Background: Invasive fungal diseases (IFD) are a serious threat, but physicians in Asia lack access to many
advanced diagnostics in mycology. It is likely that they face other impediments in the management of IFD.
A gap analysis was performed to understand the challenges Asian physicians faced in medical mycology.
Methods: The Asia Fungal Working Group (AFWG) conducted a web-based survey on management
practices for IFD among clinicians in China, India, Indonesia, Philippines, Singapore, Taiwan and Thailand.
Findings: Among 292 respondents, 51.7% were infectious disease (ID) specialists. Only 37% of respondents
had received formal training in medical mycology. They handled only around 2–4 proven cases of each
fungal infection monthly, with invasive candidiasis the most common. For laboratory support, the
majority had access to direct microscopy (96%) and histopathology (87%), but galactomannan and azole
levels were available to 60% and 25% of respondents, respectively. The majority (84%) used clinical
parameters for treatment response monitoring, and 77% followed the Infectious Diseases Society of
America guidelines. The majority (84%) did not use the services of an ID physician. Where febrile
neutropenia was concerned, 74% of respondents used the empirical approach. Only 30% had an antifungal
stewardship program in their hospital. Eighty percent could not use preferred antifungals because of cost.
Interpretation: The survey identified inadequacies in medical mycology training, non-culture diagnostics,
access to antifungal drugs, and local guidelines as the major gaps in the management of IFDs in Asian
countries. These gaps are targets for improvement