Early in August, Professor Denning visited Lanzhou, Hangzhou, Shanghai and Guangzhou meeting clinicians, visiting laboratories and educating physicians about the large burden of fungal disease and the opportunity for improved diagnostics. He cited one example from China of the likely number of deaths from invasive aspergillosis in COPD patients. Of the estimated 32.8 million people with COPD, nearly 12 million are admitted to hospital each year. A study in nearly 300 admissions in Guangzhou showed 3.9% to have invasive aspergillosis, and 43% died. If translated to the whole of China, 460,000 would develop invasive aspergillosis and nearly 200,000 die. These figures are based on culture from the respiratory tract, a notoriously insensitive test for this disease, suggestive of a substantial under-estimate.
GAFFI is advocating for China to develop a Mycology Reference Laboratory in each province. As part of the role of such laboratories, surveillance and epidemiology will be important. There is a need to study both the burden and impact of fungal disease in China . There is also a need to make major educational efforts for healthcare professionals – especially physicians, pharmacists and diagnostic microbiology lab staff with a focus on:
- Identify patients with chronic and allergic aspergillosis in respiratory medicine clinics who can benefit from antifungal therapy (esp. asthma and after TB), reducing antibiotic and steroid therapy, reducing hospitalisations and improve survival,
- Use of rapid non-culture diagnostics to identify life-thereatening fungal infections (invasive aspergillosis and candidiasis) in hospitalised patients to avoid unnecessary deaths and antibiotic therapy (which is ineffective for fungal infections), and equally important to stop empirical antifungal therapy when tests are negative, saving money,
- Matching the best antifungal drug and dose to each situation, avoiding drug interactions, development of antifungal resistance, adverse events and failure of therapy.