Andrés Soto

Background: Invasive fungal infections can cause morbidity and mortality, particularly among immunocompromised and critically ill patients, making them an important global public health problem. Outcomes depend on timely diagnosis, laboratory capacity, and access to effective antifungal therapy. As national data describing these resources in Chile remain limited, we aimed to characterize national gaps in mycological diagnostic and therapeutic access. Methods: We conducted a nationwide survey of physicians, pharmacists, and laboratory professionals representing Chilean hospitals. Multiple responses from the same institution were consolidated. A 15-item diagnostic and therapeutic access score was developed to assess differences between hospitals. Results: Thirty-five hospitals participated in the survey. Diagnostic infrastructure varied substantially across institutions; all hospitals reported access to direct mycological examination, among which 65.7% had access to MALDI-TOF MS and 51.4% used molecular identification methods. The access score differed significantly according to hospital size, with median scores of 53.3% (20.0–80.0), 66.7% (46.7–86.7), and 73.3% (60.0–86.7) in hospitals with 0–300, 301–499, and ≥500 beds, respectively (p = 0.003). Conclusions: This nationwide assessment identified size-dependent inequities in mycological capacity in Chile, with larger hospitals having greater diagnostic and therapeutic access. These findings support targeted national strategies to strengthen smaller institutions and ensure equitable care.

Background: Invasive fungal infections are an important global public health problem, causing morbidity and mortality, particularly among immunocompromised and critically ill patients. Outcomes depend on timely diagnosis, laboratory capacity, and access to effective antifungal therapy. However, national data describing these resources in Chile remain limited. We aimed to characterize gaps in mycological diagnostic and therapeutic access. Methods: We conducted a nationwide survey of physicians, pharmacists, and laboratory professionals representing Chilean hospitals. Multiple responses from the same institution were consolidated. A 15-item diagnostic and therapeutic access score was developed to assess differences between hospitals. Results: 35 hospitals participated. Diagnostic infrastructure varied substantially across institutions. Although all hospitals reported access to direct mycological examination, 65.7% had MALDI-TOF MS and 51.4% had molecular identification methods. The access score differed significantly according to hospital size, with median scores of 53.3% (20.0–80.0), 66.7% (46.7–86.7), and 73.3% (60.0–86.7) in hospitals with 0–300, 301–499, and ≥500 beds, respectively (p=0.003). Conclusions: This nationwide assessment identified size-dependent inequities in mycological capacity in Chile. Larger hospitals had greater diagnostic and therapeutic access, supporting targeted national strategies to strengthen smaller institutions and ensure equitable care.

Invasive Fungal Infections (IFIs) represent a significant threat to transplant recipients and patients with non-HIV-related immunosuppression, particularly in low- and middle-income countries (LMICs). While the disease burden in HIV populations is widely recognized, this group faces a critical gap in diagnosis and treatment that perpetuates a cycle of preventable deaths. Advances in medical therapies have revolutionized the management of hematologic malignancies, autoimmune diseases, and solid organ transplantation, increasing the number of severely immunocompromised individuals susceptible to opportunistic pathogens. In the US, IFI incidence rose from 30.2 to 31.8 per 100,000 between 2006 and 2015 [1]. However, epidemiological knowledge in LMICs remains limited due to scarce surveillance, high diagnostic and treatment costs, and low access to diagnostic methods, with disparities between regions and even within centers from the same countries. Current clinical guidelines must be adapted to regional resources to optimize diagnostic strategies and timely treatment. This review aims to analyze the primary gaps in LMICs to identify key intervention nodes for reducing mortality in non-HIV immunocompromised patients in our region.

