1 - Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal.
2 - ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal.
3 - Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge (INSA), Lisbon, Portugal.
4 - Faculdade de Medicina, Instituto de Saúde Ambiental, Universidade de Lisboa, Lisbon, Portugal.
5 - Laboratório Associado TERRA-Laboratório para o Uso Sustentável da Terra e dos Serviços dos Ecossistemas, Instituto Superior de Agronomia, Lisbon, Portugal.
6 - Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstr. 52, 50931, Cologne, Germany.
7 - Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.
8 - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
9 - Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
10 - Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal. Este endereço de email está protegido contra piratas. Necessita ativar o JavaScript para o visualizar..
11 - ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal. Este endereço de email está protegido contra piratas. Necessita ativar o JavaScript para o visualizar..
12 - Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstr. 52, 50931, Cologne, Germany. Este endereço de email está protegido contra piratas. Necessita ativar o JavaScript para o visualizar..
13 - Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany. Este endereço de email está protegido contra piratas. Necessita ativar o JavaScript para o visualizar..
14 - German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. Este endereço de email está protegido contra piratas. Necessita ativar o JavaScript para o visualizar.
15 - PT Group for IFI Management Capacity: Joana Batista, Dinah Carvalho, Adriana Coutinho, Flávia Cunha, Augusta Gonçalves, Catarina Gouveia, António Guerra Maio, Augusto Machado E Costa, Dolores Pinheiro, Pedro Póvoa, Elmano Ramalheira, Valentina Santos, Ana Cristina Silva, Zélia Videira
- Mycopathologia. 2024 Jan 24;189(1):15. doi: 10.1007/s11046-024-00830-9. PMID: 38265528; PMCID: PMC10808446.
Resumo: The success of the clinical management of invasive fungal diseases (IFD) is highly dependent on suitable tools for timely and accurate diagnosis for effective treatment. An in-depth analysis of the ability of European institutions to promptly and accurately diagnose IFD was previously conducted to identify limitations and aspects to improve. Here, we evaluated and discussed the specific case of Portugal, for which, to our knowledge, there are no reports describing the national mycological diagnostic capacity and access to antifungal treatment. Data from 16 Portuguese medical institutions were collected via an online electronic case report form covering different parameters, including institution profile, self-perceived IFD incidence, target patients, diagnostic methods and reagents, and available antifungals. The majority of participating institutions (69%) reported a low-very low incidence of IFD, with Candida spp. indicated as the most relevant fungal pathogen, followed by Aspergillus spp. and Cryptococcus spp. All institutions had access to culture and microscopy, whereas 94 and 88% were able to run antigen-detection assays and molecular tests, respectively. All of the institutions capable of providing antifungal therapy declared to have access to at least one antifungal. However, echinocandins were only available at 85% of the sites. Therapeutic drug monitoring (TDM) was reported to remain a very restricted practice in Portugal, being available in 19% of the institutions, with the TDM of itraconazole and posaconazole performed in only 6% of them. Importantly, several of these resources are outsourced to external entities. Except for TDM, Portugal appears to be well-prepared concerning the overall capacity to diagnose and treat IFD. Future efforts should focus on promoting the widespread availability of TDM and improved access to multiple classes of antifungals, to further improve patient outcomes
Palavras Chave: Antifungals; Clinical mycology; Diagnosis; Invasive fungal disease; Portugal; Therapy