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Fathallah A, Chouaieb H, Saief MB, Ismaïl S, Said MB, Denning DW. The incidence and prevalence of serious fungal diseases in Tunisia. J Mycol Med 2024; 34:101479. [PMID: 38604083 DOI: 10.1016/j.mycmed.2024.101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/08/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
With increasing concern about the negative health impact of fungal disease, there is a need to survey what is and is not known about the epidemiology of these infections in Tunisia. We have estimated the incidence and prevalence of the most serious fungal diseases in Tunisia for the first time. Using published literature from Tunisia, or if absent other countries, we have estimated the burden of life-threatening fungal infections and those causing significant morbidity, using deterministic modeling, based on populations at greatest risk. An estimated 250,494 (2.12% of the Tunisian population) are affected by a serious fungal disease annually. Invasive and chronic pulmonary aspergillosis are relatively common with 708 and 2090 patients affected, partly linked to the prevalence of chronic obstructive pulmonary disease (COPD). Fungal asthma (allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization) have an estimated prevalence of 38,264 (5.8% of the adult asthma population). Fungal keratitis probably affects 1,761 eyes annually, often leading to uniocular blindness. Candidaemia and Candida peritonitis probably affect at least 680 people annually, with a high mortality. Recurrent vulvovaginal candidiasis probably affects over 200,000 women. While fungal diseases are regularly diagnosed in Tunisia, epidemiological studies with denominators are uncommon. Some fungal diseases are poorly addressed with the current diagnostic portfolio, and surveillance is lacking. Studies on these diseases and the implementation of a national program of surveillance are required.
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Affiliation(s)
- Akila Fathallah
- Laboratory of Parasitology - Mycology, Farhat Hached Hospital, Sousse, Tunisia; Department of Parasitology-Mycology, Faculty of Medicine of Sousse, University of Sousse Mohamed El Karoui Street, Bp 126,4002 Sousse, Tunisia
| | - Hamed Chouaieb
- Laboratory of Parasitology - Mycology, Farhat Hached Hospital, Sousse, Tunisia; Department of Parasitology-Mycology, Faculty of Medicine of Sousse, University of Sousse Mohamed El Karoui Street, Bp 126,4002 Sousse, Tunisia
| | - Moadh Ben Saief
- Laboratory of Parasitology - Mycology, Farhat Hached Hospital, Sousse, Tunisia
| | - Samar Ismaïl
- Laboratory of Parasitology - Mycology, Farhat Hached Hospital, Sousse, Tunisia; Department of Parasitology-Mycology, Faculty of Medicine of Sousse, University of Sousse Mohamed El Karoui Street, Bp 126,4002 Sousse, Tunisia
| | - Moncef Ben Said
- Laboratory of Parasitology - Mycology, Farhat Hached Hospital, Sousse, Tunisia; Department of Parasitology-Mycology, Faculty of Medicine of Sousse, University of Sousse Mohamed El Karoui Street, Bp 126,4002 Sousse, Tunisia
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
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Shahabudin S, Azmi NS, Lani MN, Mukhtar M, Hossain MS. Candida albicans skin infection in diabetic patients: An updated review of pathogenesis and management. Mycoses 2024; 67:e13753. [PMID: 38877612 DOI: 10.1111/myc.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
Candida species, commensal residents of human skin, are recognized as the cause of cutaneous candidiasis across various body surfaces. Individuals with weakened immune systems, particularly those with immunosuppressive conditions, are significantly more susceptible to this infection. Diabetes mellitus, a major metabolic disorder, has emerged as a critical factor inducing immunosuppression, thereby facilitating Candida colonization and subsequent skin infections. This comprehensive review examines the prevalence of different types of Candida albicans-induced cutaneous candidiasis in diabetic patients. It explores the underlying mechanisms of pathogenicity and offers insights into recommended preventive measures and treatment strategies. Diabetes notably increases vulnerability to oral and oesophageal candidiasis. Additionally, it can precipitate vulvovaginal candidiasis in females, Candida balanitis in males, and diaper candidiasis in young children with diabetes. Diabetic individuals may also experience candidal infections on their nails, hands and feet. Notably, diabetes appears to be a risk factor for intertrigo syndrome in obese individuals and periodontal disorders in denture wearers. In conclusion, the intricate relationship between diabetes and cutaneous candidiasis necessitates a comprehensive understanding to strategize effective management planning. Further investigation and interdisciplinary collaborative efforts are crucial to address this multifaceted challenge and uncover novel approaches for the treatment, management and prevention of both health conditions, including the development of safer and more effective antifungal agents.
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Affiliation(s)
- Sakina Shahabudin
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Nina Suhaity Azmi
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Mohd Nizam Lani
- Faculty of Fisheries and Food Science, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | | | - Md Sanower Hossain
- Centre for Sustainability of Mineral and Resource Recovery Technology (Pusat SMaRRT), Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
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3
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Al Dhaheri F, Thomsen J, Everett D, Denning DW. Mapping the Burden of Fungal Diseases in the United Arab Emirates. J Fungi (Basel) 2024; 10:353. [PMID: 38786708 PMCID: PMC11121979 DOI: 10.3390/jof10050353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
The United Arab Emirates has very little data on the incidence or prevalence of fungal diseases. Using total and underlying disease risk populations and likely affected proportions, we have modelled the burden of fungal disease for the first time. The most prevalent serious fungal conditions are recurrent vulvovaginitis (~190,000 affected) and fungal asthma (~34,000 affected). Given the UAE's low prevalence of HIV, we estimate an at-risk population of 204 with respect to serious fungal infections with cryptococcal meningitis estimated at 2 cases annually, 15 cases of Pneumocystis pneumonia (PCP) annually, and 20 cases of esophageal candidiasis in the HIV population. PCP incidence in non-HIV patients is estimated at 150 cases annually. Likewise, with the same low prevalence of tuberculosis in the country, we estimate a total chronic pulmonary aspergillosis prevalence of 1002 cases. The estimated annual incidence of invasive aspergillosis is 505 patients, based on local data on rates of malignancy, solid organ transplantation, and chronic obstructive pulmonary disease (5.9 per 100,000). Based on the 2022 annual report of the UAE's national surveillance database, candidaemia annual incidence is 1090 (11.8/100,000), of which 49.2% occurs in intensive care. Fungal diseases affect ~228,695 (2.46%) of the population in the UAE.
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Affiliation(s)
- Fatima Al Dhaheri
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Jens Thomsen
- Department of Public Health and Epidemiology, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (J.T.); (D.E.)
| | - Dean Everett
- Department of Public Health and Epidemiology, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (J.T.); (D.E.)
