Aspergillus and Candida species isolated from the sputa of patients with bronchopulmonary disorders in Nigeria

Invasive candidiasis in Africa, what is the current picture?

Invasive candidiasis is a serious, progressive, and potentially deadly infection that can affect the brain, heart, bones, eyes, and other parts of the body. It is associated with risk factors such as the use of indwelling medical devices and prolonged hospital stay, and broad-spectrum antibiotics use. It is especially seen in immunocompromised individuals such as patients with prolonged hospital stay, gastrointestinal surgery, haematological malignancies, and respiratory diseases. We have conducted a systematic search of literature using a select group of database and appropriate search words and found that in Africa, there are 18,293 documented/reported cases of invasive candidiasis in the last few decades (1976-2021) and 16,636(91%) were cases of candidaemia. South Africa had the highest number of reported cases - 15,002(82%), which may be due to underreporting of cases in other countries. HIV positive persons with invasive candidiasis in Africa accounted for 1,052(5.8%). C. albicans was the most frequently isolated species 6,328(32.6%), followed by Candida parapsilosis 5,910(30.4%), and Candida auris 1,505(7.8%). Due to the affordability and availability of blood culture, it was used for diagnosis in most of the studies examined, while a few studies combined other techniques and just 3 studies from 2 countries used serological tests. Echinocandins are recommended as first-line therapy but are only available in 12 countries and are highly priced. The use of fluconazole because of its availability and relatively inexpensive nature has led to increased resistance of Candida species to the drug.

Triazole susceptibility of Aspergillus species: environmental survey in Lagos, Nigeria and review of the rest of Africa

BACKGROUND

Triazole resistance is an emerging problem in the management of human aspergillosis globally and can arise in Aspergillus species which have been exposed to azole fungicides in the environment. We surveyed local government and council development areas in Lagos, Nigeria, to determine the distribution of Aspergillus species in the environment and their susceptibility to locally available triazole antifungal agents. We also reviewed the literature on the subject from the rest of Africa.

METHODS

A total of 168 soil samples from six locations in Lagos, Nigeria were processed and cultured on Saboraud dextrose agar impregnated with chloramphenicol to isolate Aspergillus species. Isolates were tested for susceptibility to itraconazole and voriconazole by microbroth dilution according to the European Committee on Antimicrobial Susceptibility Testing reference method. Relevant databases were searched to identify published work pertaining to triazole susceptibility of Aspergillus species in Africa.

RESULTS

A total of 117 Aspergillus species were isolated. Aspergillus niger was the most frequently isolated species (42.7%). Other species isolated were Aspergillus flavus, 37 (31.6%), Aspergillus terreus, 20 (17.1%), Aspergillus fumigatus, 5 (4.3%) and Aspergillus nidulans, 5 (4.3%). All isolates were susceptible to itraconazole and voriconazole. The literature review showed documented evidence of triazole-resistant Aspergillus species from East and West Africa.

CONCLUSIONS

We found no triazole resistance in environmental isolates of Aspergillus in Lagos, Nigeria. Nevertheless, regular surveillance in clinical and environmental isolates is necessary in the light of findings from other African studies.

The incidence of candidiasis amongst the asymptomatic female students of the University of Jos, Nigeria

A survey was carried out on the incidence of candidiasis amongst the asymptomatic female students of University of Jos. One hundred and three students were selected at guided random. Their first stream urine samples were collected with the aid of sterile McCarthney bottles. The deposits of the centrifuged urine samples were plated out on sabouraud's dextrose agar (SDA) fortified with antibiotics (penicillin G and streptomycin). A total number of 42 positive Candida cases were obtained. This represented 40.78% of the total samples (103) examined. The Candida species isolated included C. albicans, C. glabrata, C. guilliermondi, C. parapsilosis, C. pseudotropicalis, C. stellatoidea, C. tropicalis and C. viswanathii. C. albicans and C. tropicalis were more predominant than the other species. C. albicans had 38.10% frequency of occurrence while C. tropicalis had 21.43% occurrence. The least percentage occurrence was recorded for C. viswanathii which had 2.38%. There were significant relationships between the incidence of candidiasis and the predisposing factors like drug administration (antibiotics and contraceptive pills), cases of pregnancy and previous cases of urinogenital tract infection. Neither the marital status nor the age groups of the test female students had significant effects on the incidence of this disease. The pH values of the infected urine samples had a significant effect on the incidence of the disease.