# P-1731. Strengthening Fungal Infection Diagnosis And Treatment: An In-Depth Analysis Of Capabilities In Honduras

## TL;DR

This study highlights the challenges in diagnosing and treating invasive fungal infections in Honduras due to limited resources and infrastructure.

## Contribution

The study provides an in-depth analysis of Honduras' healthcare capacity for managing fungal infections, identifying critical gaps in diagnostics and treatment.

## Key findings

- Candida spp. and Aspergillus spp. are the most concerning fungal pathogens in Honduras.
- Advanced diagnostic techniques like PCR and antigen detection are largely absent in most healthcare institutions.
- Access to potent antifungal medications like amphotericin B and echinocandins is limited.

## Abstract

Invasive fungal infections (IFI) pose a major public health challenge in low- and middle-income countries (LMICs) due to limited diagnostic and treatment resources, resulting in high morbidity and mortality. Despite their global burden, IFIs remain under-recognized and under-diagnosed in LMICs. This study assesses Honduras' capacity to diagnose and treat IFIs amid its distinct healthcare challenges.

From March to December 2023, a comprehensive survey was conducted across multiple healthcare centers in Honduras. The survey, reviewed for content and clarity by local medical institutions, targeted medical microbiologists and clinicians to assess various aspects of fungal disease diagnosis and treatment. Data collected included the availability and use of diagnostic tools and antifungal therapies, identifying gaps and limitations in current practices.

The survey revealed that Candida spp. (97.4%) and Aspergillus spp. (35.9%) were the most concerning pathogens. Although microscopy and culture methods were available in most institutions, their application in suspected IFI cases was inconsistent, and antifungal susceptibility testing was rarely performed. Advanced diagnostic techniques, such as antigen detection, were available in only a few institutions, while antibody detection and PCR testing were entirely absent. All hospitals had access to at least one triazole antifungal, typically fluconazole, but there was a notable scarcity of more potent antifungals, including amphotericin B formulations and echinocandins. The limited use of available diagnostic tools and the restricted availability of essential antifungals were identified as major barriers to effective IFI management.

This study reveals major gaps in Honduras' capacity to diagnose and treat IFIs, including limited use of basic diagnostics, lack of advanced testing, and scarce access to antifungal medications. These deficiencies highlight the urgent need for capacity-building, infrastructure upgrades, and policy reforms. The findings can guide targeted interventions and resource allocation to improve IFI outcomes in Honduras and similar LMICs.

Jon Salmanton-Garcia, MSc, MPH, PhD, menarini, gilead, astrazeneca, pfizer: Honoraria Oliver A. Cornely, Prof. Dr., Al-Jazeera Pharmaceuticals/Hikma: Honoraria|Basilea: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Grant/Research Support|Elion: Advisor/Consultant|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|Melinta: Advisor/Consultant|Melinta: Board Member|MSD: Honoraria|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria