leading to the assumption that their characteristics are uniform. However, until proven otherwise, we must assume that their sensitivity and specificity can be influenced by the underlying diseases that increase the risk of severe Fungal Disease. Recent scientific literature demonstrates the varying sensitivity of the cryptococcal antigen depending on whether the patient has HIV or another underlying condition. Additionally, we must consider the cross-reactions these biomarkers have with other infections, which, depending on their prevalence in different geographic areas, can cause serious interpretation problems. Therefore, it seems reasonable to have other technologies available to complement the deficiencies of any single diagnostic tool. Invariably, the laboratory portfolios in HICs are diverse and aligned with the diagnostic challenges of each pathology. One might think that the relentless advancement of technology has rendered classical techniques such as microscopy and culture obsolete, but, as of today, they remain indispensable. If positive, microscopy provides a very rapid response, reinforcing the clinical suspicion, and culture is needed to isolate the fungus present in the clinical sample, identify it unequivocally, determine its sensitivity or resistance to antifungals—the molecular detection of resistance mechanisms is rapid but can only be applied to some known mechanisms—type it if it is suspected to be part of an infection outbreak, and preserve it carefully for ongoing research. In summary, and without diminishing their growing importance and usefulness, POCTs are just one part of the portfolio that a medical mycology laboratory must have to diagnose Fungal Disease quickly and accurately. It is urgent to transfer diagnostic technology between HICs and LMICs, along with the necessary training, to bridge the existing gap. Access to diagnosis is crucial for the patient and essential for containing antimicrobial resistance, preventing infections from becoming #UntreatableDiseases again. When that long-awaited nuclear scanner becomes available, allowing us to identify and correct atomic misplacements with just the press of the famous RESET button, we can dispense with all current diagnostic tools. Until then, let's ensure they are available globally.