Fungal Disease Response Centre: Pioneering Diagnostic Approach for Regions With Dispersed Hospital Centres

Abstract

Background: Access to fungal disease diagnosis is crucial for reducing mortality, yet it varies widely across Argentina, especially outside Buenos Aires. In regions like Santa Fe and Paraná, where most healthcare facilities are under 150 beds, maintaining specialised mycology labs is challenging. Objectives: This work describes the establishment and first-year results of a centralised Fungal Disease Response Centre (FDRC) and referral network serving this region, covering approximately 1 million inhabitants. Methods: The FDRC provided tests from the WHO's Essential Diagnostic List, along with antifungal susceptibility testing and molecular diagnostics. Additionally, we offered continuous training, a courier service and digital tools for service requests and result reporting. Methods: In 2023, the FDRC handled samples from 878 patients from 22 institutions, performing 1151 tests on 897 samples. Common tests included Aspergillus galactomannan quantification and molecular diagnostics, diagnosing 101 fungal infections including fungaemias, histoplasmosis, aspergillosis and deep-seated candidiasis. Average turnaround times were 6.2h for antigen-based tests and 21.5h for molecular tests. Conclusions: This centralised service improved diagnosis speed and quality, overcoming limitations of smaller labs. It also enabled population-based studies, revealing higher-than-expected histoplasmosis prevalence. The FDRC's first-year results demonstrate that regional centralisation can enhance diagnostic quality, improve patient outcomes and advance epidemiological knowledge.