- Infection Research Unit, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - David W. Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester Academic Health Science Centre, Grafton Street, Manchester M13 9NT, UK
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Afifi HAM, Mansour MMA, Hassan AGAI, Salem MZM. Biodeterioration effects of three Aspergillus species on stucco supported on a wooden panel modeled from Sultan al-Ashraf Qaytbay Mausoleum, Egypt. Sci Rep 2023; 13:15241. [PMID: 37709813 PMCID: PMC10502143 DOI: 10.1038/s41598-023-42028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
This study focuses on the magnificent decoration of a painted and gilded wooden panel with signs of fungal biodeterioration caused by Aspergillus species in the Mausoleum of Sultan al-Ashraf Qaytbay, Cairo, Egypt. Numerous spectroscopic analyses and investigation techniques, including Scanning Electron Microscope Equipped with Energy Dispersive X-ray analysis (SEM-EDX), Fourier Transform Infrared analysis (FTIR), and X-Ray Diffraction (XRD) have been used to study the materials that comprise this painted and gilded wooden panel composition. Aspergillus niger, A. flavus, and A. terreus were recognized as isolated fungi, and their accession numbers are OQ820164, OQ820163, and OQ820160, respectively. The findings showed that the wooden support is of pinewood (Pinus halepensis), the white priming layer on top of the wooden support was identified as gypsum, the blue paint layer has been proposed to be Azurite, Au (gold) was the primary composition of the gilding layer, while Pb (lead) was detected in some spots, suggesting the use an alloy of gold with lead, and finally, animal glue was the bonding medium. Based on these findings, mimic samples with identical substrates and structural components have been designed, and the biodeterioration signs by the growing of the three Aspergillus species-A. niger, A. flavus and A. terreus were evaluated via SEM and color change. However, A. niger was discovered with density growth on surfaces of pinewood, gypsum, and Azurite and with less growth on the gilding layer after 6-month incubation. This contrasts with A. terreus and A. flavus, which had greater density growth on Azurite and stucco than on pinewood and less growth on the gilding layer. The used analytical methods with detailed analyses revealed the novelty and significant future aspects of the conservation of the painted and gilded wooden panel. Particularly given that this location is used for prayer and is crowded with people five times a day, which increases the accumulation of fungi and negatively affects both the historic Mosque and the worshippers' health.
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Affiliation(s)
- Hala A M Afifi
- Conservation Department, Faculty of Archaeology, Cairo University, Giza, 12613, Egypt.
| | - Maisa M A Mansour
- Conservation Department, Faculty of Archaeology, Cairo University, Giza, 12613, Egypt.
| | - Alyaa G A I Hassan
- Conservation Department, Faculty of Archaeology, Cairo University, Giza, 12613, Egypt
| | - Mohamed Z M Salem
- Forestry and Wood Technology Department, Faculty of Agriculture (El-Shatby), Alexandria University, Alexandria, 21545, Egypt.
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Ahmed SA, Ismail M, Albirair M, Nail AMA, Denning DW. Fungal infections in Sudan: An underestimated health problem. PLoS Negl Trop Dis 2023; 17:e0011464. [PMID: 37656764 PMCID: PMC10501601 DOI: 10.1371/journal.pntd.0011464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/14/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.
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Affiliation(s)
- Sarah A. Ahmed
- Center of Expertise in Mycology Radboudumc / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Mawahib Ismail
- Mycology Reference laboratory, faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed Albirair
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington State, United States of America
| | - Abdelsalam Mohamed Ahmed Nail
- Tropical Diseases Teaching Hospital, Khartoum, Sudan
- Department of Internal Medicine, Faculty of Medicine and Health Sciences (OIU), Khartoum, Sudan
| | - David W. Denning
- Manchester Fungal Infection Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Spruijtenburg B, Meijer EFJ, Xiao M, Shawky SM, Meis JF, de Groot T, El-Kholy MA. Genotyping and susceptibility testing uncovers large azole-resistant Candida tropicalis clade in Alexandria, Egypt. J Glob Antimicrob Resist 2023; 34:99-105. [PMID: 37419181 DOI: 10.1016/j.jgar.2023.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/09/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Candida tropicalis is an emerging medically relevant Candida species. The yeast primarily causes opportunistic infections in intensive care units and is highly prevalent in tropical countries. The genetic diversity within this species is high, and nosocomial transmission has been reported. C. tropicalis genotyping of isolates from low- and middle-income countries is underrepresented when compared with that from high-income countries. Also, in Egypt, only limited genotyping has been conducted for C. tropicalis isolates, while antifungal resistance seems to increase, especially against azoles. METHODS Antifungal susceptibility testing was performed on 64 C. tropicalis isolates from ICU patients collected from multiple hospitals in Alexandria, Egypt. Genotyping by means of short tandem repeat (STR) and whole genome sequencing (WGS) single nucleotide polymorphism (SNP) analysis was performed. RESULTS Using antifungal susceptibility testing, fluconazole resistance was observed in 24 isolates (38%), of which 23 harboured an ERG11 G464S substitution, previously shown to cause resistance in Candida albicans. STR genotyping showed that these 23 isolates were related, forming a distinct resistant clade. WGS SNP analysis subsequently confirmed this genetic relationship, although isolates within this clade differed in at least 429 SNPs, suggesting that these were independently introduced. CONCLUSION Overall, STR and WGS SNP analysis of this collection indicates limited C. tropicalis nosocomial transmission in Alexandria, while the presence of this large azole-resistant C. tropicalis clade within this city hampers the treatment of intensive care unit patients.
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Affiliation(s)
- Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Eelco F J Meijer
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Meng Xiao
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, People's Republic of China
| | - Sherine M Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Mohammed A El-Kholy
- Department of Microbiology and Biotechnology, Division of Clinical and Biological Sciences, College of Pharmacy, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Alexandria, Egypt.
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Husni R, Bou Zerdan M, Samaha N, Helou M, Mahfouz Y, Saniour R, Hourani S, Kolanjian H, Afif C, Azar E, El Jisr T, Mokhbat J, Abboud E, Feghali R, Abboud E, Matta H, Karayakouboglo G, Matar M, Moghnieh R, Daoud Z. Characterization and susceptibility of non-albicans Candida isolated from various clinical specimens in Lebanese hospitals. Front Public Health 2023; 11:1115055. [PMID: 36969669 PMCID: PMC10036786 DOI: 10.3389/fpubh.2023.1115055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundInvasive fungal infections have presented a challenge in treatment. In the past, it was known that the frontrunner in such infections is Candida albicans with little emphasis placed on non-albicans Candida species (NAC). Studies worldwide have shown a rise in fungal infections attributed to non-albicans Candida species. The aim of this study is to describe the epidemiology of NAC infections along with an overview of resistance in Lebanese hospitals.MethodsThis is a two-year observational multi-central descriptive study. Between September 2016 and May of 2018, a total of 1000 isolates were collected from 10 different hospitals distributed all over the country. For the culture, Sabouraud Dextrose Agar was used. Antifungal Susceptibility was evaluated by determining the Minimum Inhibitory Concentration (MIC) in broth (microdilution) of the different antifungal treatments.ResultsOut of the 1000 collected isolates, Candida glabrata, being the most isolated species (40.8%), followed by Candida tropicalis: 231(23.1%), Candida parapsilosis: 103(10.3%), and other NAC species at lower percentage. Most of these isolates (88.67%) were susceptible to posaconazole, 98.22% were susceptible to micafungin, and 10% were susceptible to caspofungin.ConclusionThe change of etiology of fungal infections involving a significant increase in NAC cases is alarming due to the different antifungal susceptibility patterns and the lack of local guidelines to guide the treatment. In this context, proper identification of such organisms is of utmost importance. The data presented here can help in establishing guidelines for the treatment of candida infections to decrease morbidity and mortality. Future surveillance data are needed.
