1
|
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.
Collapse
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
| |
Collapse
|
2
|
Fulgence KK, Marie KBPC, Akoua VBT, Massafoma KEG, Etienne AK, Abibatou KT, Henriette VBA, Sebastien MAJ, Vincent D, William Y, Hervé MEI. Dermatophytosis and the associated risk factors among primary school children in southern and central Côte d'Ivoire. Mycoses 2023; 66:869-875. [PMID: 37309262 DOI: 10.1111/myc.13624] [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: 10/25/2022] [Revised: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dermatophytosis, particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood. OBJECTIVES This study aimed to determine the factors associated with tinea capitis and the prevalence rate of other dermatophytoses among primary school students in the rural and urban areas of the southern and central Côte d'Ivoire. PATIENTS AND METHODS The study was carried out in seven towns of Côte d'Ivoire from October 2008 to July 2009, among 17,745 children aged 4-17 years and attending urban and rural primary schools; a complete physical examination of the skin and appendages, including nails and hair, was performed by the physicians. Direct microscopic examination using 30% potassium hydroxide solution and culture on Sabouraud's dextrose agar supplemented with 0.5 g/L chloramphenicol and 0.4 g/L actidione was performed during sampling. RESULTS For the 17,745 children clinically examined, 2645 exhibited symptoms suggestive of tinea capitis. Positive cultures for dermatophytes were found in 2635 patients, and the overall prevalence rate of tinea capitis was 14.8%. The following factors, age, sex, pets at home, number of bathing daily, sharing of sponges, combs and towels and hair length, were statistically associated with tinea capitis (p < .001). In addition to tinea capitis, other superficial fungal infections were identified among these children. These included tinea corporis (0.9%), tinea unguium (0.6%) and pityriasis versicolor (0.4%). CONCLUSION Tinea capitis is common among pupils in rural southern and central Côte d'Ivoire, especially in young boys.
Collapse
Affiliation(s)
- Kassi Kondo Fulgence
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
- Laboratory of Parasitology and Mycology of the Diagnosis and Research Centre on AIDS and the Others Infectious Diseases, Abidjan, Côte d'Ivoire
| | | | - Valerie Bedia-Tanoh Akoua
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | - Koné Estelle Gnanyo Massafoma
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
- Laboratory of Parasitology and Mycology of the Diagnosis and Research Centre on AIDS and the Others Infectious Diseases, Abidjan, Côte d'Ivoire
| | - Angora Kpongbo Etienne
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | - Konaté-Touré Abibatou
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | - Vanga-Bosson Abo Henriette
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | | | - Djohan Vincent
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | - Yavo William
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | - Menan Eby Ignace Hervé
- Department of Parasitology and Mycology, Faculty of Pharmacy, Felix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
- Laboratory of Parasitology and Mycology of the Diagnosis and Research Centre on AIDS and the Others Infectious Diseases, Abidjan, Côte d'Ivoire
| |
Collapse
|
3
|
Badiane AS, Ramarozatovo LS, Doumbo SN, Dorkenoo AM, Mandengue C, Dunaisk CM, Ball M, Dia MK, Ngaya GSL, Mahamat HH, Kalombo H, Bah A, Cá Z, Langa JC, Mohamed AM, Mokomane M, Ahmed SA, Rapalanoro Rabenja F, Hay RJ, Penney ROS, Orefuwa E, Denning DW. Diagnostic capacity for cutaneous fungal diseases in the African continent. Int J Dermatol 2023; 62:1131-1141. [PMID: 37340531 DOI: 10.1111/ijd.16751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/11/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Cutaneous fungal infections are very common, especially in poorer communities and with intercurrent HIV infection. Determining the fungal pathogen in skin-related fungal neglected tropical diseases (NTDs) determines optimal therapy. We undertook a country survey across many African countries to determine the diagnostic capacity for skin fungal diseases. METHODS A detailed questionnaire was delivered to country contacts to collect data on availability, frequency, and location of testing for key diagnostic procedures and followed up with 2 rounds of validation by video call and by confirmation of individual country data confirmation by email. RESULTS Of 47 countries with data, seven (15%) and 21 (45%) do not offer skin biopsy in the public or private sector, respectively, but 22 (46%) countries do it regularly, mostly in university hospitals. Direct microscopy is often performed in 20 of 48 (42%) countries in the public sector and not done in 10 (21%). Fungal cultures are often performed in 21 of 48 (44%) countries in the public sector but not done in nine (20%) or 21 (44%) in either public or private facilities. Histopathological examination of tissue is frequently used in 19 of 48 (40%) countries but not in nine (20%) countries in the public sector. The cost of diagnostics to patients was a major limiting factor in usage. CONCLUSION Major improvements in the availability and use of diagnostic tests for skin, hair, and nail fungal disease are urgently needed across Africa.
Collapse
Affiliation(s)
- Aida S Badiane
- Cheikh Anta Diop University of Dakar, Aristide Le Dantec Hospital, Dakar, Senegal
| | - Lala S Ramarozatovo
- USFR Dermatologie-Rhumatologie, de ahead of Dermatologie, Hôpital Universitaire JRB Antananarivo, Antananarivo, Madagascar
| | - Safiatou N Doumbo
- Department of Epidemiology in Parasitic Diseases, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ameyo M Dorkenoo
- Département des Sciences Biologiques et Fondamentales, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | | | - Cara M Dunaisk
- Health Sciences, Namibia University of Science and Technology, Windhoek, Namibia
| | - Mamadou Ball
- The Faculty of Medicine at the University of Nouakchott and Ministry of Health, Nouakchott, Mauritania
| | - Mariem K Dia
- The Faculty of Medicine at the University of Nouakchott and Ministry of Health, Nouakchott, Mauritania
| | | | - Hassane H Mahamat
- L'Association des Vétérinaires Africains (Rég. Afrique Centrale), N'Djamena, Chad
| | - Hortense Kalombo
- Direction des Laboratoires de Santé, Ministère de la Santé Publique, Hygiène et Prévention, Kinshasa, Democratic Republic of Congo (DRC)
| | - Alasana Bah
- Medical Research Council (MRC) Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Zimania Cá
- Guinea Bissau National Health Center (CENAS), Bissau, Guinea Bissau
| | - Jose C Langa
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ayni M Mohamed
- National Public Health Reference Laboratory, Ministry of Health, Mogadishu, