{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:50:42Z","timestamp":1787871042534,"version":"build-2784847793"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"received research grants from PAHO"},{"name":"works for the Pan American Health Organization"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Commun"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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.\n                    <jats:italic>Candida<\/jats:italic>\n                    spp. (92%) and\n                    <jats:italic>Aspergillus<\/jats:italic>\n                    spp. (54%) are most frequently reported as major fungal threats. Culture (90%) is widely available, whereas access to galactomannan (41%), \u03b2-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 &gt;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.\n                  <\/jats:p>","DOI":"10.1038\/s41467-026-73165-2","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:26:49Z","timestamp":1785227209000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fungal diagnostics and antifungal drug access in Latin America and the Caribbean: an ESCMID EFISG multinational survey"],"prefix":"10.1038","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6782-5395","authenticated-orcid":false,"given":"Alessandro C.","family":"Pasqualotto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Berrio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Ortiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3698-8343","authenticated-orcid":false,"given":"Julio","family":"Maquera-Afaray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Varela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis E.","family":"Cu\u00e9llar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freddy","family":"P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayda Rosa","family":"Perurena Lancha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Perales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maribel","family":"Dolande","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2045-3317","authenticated-orcid":false,"given":"Alexandro","family":"Bonifaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Ceballos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulio C. O.","family":"Magalh\u00e3es","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9599-3137","authenticated-orcid":false,"given":"Oliver A.","family":"Cornely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego R.","family":"Falci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6766-8297","authenticated-orcid":false,"given":"Jon","family":"Salmanton-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"73165_CR1","doi-asserted-by":"crossref","unstructured":"Bongomin, F., Gago, S., Oladele, R. O. & Denning, D. W. Global and multi-national prevalence of fungal diseases\u2014estimate precision. J. Fungi 3, 57 (2017).","DOI":"10.3390\/jof3040057"},{"key":"73165_CR2","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1111\/myc.12890","volume":"62","author":"DR Falci","year":"2019","unstructured":"Falci, D. R. & Pasqualotto, A. C. Clinical mycology in Latin America and the Caribbean: a snapshot of diagnostic and therapeutic capabilities. Mycoses 62, 368\u2013373 (2019).","journal-title":"Mycoses"},{"key":"73165_CR3","first-page":"785","volume":"49","author":"AL Colombo","year":"2011","unstructured":"Colombo, A. L., Tobon, A., Restrepo, A., Queiroz-Telles, F. & Nucci, M. Epidemiology of endemic systemic fungal infections in Latin America. Med. Mycol. 49, 785\u2013798 (2011).","journal-title":"Med. Mycol."},{"key":"73165_CR4","doi-asserted-by":"publisher","first-page":"e367","DOI":"10.1016\/S1473-3099(17)30306-7","volume":"17","author":"F Queiroz-Telles","year":"2017","unstructured":"Queiroz-Telles, F. et al. Neglected endemic mycoses. Lancet Infect. Dis. 17, e367\u2013e377 (2017).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR5","doi-asserted-by":"crossref","unstructured":"Riera, F., Caeiro, J. P., Cornely, O. A., Salmanton-Garcia, J. & Argentinian IFI diagnostic and treatment capacity group. The Argentinian landscape of mycological diagnostic capacity and treatment accessibility. Med. Mycol. 61, myad058 (2023).","DOI":"10.1093\/mmy\/myad058"},{"key":"73165_CR6","unstructured":"Maquera-Afaray, J. et al. Fungi under fire: diagnostic capacities and antifungal availability in Peruvian healthcare facilities. Microbiol. Spectr. 13, e0202024 (2025)."},{"key":"73165_CR7","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae578","volume":"11","author":"B Ortiz","year":"2024","unstructured":"Ortiz, B. et al. Strengthening fungal infection diagnosis and treatment: an in-depth analysis of capabilities in Honduras. Open Forum Infect. Dis. 11, ofae578 (2024).","journal-title":"Open Forum Infect. Dis."},{"key":"73165_CR8","doi-asserted-by":"publisher","first-page":"e0211224","DOI":"10.1128\/spectrum.02112-24","volume":"13","author":"J Salmanton-Garcia","year":"2025","unstructured":"Salmanton-Garcia, J. et al. Elevating fungal care: bridging Brazil\u2019s healthcare practices to global standards. Microbiol. Spectr. 13, e0211224 (2025).","journal-title":"Microbiol. Spectr."},{"key":"73165_CR9","unstructured":"World Health Organization. WHO fungal priority pathogens list to guide research, development and public health action. https:\/\/www.who.int\/publications\/i\/item\/9789240060241 (accessed 22 July 2025)."},{"key":"73165_CR10","unstructured":"World Health Organization. World Health Organization Model List of Essential Medicines 22nd Edition 2021. https:\/\/apps.who.int\/iris\/rest\/bitstreams\/1374779\/retrieve (accessed 22 July 2025)."},{"key":"73165_CR11","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1016\/S1473-3099(18)30373-6","volume":"18","author":"AC Pasqualotto","year":"2018","unstructured":"Pasqualotto, A. C. & Quieroz-Telles, F. Histoplasmosis dethrones tuberculosis in Latin America. Lancet Infect. Dis. 18, 1058\u20131060 (2018).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2023.106718","volume":"61","author":"J Salmanton-Garcia","year":"2023","unstructured":"Salmanton-Garcia, J. et al. The current state of laboratory mycology in Asia\/Pacific: a survey from the European Confederation of Medical Mycology (ECMM) and International Society for Human and Animal Mycology (ISHAM). Int. J. Antimicrob. Agents 61, 106718 (2023).","journal-title":"Int. J. Antimicrob. Agents"},{"key":"73165_CR13","doi-asserted-by":"publisher","first-page":"e47","DOI":"10.1016\/S2666-5247(22)00261-0","volume":"4","author":"J Salmanton-Garcia","year":"2023","unstructured":"Salmanton-Garcia, J. et al. The current state of laboratory mycology and access to antifungal treatment in Europe: a European Confederation of Medical Mycology survey. Lancet Microbe 4, e47\u2013e56 (2023).","journal-title":"Lancet Microbe"},{"key":"73165_CR14","doi-asserted-by":"crossref","unstructured":"Ceballos-Garzon, A. et al. Diagnostic and therapeutic capacity for fungal infections: an ESCMID-EFISG nationwide multicentre assessment of mycological healthcare in Colombia. Int. J. Infect. Dis. 162, 108182 (2026).","DOI":"10.1016\/j.ijid.2025.108182"},{"key":"73165_CR15","doi-asserted-by":"publisher","first-page":"ofz073","DOI":"10.1093\/ofid\/ofz073","volume":"6","author":"DR Falci","year":"2019","unstructured":"Falci, D. R. et al. Histoplasmosis, an underdiagnosed disease affecting people living with HIV\/AIDS in Brazil: results of a multicenter prospective cohort study using both classical mycology tests and histoplasma urine antigen detection. Open Forum Infect. Dis. 6, ofz073 (2019).","journal-title":"Open Forum Infect. Dis."},{"key":"73165_CR16","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1111\/myc.13303","volume":"64","author":"DH Caceres","year":"2021","unstructured":"Caceres, D. H. et al. Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in Central American people living with HIV. Mycoses 64, 1396\u20131401 (2021).","journal-title":"Mycoses"},{"key":"73165_CR17","unstructured":"World Health Organization. World Health Organization Model List of Essential In Vitro Diagnostics 3rd Edition 2021. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/339064\/9789240019102-eng.pdf?sequence=1&isAllowed=y (accessed 25 July 2025)."},{"key":"73165_CR18","doi-asserted-by":"publisher","first-page":"e495","DOI":"10.1016\/S1473-3099(23)00731-4","volume":"24","author":"CC Chang","year":"2024","unstructured":"Chang, C. C. et al. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. Lancet Infect. Dis. 24, e495\u2013e512 (2024).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR19","doi-asserted-by":"publisher","first-page":"e375","DOI":"10.1016\/S1473-3099(21)00203-6","volume":"21","author":"SC Chen","year":"2021","unstructured":"Chen, S. C. et al. Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect. Dis. 21, e375\u2013e386 (2021).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR20","doi-asserted-by":"publisher","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","volume":"19","author":"OA Cornely","year":"2019","unstructured":"Cornely, O. A. et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect. Dis. 19, e405\u2013e421 (2019).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR21","doi-asserted-by":"publisher","first-page":"e280","DOI":"10.1016\/S1473-3099(24)00749-7","volume":"25","author":"OA Cornely","year":"2025","unstructured":"Cornely, O. A. et al. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect. Dis. 25, e280\u2013e293 (2025).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR22","doi-asserted-by":"publisher","first-page":"e246","DOI":"10.1016\/S1473-3099(20)30784-2","volume":"21","author":"M Hoenigl","year":"2021","unstructured":"Hoenigl, M. et al. Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology. Lancet Infect. Dis. 21, e246\u2013e257 (2021).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR23","doi-asserted-by":"publisher","first-page":"e364","DOI":"10.1016\/S1473-3099(21)00191-2","volume":"21","author":"GR Thompson","year":"2021","unstructured":"Thompson, G. R. et al. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect. Dis. 21, e364\u2013e374 (2021).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR24","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.cmi.2018.01.002","volume":"24","author":"AJ Ullmann","year":"2018","unstructured":"Ullmann, A. J. et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin. Microbiol. Infect. 24, e1\u2013e38 (2018).","journal-title":"Clin. Microbiol. Infect."},{"key":"73165_CR25","doi-asserted-by":"publisher","first-page":"e25","DOI":"10.1016\/S2214-109X(24)00461-3","volume":"13","author":"A Flores","year":"2025","unstructured":"Flores, A. & Falci, D. R. Improving access to liposomal amphotericin B worldwide. Lancet Glob. Health 13, e25 (2025).","journal-title":"Lancet Glob. Health"},{"key":"73165_CR26","doi-asserted-by":"publisher","first-page":"e464","DOI":"10.1016\/S2666-5247(21)00190-7","volume":"3","author":"C Driemeyer","year":"2022","unstructured":"Driemeyer, C. et al. The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey. Lancet Microbe 3, e464\u2013e470 (2022).","journal-title":"Lancet Microbe"},{"key":"73165_CR27","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1016\/S1473-3099(22)00656-9","volume":"23","author":"S Lakoh","year":"2023","unstructured":"Lakoh, S. et al. Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey. Lancet Infect. Dis. 23, 598\u2013608 (2023).","journal-title":"Lancet Infect. Dis."},{"key":"73165_CR28","unstructured":"ECMM European Confederation of Medical Mycology. ECMM Excellence Centers. https:\/\/www.ecmm.info\/ecmm-excellence-centers\/ (accessed 22 July 2025)."},{"key":"73165_CR29","unstructured":"National Accounts Estimates of Main Aggregates, United Nations Statistics Division. https:\/\/data.un.org\/Data.aspx?d=SNAAMA&f=grID%3A101%3BcurrID%3AUSD%3BpcFlag%3A1 (accessed 25 July 2025)."}],"container-title":["Nature Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41467-026-73165-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-026-73165-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41467-026-73165-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:29:18Z","timestamp":1785518958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41467-026-73165-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["73165"],"URL":"https:\/\/doi.org\/10.1038\/s41467-026-73165-2","relation":{},"ISSN":["2041-1723"],"issn-type":[{"value":"2041-1723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"assertion":[{"value":"17 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A.C.P. and D.R.F. received research grants from PAHO. Other authors declare no competing interests for this specific publication.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}],"article-number":"7552"}}