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Affiliation(s)
- Rola Husni
- Lebanese American University, School of Medicine, Beirut, Lebanon
- Department of Internal Medicine, Lebanese American University-Rizk Hospital, Beirut, Lebanon
- *Correspondence: Rola Husni
| | - Maroun Bou Zerdan
- Department of Internal Medicine, SUNY Upstate Medical University Hospital, Syracuse, NY, United States
| | - Nadia Samaha
- Georgetown University School of Medicine, Washington, DC, United States
| | - Mariana Helou
- Lebanese American University, School of Medicine, Beirut, Lebanon
- Department of Internal Medicine, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Youssef Mahfouz
- Faculty of Medicine and Medical Sciences, University of Balamand, Tripoli, Lebanon
| | - Rim Saniour
- Faculty of Medicine and Medical Sciences, University of Balamand, Tripoli, Lebanon
| | - Sawsan Hourani
- Faculty of Medicine and Medical Sciences, University of Balamand, Tripoli, Lebanon
| | - Harout Kolanjian
- Lebanese American University, School of Medicine, Beirut, Lebanon
- Department of Internal Medicine, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Claude Afif
- Department of Internal Medicine, Saint George Hospital-University Medical Center, Beirut, Lebanon
| | - Eid Azar
- Department of Internal Medicine, Saint George Hospital-University Medical Center, Beirut, Lebanon
| | - Tamima El Jisr
- Department of Laboratory, Makased General Hospital, Beirut, Lebanon
| | - Jacques Mokhbat
- Lebanese American University, School of Medicine, Beirut, Lebanon
- Department of Internal Medicine, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Emma Abboud
- Department of Laboratory, Mount Liban Hospital, Hazmiyeh, Lebanon
| | - Rita Feghali
- Department of Laboratory, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Edmond Abboud
- Department of Laboratory, The Middle East Institute of Health University Hospital, Mount Lebanon, Lebanon
| | - Hiam Matta
- Saint Georges Ajaltoun Hospital, Ajaltoun, Lebanon
| | | | - Madonna Matar
- Department of Internal Medicine, Notre Dame de Secours University Hospital, Byblos, Lebanon
| | - Rima Moghnieh
- Lebanese American University, School of Medicine, Beirut, Lebanon
- Department of Internal Medicine, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Ziad Daoud
- College of Medicine, Central Michigan University, Saginaw, MI, United States
- Department of Clinical Microbiology and Infection Prevention, Michigan Health Clinics, Saginaw, MI, United States
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Yerbanga IW, Nakanabo Diallo S, Rouamba T, Denis O, Rodriguez-Villalobos H, Montesinos I, Bamba S. A systematic review of epidemiology, risk factors, diagnosis, antifungal resistance, and management of invasive aspergillosis in Africa. J Mycol Med 2023; 33:101328. [PMID: 36265260 DOI: 10.1016/j.mycmed.2022.101328] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/28/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022]
Abstract
Invasive aspergillosis (IA) affects more than 300,000 people annually worldwide with a case fatality rate reaching 80%. However, in Africa despite the presence of risk factors for the development of IA, the burden of these fungal infections remained unknown. This systematic review aimed to update the available information on the epidemiology and the therapeutic management of IA in Africa. The published papers were systematically searched on major medical databases from September 20 to October 10, 2021. The list of references of eligible articles and the Google scholar database were also checked in order to search for possible eligible articles. Results were reported following the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) guidelines. The search yielded 1864 articles of which 29 met the inclusion criteria. This systematic review showed the existence of IA in Africa. The prevalence of IA can reach 27% with a fatality rate of more than 60%. The most common clinical form of IA found was invasive pulmonary aspergillosis. The main predisposing conditions identified were neutropenia, HIV/AIDS, renal transplant recipients, and renal failure. Aspergillus section Flavi and Nigri were the main Aspergillus species identified and Aspergillus section Fumigati was uncommon. The main management strategy for IA cases was to start antifungal therapy only after a failure of broad-spectrum antibiotic therapy. This review provided evidence of the existence of invasive aspergillosis in Africa and especially a high rate of undiagnosed invasive aspergillosis cases.
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Affiliation(s)
- Isidore W Yerbanga
- Centre Hospitalier Universitaire Régional de Ouahigouya, 01 BP 36 Ouahigouya 01, Burkina Faso; Université Nazi Boni, 01 BP 1091 Bobo-Dioulasso 01, Burkina Faso.
| | - Seydou Nakanabo Diallo
- Université Nazi Boni, 01 BP 1091 Bobo-Dioulasso 01, Burkina Faso; Centre Muraz/ Institut National de Santé Publique, 01 BP 390 Bobo-Dioulasso 01, Burkina Faso
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, BP: 218 Ouaga 11, Ouagadougou, Burkina Faso
| | - Olivier Denis
- Department of Microbiology, CHU Namur site-Godinne, Université Catholique de Louvain, Rue Dr Gaston Therasse 1, 5530 Yvoir, Belgium; Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hector Rodriguez-Villalobos
- Department of Microbiology, Cliniques Universitaires Saint-Luc - Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - Isabel Montesinos
- Department of Microbiology, CHU Namur site-Godinne, Université Catholique de Louvain, Rue Dr Gaston Therasse 1, 5530 Yvoir, Belgium
| | - Sanata Bamba
- Université Nazi Boni, 01 BP 1091 Bobo-Dioulasso 01, Burkina Faso; Centre Hospitalier Universitaire Sourô Sanou, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
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Martins-Santana L, Rezende CP, Rossi A, Martinez-Rossi NM, Almeida F. Addressing Microbial Resistance Worldwide: Challenges over Controlling Life-Threatening Fungal Infections. Pathogens 2023; 12:pathogens12020293. [PMID: 36839565 PMCID: PMC9961291 DOI: 10.3390/pathogens12020293] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
Fungal infections are a serious global concern because of their ability to spread and colonize host tissues in immunocompromised individuals. Such infections have been frequently reported worldwide and are currently gaining clinical research relevance owing to their resistant character, representing a bottleneck in treating affected people. Resistant fungi are an emergent public health threat. The upsurge of such pathogens has led to new research toward unraveling the destructive potential evoked by these species. Some fungi-grouped into Candida, Aspergillus, and Cryptococcus-are causative agents of severe and systemic infections. They are associated with high mortality rates and have recently been described as sources of coinfection in COVID-hospitalized patients. Despite the efforts to elucidate the challenges of colonization, dissemination, and infection severity, the immunopathogenesis of fungal diseases remains a pivotal characteristic in fungal burden elimination. The struggle between the host immune system and the physiological strategies of the fungi to maintain cellular viability is complex. In this brief review, we highlight the relevance of drug resistance phenotypes in fungi of clinical significance, taking into consideration their physiopathology and how the scientific community could orchestrate their efforts to avoid fungal infection dissemination and deaths.
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Affiliation(s)
- Leonardo Martins-Santana
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Caroline Patini Rezende
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Antonio Rossi
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Nilce Maria Martinez-Rossi
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Fausto Almeida
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
- Correspondence:
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Wei Z, Wang S, Wang Z, Zhang Y, Chen K, Gong L, Li G, Zheng Q, Zhang Q, He Y, Zhang Q, Chen D, Cao K, Pang J, Zhang Z, Wang L, Ou Z, Liang Q. Development and multi-center validation of machine learning model for early detection of fungal keratitis. EBioMedicine 2023; 88:104438. [PMID: 36681000 PMCID: PMC9869416 DOI: 10.1016/j.ebiom.2023.104438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/08/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Fungal keratitis (FK) is a leading cause of corneal blindness in developing countries due to poor clinical recognition and laboratory identification. Here, we aimed to identify the distinct clinical signature of FK and develop a diagnostic model to differentiate FK from other types of infectious keratitis. METHODS We reviewed the electronic health records (EHRs) of all patients with suspected infectious keratitis in Beijing Tongren Hospital from January 2011 to December 2021. Twelve clinical signs of slit-lamp images were assessed by Lasso regression analysis and collinear variables were excluded. Three models based on binary logistic regression, random forest classification, and decision tree classification were trained for FK diagnosis and employed for internal validation. Independent external validation of the models was performed in a cohort of 420 patients from seven different ophthalmic centers to evaluate the accuracy, specificity, and sensitivity in real world. FINDINGS Three diagnostic models of FK based on binary logistic regression, random forest classification, and decision tree classification were established and internal validation were achieved with the mean AUC of 0.916, 0.920, and 0.859, respectively. The models were well-calibrated by external validation using a prospective cohort including 210 FK and 210 non-FK patients from seven eye centers across China. The diagnostic model with the binary logistic regression algorithm classified the external validation dataset with a sensitivity of 0.907 (0.774, 1.000), specificity 0.899 (0.750, 1.000), accuracy 0.905 (0.805, 1.000), and AUC 0.903 (0.808, 0.998). INTERPRETATION Our model enables rapid identification of FK, which will help ophthalmologists to establish a preliminary diagnosis and to improve the diagnostic accuracy in clinic. FUNDING The Open Research Fund from the National Key Research and Development Program of China (2021YFC2301000) and the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Tongren Hospital, Beihang University &Capital Medical University (BHTR-KFJJ-202001) supported this study.