Background: Human metapneumovirus (hMPV) is an increasingly recognized respiratory pathogen in immunocompromised patients, but its impact in haematological malignancies is poorly defined. Unlike influenza or SARS-CoV-2, hMPV has no specific treatment or vaccine, contributing to underdiagnosis and underestimation of its clinical relevance. Method: We performed a multicentre retrospective cohort study within the Epidemiology of COVID-19 in patients with hematological malignancies: A European Haematology Association Survey/ Epidemiology of respiratory viral infections in patients with hematological malignancies: A European Haematology Association Survey registry of haematological patients with hMPV (January 2023–December 2024), comparing clinical features and outcomes with matched influenza and SARS-CoV-2 cohorts. Results: The study included 130 patients with hMPV. Median age was 58.5 years; 57% were male. Plasma cell neoplasms (25%), lymphoma (23%), and acute myeloid leukemia (20%) were the most common hematological malignancies. Hospitalization occurred in 64%, intensive care unit (ICU) admission in 19%, and 30-day mortality was 8%. Most cases (73%) received supportive care only. Secondary infections were common (24%). Chronic renal disease significantly increased mortality risk (hazard ratio 20.9 11.05, P = .014). Compared with influenza and SARS-CoV-2, hMPV patients had comparable severity and outcomes, with 18.5% ICU admission rates versus 25.9% for influenza (P = .316) and 20.9% versus 4.7% for SARS-CoV-2 (P = .006), and 30-day mortality of 5.6% versus 11.1% for influenza (P = .489) and 7.0% versus 2.3% for SARS-CoV-2 (P = .277), yet received fewer targeted interventions. Conclusions: hMPV causes clinically significant disease in patients with hematological malignancy, often necessitating hospital and ICU care, and leading to mortality. In the absence of specific treatments or vaccines, this virus remains an underrecognized pathogen in patients with hematological malignancy. Enhanced clinical awareness and investment in diagnostics, prevention, and therapeutics are needed.

Candida inconspicua is an uncommon opportunistic yeast, increasingly reported in immunocompromised patients. We describe a case of asymptomatic Candiduria caused by C. inconspicua in a 43‐year‐old woman with Philadelphia chromosome‐positive B‐cell acute lymphoblastic leukemia undergoing chemotherapy. During multiple episodes of high‐risk febrile neutropenia, urine cultures repeatedly isolated C. inconspicua , identified via MALDI‐TOF MS and exhibiting high fluconazole resistance (MIC: 16.0 μg/mL). Despite these findings, no antifungal therapy was administered due to the absence of urinary symptoms and resolution of fever with antibacterial treatment. This case illustrates the clinical dilemma posed by rare, drug‐resistant Candida species in asymptomatic infections, emphasizing the importance of precise microbiological identification and antimicrobial stewardship. The emergence of C. inconspicua , with potential for resistance and biofilm formation, underscores the need for careful evaluation in hemato‐oncological patients, particularly when considering the risks and benefits of initiating antifungal therapy in the absence of clinical symptoms.

Desde la llegada de la pandemia por COVID-19, se ha descrito un sinnúmero de consecuencias respecto a la infección por VIH en Chile, tanto en su diagnóstico como en su prevención, principalmente manifestadas en el descenso de la realización de exámenes serológicos, la interrupción de la atención, el retraso en el inicio de la terapia antirretroviral y la falta de acceso a métodos preventivos. A ello, se le suma el deterioro en algunas condiciones relacionadas con aspectos sociales y sobre salud mental. Todo esto implica, entre otras consecuencias, un probable empeoramiento en la situación epidemiológica de la infección por VIH en Chile. En el presente artículo, se revisarán algunos de los impactos señalados y se plantean algunos desafíos, para el enfrentamiento de esta problemática.

Introduction Patients with Coronavirus Disease 2019 (COVID-19) frequently experience a hyperinflammatory syndrome, that leads to unfavorable outcomes. This condition resembles Secondary Hemophagocytic Lymphohistiocytosis (sHLH) described in neoplastic, rheumatic and other infectious diseases. However, it has not been prospectively studied on these patients. A scoring system (HScore) has been validated for sHLH, and recently proposed to evaluate hyperinflammation in COVID-19. Methods 143 patients aged ≥18 years admitted because of COVID-19 were enrolled in a prospective, single-center, cohort study. HScore was calculated within the 72 hours since admission. The incidence of sHLH during hospitalization was evaluated. Additionally, the relationship between HScore ≥130 points and either the requirement of mechanical ventilation or 60-days mortality was explored. Results The median age of enrolled patients was 57 (21-100), and 63.6% were male. The median HScore was 96 (33-169). One patient was diagnosed with sHLH (incidence 0,7%), due to a HScore of 169. After adjusting for age, sex, comorbidities and obesity, HScore ≥130 was independently associated with the composite clinical outcome (HR 2.13, p=0.022). Conclusion sHLH is not frequent among COVID-19 patients. HScore can efficiently predict the risk for poor outcomes.

Key words: Antimicrobial Stewardship; Competitive Bidding; Drug Resistance, Bacterial