The global burden of serious fungal diseases is thought to exceed 15 million cases annually with over
1.6 million deaths. Deaths from fungal infection in AIDS is estimated to exceed 700,000, nearly 50% of the
total AIDS deaths. All those patients that present for care will be administered antibiotics, most without any
effect. Antifungal therapy may also be given, but without a specific fungal diagnosis may be incorrect and will
often be administered too late. Antimicrobial resistance (AMR) is a major public health concern developing
largely from the excess use of antibacterial and antifungal drugs. The lack of fungal disease diagnostic tests
exacerbates the problem of antimicrobial empiricism, both antibiotic and antifungal. For example, the failure
to diagnose chronic pulmonary aspergillosis in those with smear-negative TB by not testing for Aspergillus
antibody, typically means unnecessary and ineffective first or second line antituberculous therapy is given.
Another example is mis-diagnosing ‘fungal asthma’ and hence omitting a trial of oral antifungal therapy
avoiding repetitive courses of antibiotics. Not diagnosing Aspergillus bronchitis will usually mean repetitive
oral courses of antibiotics and corticosteroids. All communities should have access to fungal diagnostics
which will have a substantial benefit for antimicrobial stewardship and AMR control.