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Affiliation(s)
- Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Shigeng Wang
- Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Zhiqun Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Yang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Kexin Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Lan Gong
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Guigang Li
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qinxiang Zheng
- Eye Hospital, Wenzhou Medical College, Wenzhou, 325027, China
| | - Qin Zhang
- Department of Ophthalmology, Key Laboratory of Vision Loss and Restoration, Ministry of Education, People's Hospital, Peking University, Beijing, 100044, China
| | - Yan He
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Qi Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Jinding Pang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China
| | - Zhonghong Ou
- Beijing University of Posts and Telecommunications, Beijing, 100876, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, 100005, China.
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11
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Bongomin F, Ekeng BE, Kibone W, Nsenga L, Olum R, Itam-Eyo A, Kuate MPN, Pebolo FP, Davies AA, Manga M, Ocansey B, Kwizera R, Baluku JB. Invasive Fungal Diseases in Africa: A Critical Literature Review. J Fungi (Basel) 2022; 8:jof8121236. [PMID: 36547569 PMCID: PMC9853333 DOI: 10.3390/jof8121236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Correspondence:
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | - Winnie Kibone
- Department of Medicine, School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Lauryn Nsenga
- Department of Medicine, School of Medicine, Kabale University, Kabale P.O. Box 317, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis’s Hospital Nsambya, Kampala P.O. Box 7176, Uganda
| | - Asa Itam-Eyo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | | | - Francis Pebalo Pebolo
- Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - Adeyinka A. Davies
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu P.O. Box 121102, Nigeria
| | - Musa Manga
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4114 McGavran-Greenberg, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Bright Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala P.O. Box 7178, Uganda
- Makerere Lung Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
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12
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Dougue AN, El‐Kholy MA, Giuffrè L, Galeano G, D′Aleo F, Kountchou CL, Nangwat C, Dzoyem JP, Giosa D, Pernice I, Shawky SM, Ngouana T, Boyom FF, Romeo O. Multilocus sequence typing (MLST) analysis reveals many novel genotypes and a high level of genetic diversity in Candida tropicalis isolates from Italy and Africa. Mycoses 2022; 65:989-1000. [PMID: 35713604 PMCID: PMC9796097 DOI: 10.1111/myc.13483] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Candida tropicalis is a human pathogenic yeast frequently isolated in Latin America and Asian-Pacific regions, although recent studies showed that it is also becoming increasingly widespread throughout several African and south-European countries. Nevertheless, relatively little is known about its global patterns of genetic variation as most of existing multilocus sequence typing (MLST) data come from Asia and there are no genotyped African isolates. OBJECTIVES We report detailed genotyping data from a large set of C. tropicalis isolates recovered from different clinical sources in Italy, Egypt and Cameroon in order to expand the allele/genotype library of MLST database (https://pubmlst.org/ctropicalis), and to explore the genetic diversity in this species. METHODS A total of 103 C. tropicalis isolates were genotyped using the MLST scheme developed for this species. All isolates were also tested for in vitro susceptibility to various antifungals to assess whether certain genotypes were associated with drug-resistance. RESULTS AND CONCLUSIONS A total of 104 different alleles were detected across the MLST-loci investigated. The allelic diversity found at these loci resulted in 51 unique MLST genotypes of which 36 (70.6%) were novel. Global optimal eBURST analysis identified 18 clonal complexes (CCs) and confirm the existence of a specific Italian-cluster (CC36). Three CCs were also statistically associated with fluconazole resistance, which was elevated in Cameroon and Egypt. Our data show high genetic diversity in our isolates suggesting that the global population structure of C. tropicalis is still poorly understood. Moreover, its clinical impact in Italy, Egypt and Cameroon appears to be relevant and should be carefully considered.
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Affiliation(s)
- Aude Ngueguim Dougue
- Antimicrobial & Biocontrol Agents Unit (AmBcAU), Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, Faculty of ScienceUniversity of Yaoundé IYaoundéCameroon
| | - Mohammed A. El‐Kholy
- Department of Microbiology and Biotechnology, Division of Clinical and Biological Sciences, College of PharmacyArab Academy for Science, Technology and Maritime Transport (AASTMT)AlexandriaEgypt
| | - Letterio Giuffrè
- Department of Chemical, Biological, Pharmaceutical and Environmental SciencesUniversity of MessinaMessinaItaly
| | - Grazia Galeano
- Department of Veterinary SciencesUniversity of MessinaMessinaItaly
| | - Francesco D′Aleo
- Laboratory of Clinical MicrobiologyGreat Metropolitan Hospital of Reggio CalabriaReggio CalabriaItaly
| | - Cyrille Levis Kountchou
- Research Unit of Laboratory of Microbiology and Antimicrobial Substances (RUMAS), Department of Biochemistry, Faculty of ScienceUniversity of DschangDschangCameroon,Institute of Medical Research and Medicinal Plant StudiesCenter for Medical Research in Health and Priority PathologiesYaoundéCameroon
| | - Claude Nangwat
- Research Unit of Laboratory of Microbiology and Antimicrobial Substances (RUMAS), Department of Biochemistry, Faculty of ScienceUniversity of DschangDschangCameroon
| | - Jean Paul Dzoyem
- Research Unit of Laboratory of Microbiology and Antimicrobial Substances (RUMAS), Department of Biochemistry, Faculty of ScienceUniversity of DschangDschangCameroon
| | - Domenico Giosa
- Department of Chemical, Biological, Pharmaceutical and Environmental SciencesUniversity of MessinaMessinaItaly
| | - Ida Pernice
- Department of Chemical, Biological, Pharmaceutical and Environmental SciencesUniversity of MessinaMessinaItaly
| | - Sherine M. Shawky
- Department of Microbiology, Medical Research InstituteUniversity of AlexandriaAlexandriaEgypt
| | - Thierry Kammalac Ngouana
- Antimicrobial & Biocontrol Agents Unit (AmBcAU), Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, Faculty of ScienceUniversity of Yaoundé IYaoundéCameroon,Biomedical Research UnitLaboratoire SionYaoundéCameroon
| | - Fabrice Fekam Boyom
- Antimicrobial & Biocontrol Agents Unit (AmBcAU), Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, Faculty of ScienceUniversity of Yaoundé IYaoundéCameroon
| | - Orazio Romeo
- Department of Chemical, Biological, Pharmaceutical and Environmental SciencesUniversity of MessinaMessinaItaly
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13
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Ahmed SA, El-Sobky TA, de Hoog S, Zaki SM, Taha M. A scoping review of mycetoma profile in Egypt: revisiting the global endemicity map. Trans R Soc Trop Med Hyg 2022; 117:1-11. [PMID: 36084235 PMCID: PMC9808524 DOI: 10.1093/trstmh/trac085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 01/07/2023] Open
Abstract
Mycetoma is a chronic infectious disease endemic in sub-Saharan Africa (SSA), India and parts of South and North America. The epidemiologic profile of the disease in Egypt, which neighbours SSA, has not been explored previously. Therefore we conducted a scoping review of the literature on mycetoma in Egypt. We searched the literature comprehensively on MEDLINE and Google Scholar using free-text words and Medical Subject Headings and terms. Both published and non-peer-reviewed (grey literature) articles were included. The initial search identified 133 reports. Of these, only eight were found to be relevant and were included in the study. The total number of mycetoma patients was 59, reported between 1949 and 2015. There was a predilection for eumycetoma (44 of 59) patients (75%), while actinomycetoma constituted 15 patients (25%). Six patients were female, 28 were male and 25 were unreported. Children and adolescents constituted 3 of 59 (5%), 52 (88%) were adults and age was not provided for 4 patients. Only four patients (7%) were non-autochthonous. The incidence of mycetoma in Egypt is higher than previously reported. Egypt is probably a low-endemic country. An accurate estimate of the prevalence and epidemiology of mycetoma necessitates further research collaboration.
