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.