Estimates of the global burden of serious fungal diseases place the main burden in 3 categories: potentially life-threatening infections in AIDS (cryptococcal meningitis, Pneumocystis pneumonia and disseminated histoplasmosis); life-threatening infection in hospitalised and immunocompromised patients (invasive candidiasis and aspergillosis); and chronic debilitating lung infections and allergies (‘fungal asthma’ and chronic pulmonary aspergillosis, many after TB). Deaths from fungal infection in AIDS are estimated to exceed 700,000, nearly 50% of the total AIDS deaths.
Recently major improvements in diagnostics allow earlier diagnosis and better therapy, even discontinuing unnecessary antibacterial and antifungal therapies. There is a major need to build capacity and expertise in this area, to reduce deaths, reduce pressure on antibacterial and antifungal resistance and to reduce ill-health. Adequate and well established antifungal agents have been available since the 1960’s (amphotericin B), 1970’s (flucytosine) and 1990’s (fluconazole and itraconazole), yet the first 2 are unavailable in many countries.
The potential impact of improved access to fungal diagnostic tests and antifungal therapy will be illustrated by reference to reducing deaths in AIDS. Most patients who die of AIDS are in their 30’s. If at least 60% of the 35 million HIV population has access to fungal diagnosis and therapy by 2020, conservative estimates of reduced deaths from cryptococcal disease, Pneumocystis pneumonia, disseminated histoplasmosis and chronic pulmonary aspergillosis are a fall between from 233,750 to 163,000, from 260,000 to 97,500, from 80,000 to 32,000 and from 56,000 to 22,500 respectively, a cumulative total of 1,642,000 people, who do not die in the prime of life.