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Affiliation(s)
| | | | - Sybren de Hoog
- Center of Expertise in Mycology Radboudumc, Canisius Wilhelmina Hospital, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Sherif M Zaki
- Mycology Unit, Department of Microbiology, Faculty of Science, Ain Shams University, Cairo Governorate 4392001, Cairo, Egypt
| | - Mohamed Taha
- Department of Microbiology, Zagazig University, Ash Sharqia Governorate 7120001, Zagazig, Egypt
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14
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Mycotic Keratitis in the Middle East: A Systematic Review and Meta-Analysis. MEDICAL LABORATORY JOURNAL 2022. [DOI: 10.52547/mlj.16.5.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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15
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Werkneh S, Orefuwa E, Denning DW. Current situation of fungal diseases in Eritrea. Mycoses 2022; 65:806-814. [PMID: 35633079 PMCID: PMC9545796 DOI: 10.1111/myc.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
The epidemiology of fungal infections in Eritrea is unknown. Most cases are under‐reported due to a lack of diagnostics. This study estimates the burden of serious fungal infections and highlights treatment and diagnostic gaps in the country. All publications related to fungal infections were identified by searches using PubMed/Medline and Google Scholar. Where no data were available, data from neighbouring countries, then sub‐Saharan African countries, then other parts of the world were considered for deriving estimates. The Eritrea population was 3,546,427 in 2020. In 2020, HIV/AIDS patients numbered 1400 and TB incidence were 2875. The five‐year adult prevalence of asthma (2016–2020) was 41,390, and the total prevalence estimate of chronic obstructive pulmonary disease (COPD) was 308,328. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in AIDS patients was estimated at 96 and 205 cases. Oesophageal candidiasis incidence is 715 HIV‐infected patients. Chronic pulmonary aspergillosis prevalence, including post‐tuberculosis cases, was estimated at 1399 (39/100,000). Fungal asthma has a prevalence of 1035 and 1366 in adults. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 59,391 and 342,585, respectively. There are no data on candidaemia, but it is estimated at 5/100,000 (177 cases annually). Invasive aspergillosis in leukaemia, lung cancer, COPD and HIV is estimated at 540 cases and fungal keratitis in 514 cases annually. Serious fungal infections are prevalent in Eritrea with approximately 408,164 people (11.5%) affected annually. Studies on fungal diseases to improve diagnosis and treatment are required with the implementation of a national surveillance program.
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Affiliation(s)
- Sara Werkneh
- Global Action For Fungal Infections, Geneva, Switzerland
| | - Emma Orefuwa
- Global Action For Fungal Infections, Geneva, Switzerland
| | - David W Denning
- Global Action For Fungal Infections, Geneva, Switzerland.,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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16
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The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey. THE LANCET MICROBE 2022; 3:e464-e470. [DOI: 10.1016/s2666-5247(21)00190-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/12/2021] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
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17
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Sadik N, Elzeiny SM, Ali YE, Sobeih D. Fungal Keratitis in the Egyptian Delta: Epidemiology, Risk Factors, and Microbiological Diagnosis. Ophthalmic Epidemiol 2021; 29:198-205. [PMID: 33853473 DOI: 10.1080/09286586.2021.1914667] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: The current study evaluates the epidemiological characteristics, risk factors, and microbiological diagnosis of fungal keratitis among patients living in the Egyptian Delta.Methods: This is a prospective hospital-based study that included patients who were clinically diagnosed and confirmed by culture test to have fungal keratitis. Patients were examined at baseline and risk factors were identified and collected. Patients were followed over 6 months and the outcomes were documented.Results: A total of 171 (67%) of 252 microbial keratitis patients was proved fungal by microbial culture test. Rural residence and agricultural activity were reported in 139 (81.3%) and 85 (49.7%) patients, respectively. Patients presented within 1 week from the start of symptoms were 120 (70.2%). A total of 54 (31.6%) patients reported ocular trauma. Forty patients (23.4%) had prior ocular surgery and 43 (25.1%) patients had a history of previous ocular disorders. Aspergillus species was the most common organism found in 120 (70.17%) patients, followed by Dematiceous fungi that were found in 25 (14.6%) patients. The main outcome was corneal opacity in 132 (77.2%) patients following medical treatment.Conclusion: Filamentary fungal predominance in Mansoura is influenced by the rural residence of its population. Therefore, more efforts in spreading awareness about microbial keratitis among villagers are important to reduce blindness caused by corneal opacity in rural areas.
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Affiliation(s)
- Nashwa Sadik
- Mansoura Ophthalmic Hospital, Ministry of Health, Mansoura, Egypt
| | | | | | - Doaa Sobeih
- Mansoura Ophthalmic Hospital, Ministry of Health, Mansoura, Egypt
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18
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Brown L, Leck AK, Gichangi M, Burton MJ, Denning DW. The global incidence and diagnosis of fungal keratitis. THE LANCET. INFECTIOUS DISEASES 2021; 21:e49-e57. [PMID: 33645500 DOI: 10.1016/s1473-3099(20)30448-5] [Citation(s) in RCA: 186] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
Abstract
Fungal keratitis is a severe corneal infection that often results in blindness and eye loss. The disease is most prevalent in tropical and subtropical climates, and infected individuals are frequently young agricultural workers of low socioeconomic status. Early diagnosis and treatment can preserve vision. Here, we discuss the fungal keratitis diagnostic literature and estimate the global burden through a complete systematic literature review from January, 1946 to July, 2019. An adapted GRADE score was used to evaluate incidence papers-116 studies provided the incidence of fungal keratitis as a proportion of microbial keratitis and 18 provided the incidence in a defined population. We calculated a minimum annual incidence estimate of 1 051 787 cases (736 251-1 367 323), with the highest rates in Asia and Africa. If all culture-negative cases are assumed to be fungal, the annual incidence would be 1 480 916 cases (1 036 641-1 925 191). In three case series, 8-11% of patients had to have the eye removed, which represents an annual loss of 84 143-115 697 eyes. As fungal keratitis probably affects over a million people annually, an inexpensive, simple diagnostic method and affordable treatment are needed in every country.
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Affiliation(s)
| | - Astrid K Leck
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital NHS Trust, London, UK
| | - David W Denning
- University of Manchester, Manchester, UK; National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester UK; Global Action Fund for Fungal Infections, Geneva, Switzerland.
