‘There’s Not Enough Training & Expertise On Fungal Infection In India’

Prof David W Denning is a leading physician at Manchester’s University Hospitals with expertise in fungal infections, particularly aspergillosis, antifungal resistance and the treatment of fungal infection. His clinical interests are in fungal diseases, immunocompromised patients and complex hospital infection problems. In his recent trip to India to interact with Indian doctors on Aspergillus infections, Dr Denning spoke to Sapna Dogra.

What is the situation in India with regard to fungal infection and treatment?

I was surprised to find that fungal infections are so common in India. They appear to be complex than they are in Europe or North America. For instance, after kidney transplantation, 10 per cent of Indian patients get fungal infection whereas it is just 0.5 per cent in North America and Europe; this gives some idea about the scale of difference.

What could be the reasons for this high incidence?

Fungal infections are on the rise in India due to various reasons. For instance, HIV/AIDS is one of the reasons for new cases. Prolonged stay of patients like cancer patients in ICUs expose them to fungal diseases. Around 20 per cent of blood culture are positive for fungal infections in an Indian hospital, while in the US it is nine per cent and in Britain it is 3.0 per cent.

What are the treatment options for Aspergillus infections?

Treatment options have improved recently with the introduction of Caspofungin (Merck Sharpe & Dome) and Voriconazole (Pfizer).  However, these are expensive drugs and already there’s so much load on the healthcare system in India. The problems is compounded by the fact that the diagnostic tools available are inadequate and symptoms related to the disease are often subtle and therefore the diagnosis is often missed, which is why doctors are unable to identify the disease at early stages. There are also new diagnostics coming through, but we are lagging behind in that which is why we still are not able to make diagnosis fast and accurate enough in the area of fungal diseases. So, there’s need for better diagnostics. Also, there are not enough people interested in the subject.

Does it mean it is a neglected area?

Well, there’s not enough training and expertise in India. There are only a very few experts to drive the field forward. It is a neglected area particularly in diagnostics. However, clinically doctors are competent and are doing good job, but lab support is lacking. The awareness levels are very high here, but tests are sophisticated and already the system is burdened with other diseases. Mortality rates here are very high, for instance candida in the blood causes 40 per cent mortality; Aspergillus in lungs causes 50 per cent mortality. Hence there’s need for more training, better diagnostics, research to understand the problems and better management and monitoring of fungal infections.

Tell us about your other activities.

I am interested in molecular diagnostics and I am trying to raise venture capital to start a diagnostic company to do that.

sapnadogra@gmail.com