Organizational and clinical measures for early detection and diagnosis of pharyngeal mycosis associated with respiratory diseases

Objective. To conduct medical and sociological study of the awareness of the population and healthcare professionals (HCPs) on medical prevention, diagnosis, and treatment of patients with pharyngeal mycosis (PM) against the background of respiratory diseases (RDs); to improve effectiveness of early detection and diagnosis of pharyngomycosis (PhM) associated with RDs through the implementation of a standardized clinical and organizational algorithm

Materials and Methods. A comprehensive clinical and organizational algorithm including original questionnaires, a sequence of diagnostic stages, regulated techniques for obtaining biological material, and pharyngeal tissue biopsy for resistant and/or invasive forms of PhM, was developed. The medical and sociological study on the awareness of the population (108 respondents of different age categories and education levels) and healthcare professionals (100 specialist doctors in otorhinolaryngology (ENT) and other specialties) regarding medical prevention, diagnosis, and treatment of patients with PM against the background of RDs was conducted. All questionnaires were developed based on international analogues and underwent a process of sociological review. A statistical analysis was performed in the R environment (version 4.5.0) using packages: rstatix (performing statistical tests), ggstatsplot and ggplot2 (visualization of results), pROC (ROC-analysis), dplyr (data manipulation).

Results. Developed clinical and organizational algorithm for early detection and diagnosis of PM associated with respiratory diseases (RDs) increased the detection rate of superficial forms to 32.3%, and pharyngeal fungal lesion to 40.2% (clinically, microscopically, microbiologically), and invasive forms to 2% (morphologically), owing to standardized questionnaires, stepwise diagnostics with clear criteria of pharyngeal tissue biopsy and standards for obtaining biological material. The implementation of the algorithm justified by critical knowledge deficits in the population (only 35.2% associate hormone therapy with the risk of mycoses, χ² = 9.48, p = 0.002; 70.4% mistakenly consider PM as contagious, χ² = 18.93, p < 0.001) and healthcare professionals (low awareness of algorithms, p = 0.099; U-shaped relationship of knowledge with work experience), ensured medical and economic efficiency: preventing one case of invasive PM saves ~ 98 thousand BYN (system potential is ~ 45.5 million BYN/year), optimized patient flow (67.6% of the population is ready to seek care for symptoms), and unified approaches for early detection and diagnostics of PM associated with RDs in the healthcare system of the Republic of Belarus.

Conclusion. Implementation of the clinical and organizational algorithm for early diagnosis of RD-associated PM eliminates critical knowledge deficiency among doctors (only 24% of HCPs are aware of algorithms), increases the detection of superficial forms to 32.3%–40.2% and invasive forms to 2%, ensuring annual savings of ~45.5 million BYN and standardization of medical care in the Republic of Belarus.

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