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19
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Alfouzan W, Al-Wathiqi F, Altawalah H, Asadzadeh M, Khan Z, Denning DW. Human Fungal Infections in Kuwait-Burden and Diagnostic Gaps. J Fungi (Basel) 2020; 6:jof6040306. [PMID: 33233367 PMCID: PMC7711545 DOI: 10.3390/jof6040306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
Fungal infections are an increasingly important public health issue, yet accurate statistics on fungal burden worldwide and in Kuwait are scarce. Here we estimate the incidence and prevalence of fungal infections in Kuwait. Population statistics from 2018 collected by the Public Authority for Civil Information were used, as well as data from the Ministry of Health. A literature search for Kuwait data on mycotic diseases and population at risk (chronic obstructive pulmonary disease, HIV infection/AIDS, cancer, and transplant patients) was conducted. The population in 2018 was estimated at 4,226,920 million people: 1,303,246 million Kuwaitis and 2,923,674 million expatriates. We determined the annual burden of serious fungal infections number (per 100,000) from high to low based on earlier reported fungal rates for populations at risk: recurrent Candida vaginitis 54,842 (2595); severe asthma with fungal sensitisation 10,411 (246); allergic bronchopulmonary aspergillosis, 7887 (187); chronic pulmonary aspergillosis 995 (21.3); invasive aspergillosis 704 (16.7); fungal keratitis 654 (15.5); candidaemia 288 (6.8); Candida peritonitis 63 (3.5) and oesophageal candidiasis in HIV 33 (0.8). Besides identifying rising new risk groups and expanding reports on antifungal resistance, surveillance programs and further epidemiological studies are needed to achieve more precise assessments of fungal disease epidemiology and correlated morbidity and mortality.
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Affiliation(s)
- Wadha Alfouzan
- Microbiology Unit, Department of Laboratories, Farwaniya Hospital, P. O. Box 13373, Farwaniya 81004, Kuwait;
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat 13110, Kuwait; (H.A.); (M.A.); (Z.K.)
| | - Faten Al-Wathiqi
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, P. O. Box. 31470, Sulaibikhat 90805, Kuwait
- Correspondence:
| | - Haya Altawalah
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat 13110, Kuwait; (H.A.); (M.A.); (Z.K.)
- Virology Unit, Department of Laboratories, Yacoub Behbehani Center, Sabah Medical Area, P.O. Box 4078, Shuwaikh 13001, Kuwait
| | - Mohammad Asadzadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat 13110, Kuwait; (H.A.); (M.A.); (Z.K.)
| | - Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat 13110, Kuwait; (H.A.); (M.A.); (Z.K.)
| | - David W. Denning
- Manchester Fungal Infection Group, The University of Manchester and the Manchester Academic Health Science Centre, Manchester M13 9PL, UK;
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20
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Abbas HS, Krishnan A. Magnetic Nanosystems as a Therapeutic Tool to Combat Pathogenic Fungi. Adv Pharm Bull 2020; 10:512-523. [PMID: 33072531 PMCID: PMC7539303 DOI: 10.34172/apb.2020.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 12/14/2022] Open
Abstract
The overuse of antibiotics is the main reason for the expansion of multidrug-resistant microorganisms, especially, pathogenic fungi, such as Candida albicans and others. Nanotechnology provides an excellent therapeutic tool for pathogenic fungi. Several reports focused on metal oxide nanoparticles, especially, iron oxide nanoparticles due to their extensive applications such as targeted drug delivery. Using biological entities for iron oxide nanoparticle synthesis attracted many concerns for being eco-friendly, and inexpensive. The fusion of biologically active substances reduced and stabilized nanoparticles. Recently, the advancement and challenges for surface engineered magnetic nanoparticles are reviewed for improving their properties and compatibility. Other metals on the surface nanoparticles can enhance their biological and antimicrobial activities against pathogenic fungi. Furthermore, conjugation of antifungal drugs to magnetic nanoparticulate increases their antifungal effect, antibiofilm properties, and reduces their undesirable effects. In this review, we discuss different routes for the synthesis of iron oxide nanoparticles, surface coating manipulation, their applications as antimicrobials, and their mode of action.
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Affiliation(s)
- Heba Salah Abbas
- National Organization for Drug Control and Research, Cairo, Egypt.,Scientist Under Scheme of Asian Research Training Fellowship for Developing Country (RTF-DCS), FICCI, NewDelhi, India.,Department of Pharmaceutical Technology, Bharathidasan Institute of Technology, Anna University, Tiruchirappalli-620024. Tamilnadu, India
| | - Akilandeswari Krishnan
- Department of Pharmaceutical Technology, Bharathidasan Institute of Technology, Anna University, Tiruchirappalli-620024. Tamilnadu, India
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Osman M, Al Bikai A, Rafei R, Mallat H, Dabboussi F, Hamze M. Update on invasive fungal infections in the Middle Eastern and North African region. Braz J Microbiol 2020; 51:1771-1789. [PMID: 32623654 PMCID: PMC7335363 DOI: 10.1007/s42770-020-00325-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/22/2020] [Indexed: 12/18/2022] Open
Abstract
In the recent years, the epidemiology of invasive fungal infections (IFIs) has changed worldwide. This is remarkably noticed with the significant increase in high-risk populations. Although surveillance of such infections is essential, data in the Middle Eastern and North African (MENA) region remain scarce. In this paper, we reviewed the existing data on the epidemiology of different IFIs in the MENA region. Epidemiological surveillance is crucial to guide optimal healthcare practices. This study can help to guide appropriate interventions and to implement antimicrobial stewardship and infection prevention and control programs in countries.
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Affiliation(s)
- Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Aisha Al Bikai
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Hassan Mallat
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
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Oladele RO, Akase IE, Fahal AH, Govender NP, Hoenigl M, Gangneux JP, Chiller TM, Denning DW, Cornely OA, Chakrabarti A. Bridging the knowledge gap on mycoses in Africa: Setting up a Pan-African Mycology Working Group. Mycoses 2019; 63:244-249. [PMID: 31829454 DOI: 10.1111/myc.13044] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022]
Abstract
Most African countries have poorly funded and overburdened health systems. Additionally, a high prevalence of HIV in Sub-Saharan Africa contributes to a high burden of opportunistic fungal infections. Data generated by GAFFI from 15 of 57 African countries revealed that an estimated 47 million Africans suffer from fungal diseases, of whom an estimated 1.7 million suffer from a serious fungal infection annually. Almost all African countries lack a surveillance system for fungal infections with the exception of South Africa. South Africa is also the only African country with a national mycology reference laboratory. Across the continent, there is a pervasive picture of inadequate/poor diagnostic capacity, low level of awareness among healthcare workers and policymakers and unavailability and non-accessibility to essential antifungal medications. Recent outreach efforts by the International Society for Human and Animal Mycology (ISHAM) and the European Confederation of Medical Mycology (ECMM) have aimed to increase involvement of African countries and experts in global initiatives such as "One World One Guideline" and also the ECMM Academy. Recently, under the auspices of ISHAM, the African sub-region created a network of mycology experts whose goal is to organise and engage African leaders in the field of medical mycology. The aim of this ISHAM Working Group was to facilitate interaction and synergy among regional leaders in order to develop educational programmes for capacity building to aid in the diagnosis and care of patients with fungal infections in Africa. The working group will also encourage country initiatives to develop clinical guidelines, to support surveys and to support the establishment of reference mycology laboratories.
