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Fungal lung disease affects tens of millions worldwide and leads to over a million deaths annually. After skin disease (1 billion affected) and mucosal candidiasis (most women at some time and oral and oesophageal candidiasis), pulmonary fungal disease is the third most common fungal disease group, and the most serious.
On 5 May 2015, the Global Action Fund for Fungal Infections (GAFFI) launched a 10-year ambitious target to enable 95% of the world's population to have access to fungal diagnostics and 95% to have access to antifungal therapy by 2025.1 The key pulmonary fungal diseases and the necessary diagnostics are shown in table 1.
The current deficiencies in diagnostic provision across the world are stark. No Aspergillus IgG or precipitins testing for chronic pulmonary aspergillosis and aspergilloma in Africa, and many other countries. No low cost PCR for Pneumocystis pneumonia (PCP) diagnosis anywhere, and currently PCP is diagnosable before death in children in only the most sophisticated hospitals. Skin prick testing and/or fungal-specific IgE testing for allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation is barely used in the assessment of severe asthma outside a few centres with a special interest. The diagnosis of invasive aspergillosis is difficult everywhere, but impossible in …