The diagnosis of fungal neglected tropical diseases (fungal NTDs) and the role of investigation and laboratory tests: An expert consensus report

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Publicated to:Trop Med Infect Dis. 4 (4): - 2019-01-01 4(4), DOI: 10.3390/tropicalmed4040122

Authors: Hay R; Denning DW; Bonifaz A; Queiroz-Telles F; Beer K; Bustamante B; Chakrabarti A; de Guadalupe Chavez-Lopez M; Chiller T; Cornet M; Estrada R; Estrada-Chavez G; Fahal A; Gomez BL; Li R; Mahabeer Y; Mosam A; Ramarozatovo LS; Andrianarivelo MR; Rabenja FR; van de Sande W; Zijlstra EE

Affiliations

Centers for Disease Control and Prevention - Author

Community Dermatology Mexico C.A. - Author

Drugs for Neglected Diseases initiative - Author

Erasmus MC - Author

Faculty of Medicine - Author

Global Action Fund for Fungal Infections - Author

Hospital General de Mexico - Author

Hospital Nacional Cayetano Heredia - Author

International Foundation of Dermatology - Author

Peking University First Hospital - Author

Postgraduate Institute of Medical Education & - Author

Research, Chandigarh - Author

Secretaría de Salud - Author

Soba University Hospital - Author

The Nelson R. Mandela Medical School - Author

Universidad del Rosario - Author

Universidade Federal do Paraná - Author

Université d'Antananarivo - Author

Universite Grenoble Alpes - Author

University of Manchester - Author

Abstract

© 2019 by the authors. The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs.

Keywords

chromoblastomycosisfungal ntdsintegrated approacheslaboratory diagnosismycetomaChromoblastomycosisFungal ntdsIntegrated approachesLaboratory diagnosisMycetomaSporotrichosis

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Trop Med Infect Dis due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2019, it was in position , thus managing to position itself as a Q2 (Segundo Cuartil), in the category Public Health, Environmental and Occupational Health.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations from Scopus Elsevier, it yields a value for the Field-Weighted Citation Impact from the Scopus agency: 3.75, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Field Citation Ratio (FCR) from Dimensions: 16.38 (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-13, the following number of citations:

WoS: 16
Scopus: 51
Europe PMC: 21
OpenCitations: 43

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Brazil; Mexico; United Kingdom.

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