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Affiliation(s)
- Rita O Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Iorhen E Akase
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Nelesh P Govender
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public, Health University of California San Diego, San Diego, CA, USA.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Jean Pierre Gangneux
- CHU de Rennes, University of Rennes, INSERM, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Tom M Chiller
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland.,The University of Manchester, Manchester, UK
| | - Oliver A Cornely
- Department I of Internal Medicine, European Diamond Excellence Center of Medical Mycology, University Hospital Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,Centre for Clinical Trials, University Hospital Cologne, Cologne, Germany
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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del Rocío Reyes-Montes M, Duarte-Escalante E, Guadalupe Frías-De-León M, Obed Martínez-Herrera E, Acosta-Altamirano G. Molecular Diagnosis of Invasive Aspergillosis. Mol Med 2019. [DOI: 10.5772/intechopen.78694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Zakaria A, Osman M, Dabboussi F, Rafei R, Mallat H, Papon N, Bouchara JP, Hamze M. Recent trends in the epidemiology, diagnosis, treatment, and mechanisms of resistance in clinical Aspergillus species: A general review with a special focus on the Middle Eastern and North African region. J Infect Public Health 2019; 13:1-10. [PMID: 31672427 DOI: 10.1016/j.jiph.2019.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 08/02/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022] Open
Abstract
Globally, more than billion people suffer from fungal infections each year. The early diagnosis of aspergillosis is mandatory for successful treatment outcome. As careful testing takes time, epidemiological surveillance is crucial to guide individual patient therapy and to promote a high standard of health care. In this paper, we first present current trends in the epidemiology and antifungal susceptibility patterns of Aspergillus spp. in Middle Eastern and North African (MENA) countries in order to support infectious disease specialists and health workforces in this geographic area to treat adequately patients with aspergillosis. Then we discuss the existing literature data regarding the available diagnostic tools and antifungal resistance mechanisms of Aspergillus spp. Although a limited number of studies were reviewed here, the currently available data show that Aspergillus infections are not negligible in the MENA region, and that the emergence of antifungal resistance is a growing health issue, especially among immunocompromised patients.
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Affiliation(s)
- Ayate Zakaria
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Hassan Mallat
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Nicolas Papon
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP), EA 3142, SFR 4208 ICAT, UNIV Angers, UNIV Brest, Angers, France
| | - Jean-Philippe Bouchara
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP), EA 3142, SFR 4208 ICAT, UNIV Angers, UNIV Brest, Angers, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
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Estimated Burden of Fungal Infections in Namibia. J Fungi (Basel) 2019; 5:jof5030075. [PMID: 31426392 PMCID: PMC6787647 DOI: 10.3390/jof5030075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 12/16/2022] Open
Abstract
Namibia is a sub-Saharan country with one of the highest HIV infection rates in the world. Although care and support services are available that cater for opportunistic infections related to HIV, the main focus is narrow and predominantly aimed at tuberculosis. We aimed to estimate the burden of serious fungal infections in Namibia, currently unknown, based on the size of the population at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports. When no data existed, risk populations were used to estimate the frequencies of fungal infections, using the previously described methodology. The population of Namibia in 2011 was estimated at 2,459,000 and 37% were children. Among approximately 516,390 adult women, recurrent vulvovaginal candidiasis (≥4 episodes /year) is estimated to occur in 37,390 (3003/100,000 females). Using a low international average rate of 5/100,000, we estimated 125 cases of candidemia, and 19 patients with intra-abdominal candidiasis. Among survivors of pulmonary tuberculosis (TB) in Namibia 2017, 112 new cases of chronic pulmonary aspergillosis (CPA) are likely, a prevalence of 354 post-TB and a total prevalence estimate of 453 CPA patients in all. Asthma affects 11.2% of adults, 178,483 people, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) were estimated in approximately 179/100,000 and 237/100,000 people, respectively. Invasive aspergillosis (IA) is estimated to affect 15 patients following leukaemia therapy, and an estimated 0.13% patients admitted to hospital with chronic obstructive pulmonary disease (COPD) (259) and 4% of HIV-related deaths (108) — a total of 383 people. The total HIV-infected population is estimated at 200,000, with 32,371 not on antiretroviral therapy (ART). Among HIV-infected patients, 543 cases of cryptococcal meningitis and 836 cases of Pneumocystis pneumonia are estimated each year. Tinea capitis infections were estimated at 53,784 cases, and mucormycosis at five cases. Data were missing for fungal keratitis and skin neglected fungal tropical diseases such as mycetoma. The present study indicates that approximately 5% of the Namibian population is affected by fungal infections. This study is not an epidemiological study—it illustrates estimates based on assumptions derived from similar studies. The estimates are incomplete and need further epidemiological and diagnostic studies to corroborate, amend them, and improve the diagnosis and management of these diseases.
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Khairat SM, Sayed AM, Nabih M, Soliman NS, Hassan YM. Prevalence of Candida blood stream infections among children in tertiary care hospital: detection of species and antifungal susceptibility. Infect Drug Resist 2019; 12:2409-2416. [PMID: 31496753 PMCID: PMC6689130 DOI: 10.2147/idr.s196972] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Of all blood stream infections (BSI), candidaemia poses the greatest threat with a high fatality rate among children. There has been an increase in the number of reports of non-C. albicans species and antifungal resistance has progressively emerge. Aim The present study aimed to demonstrate the prevalence of candidaemia among children and to characterize the involved species and their susceptibility to antifungal agents. Methodology Microbes were isolated from blood samples and identified via standard microbiological procedures. Chromogenic media was used to characterize the Candida species. The susceptibility of the isolates to the antifungal agents; caspofungin, amphotericin, itraconazole, and fluconazole was determined with the E-test. Statistical methods The data were analysed with Statistical Package for the Social Science SPSS; SPSS Inc., Chicago, IL, USA) version 15 for Microsoft Windows. Comparisons between the study groups were performed using the Chi square (χ2) test. p-values less than 0.05 were considered significant. Results Candidaemia accounted for 17.3% of all BSIs. C. albicans and non-C. albicans species accounted for 36% and 64% of the cases of candidaemia, respectively. Caspofungin, amphotericin, itraconazole, and fluconazole antifungals had activities of 99%, 97%, 73% and 64%, respectively. In total, 64% of patients with candiaemia died. Conclusion The prevalence of candidaemia was high, the fatality rate was alarming and non-C. albicans species were predominant. Fluconazole was the least effective of the tested antifungal agents owing to the high level of resistance.
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Affiliation(s)
- Sahar Mohammed Khairat
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amal Mohammed Sayed
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohammad Nabih
- Department of Pediatrics, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Noha Salah Soliman
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Yosra Mohammed Hassan
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
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27
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Could aflatoxin B1 production by Aspergillus flavus affect the severity of keratitis: an experience in two tertiary health care centers, Egypt. Eur J Clin Microbiol Infect Dis 2019; 38:2021-2027. [PMID: 31332609 DOI: 10.1007/s10096-019-03636-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Abstract
To investigate the expression of AFB1 gene in isolates obtained from corneal scrapping samples from keratitis patients and to correlate the quantity of AFB1 to the severity of keratitis. An observational study was undertaken in Medical Microbiology and Immunology department, Mansoura University, Egypt, over corneal scrapping samples that were cultured aiming to isolate fungal causes of infective keratitis followed by AFB1 gene detection in Aspergillus flavus isolates by nested PCR then quantitation of the toxin by TLC. Out of 843 corneal scrapping samples collected from patients with infective keratitis, positive fungal growth was identified in 277 cases (32.9%). A. flavus was the commonest fungal agent isolated in 93 cases (33.6%). The AFB1 toxin-encoding gene was detected in 63.4% of A. flavus isolates. There was a positive correlation between the quantity of produced AFB1 toxin and the degree of severity of keratitis (P value < 0.0001*). Aspergillus flavus was the most common cause of fungal keratitis, with the AFB1 toxin-encoding gene detected in more than half of the isolates. A significant correlation between the degree of severity of keratitis and the quantity of produced AFB1 toxin was detected. Therefore, exploring presence or absence of AFB1 toxin is important for the clinicians in their diagnostic assessment and selection of proper treatment choices.
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Kmeid J, Jabbour JF, Kanj SS. Epidemiology and burden of invasive fungal infections in the countries of the Arab League. J Infect Public Health 2019; 13:2080-2086. [PMID: 31248814 DOI: 10.1016/j.jiph.2019.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022] Open
Abstract
The burden of invasive fungal infections is alarming worldwide. The aim of this paper is to review the published literature and evaluate the knowledge gap pertaining to studies on invasive fungal infections in the countries of the Arab League. Few countries from this region have published reports. The most commonly studied invasive fungal infections is invasive candidiasis. Candida albicans remains overall the most common causative pathogen (33.8-60%), however, non-albicans Candida species are increasing. Antifungal susceptibility testing is non-standardized across the published studies. Data on aspergillosis and other fungal infections is scarce. This sheds light on the need for standardized surveillance in the region encompassing more countries of the Arab League to guide diagnostic approach and empiric therapy.
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Affiliation(s)
- Joumana Kmeid
- Division of Infectious Diseases, Department of Internal Medicine, Keserwan Medical Center, Ghazir, Lebanon
| | - Jean-Francois Jabbour
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Kwizera R, Musaazi J, Meya DB, Worodria W, Bwanga F, Kajumbula H, Fowler SJ, Kirenga BJ, Gore R, Denning DW. Burden of fungal asthma in Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0216568. [PMID: 31095641 PMCID: PMC6521988 DOI: 10.1371/journal.pone.0216568] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Asthma is one of the neglected diseases in Africa with a high prevalence. Allergic fungal diseases have been reported to complicate asthma progression and treatment outcomes. However, data about fungal asthma and its associated complications are limited in Africa. We aimed to estimate the burden of fungal asthma among adults and children in Africa using a systematic review. METHODS We first engaged the Institute for Health Metrics and Evaluation (IHME) to highlight the trend in morbidity and mortality attributed to asthma in Africa. We then searched PubMed, HINARI and Google Scholar for all studies of any design focusing on fungal asthma in any African country. Languages were restricted to English and French, but not year of publication. We estimated the weighted prevalence of allergic fungal infections among asthmatics with a 95% CI and pooled the results using a random effects model. This study is registered with PROSPERO, number CRD42019117319. RESULTS The IHME data showed that there has been a gradual increase in morbidity and mortality due to asthma in African adults with a prevalence of 4%. Our search retrieved 5233 citations. We retained 20 studies that met our selection criteria. These were from 13 African countries published between 1967 and 2018. There were eight cross-sectional studies and twelve review articles. The average asthma prevalence in Africa was 6% from these studies. The prevalence of fungal sensitisation was relatively high (3-52%) in the asthmatic population with an average of 28% and a pooled estimate of 23.3%, mostly due to Aspergillus species. Prevalence of Allergic bronchopulmonary apsergillosis was estimated at 1.6-21.2%. Diagnosis of fungal allergy was mostly made by skin prick tests. There was no data on the use of medication to manage fungal asthma. None of the studies evaluated the association between fungal allergy and asthma severity. Data were lacking in children. CONCLUSION There is a high prevalence of fungal sensitization among Africans with asthma. Fungal asthma is a significant problem in Africa but there remains a paucity of data on the epidemiology and associated complications. There is urgent need for national epidemiological studies to estimate the actual burden of fungal asthma in Africa.
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Affiliation(s)
- Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Worodria
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | - Freddie Bwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stephen J. Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Bruce J. Kirenga
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Mulago National Referral Hospital, Kampala, Uganda
| | - Robin Gore
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - David W. Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Barac A, Kosmidis C, Alastruey-Izquierdo A, Salzer HJF. Chronic pulmonary aspergillosis update: A year in review. Med Mycol 2019; 57:S104-S109. [DOI: 10.1093/mmy/myy070] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/18/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Aleksandra Barac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Chris Kosmidis
- National Aspergillosis Centre, Manchester University NHS Foundation Trust, UK and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Helmut J F Salzer
- Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital, Linz, Austria
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Hilmioğlu-Polat S, Seyedmousavi S, Ilkit M, Hedayati MT, Inci R, Tumbay E, Denning DW. Estimated burden of serious human fungal diseases in Turkey. Mycoses 2018; 62:22-31. [PMID: 30107069 DOI: 10.1111/myc.12842] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 02/05/2023]
Abstract
The current number of fungal infections occurring each year in Turkey is unknown. We estimated the burden of serious human fungal diseases based on the population at risk, existing epidemiological data from 1920 to 2017 and modelling previously described by the LIFE program (http://www.LIFE-worldwide.org). Among the population of Turkey (80.8 million in 2017), approximately 1 785 811 (2.21%) people are estimated to suffer from a serious fungal infection each year. The model used predicts high prevalences of allergic fungal rhinosinusitis episodes (312 994 cases) (392/100 000), of severe asthma with fungal sensitisation (42 989 cases) (53.20 cases/100 000 adults per year), of allergic bronchopulmonary aspergillosis (32 594 cases) (40.33/100 000), of fungal keratitis (26 671 cases) (33/100 000) and of chronic pulmonary aspergillosis (5890 cases) (7.29/100 000). The estimated annual incidence for invasive aspergillosis is lower (3911 cases) (4.84/100 000 annually). Among about 22.5 million women aged 15-50 years, recurrent vulvovaginal candidiasis is estimated to occur in 1 350 371 (3342/100 000) females. The burden of three superficial fungal infections was also estimated: tinea pedis (1.79 million), tinea capitis (43 900) and onychomycosis (1.73 million). Given that the modelling estimates reported in the current study might be substantially under- or overestimated, formal epidemiological and comprehensive surveillance studies are required to validate or modify these estimates.
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Affiliation(s)
| | - Seyedmojtaba Seyedmousavi
- Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States of America.,Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology and Parasitology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ramazan Inci
- Department of Microbiology, Faculty of Medicine, University of Ege, Izmir, Turkey
| | - Emel Tumbay
- Department of Microbiology, Faculty of Medicine, University of Ege, Izmir, Turkey
| | - David W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Bongomin F, Gago S, Oladele RO, Denning DW. Global and Multi-National Prevalence of Fungal Diseases-Estimate Precision. J Fungi (Basel) 2017; 3:E57. [PMID: 29371573 PMCID: PMC5753159 DOI: 10.3390/jof3040057] [Citation(s) in RCA: 1439] [Impact Index Per Article: 205.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 02/07/2023] Open
Abstract
Fungal diseases kill more than 1.5 million and affect over a billion people. However, they are still a neglected topic by public health authorities even though most deaths from fungal diseases are avoidable. Serious fungal infections occur as a consequence of other health problems including asthma, AIDS, cancer, organ transplantation and corticosteroid therapies. Early accurate diagnosis allows prompt antifungal therapy; however this is often delayed or unavailable leading to death, serious chronic illness or blindness. Recent global estimates have found 3,000,000 cases of chronic pulmonary aspergillosis, ~223,100 cases of cryptococcal meningitis complicating HIV/AIDS, ~700,000 cases of invasive candidiasis, ~500,000 cases of Pneumocystis jirovecii pneumonia, ~250,000 cases of invasive aspergillosis, ~100,000 cases of disseminated histoplasmosis, over 10,000,000 cases of fungal asthma and ~1,000,000 cases of fungal keratitis occur annually. Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious fungal infections country by country for over 5.7 billion people (>80% of the world's population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations. Here we interrogate the accuracy of these fungal infection burden estimates in the 43 published papers within the LIFE initiative.
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Affiliation(s)
- Felix Bongomin
- The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
| | - Sara Gago
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester M13, 9PL, UK.
| | - Rita O Oladele
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
| | - David W Denning
- The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester M13, 9PL, UK.
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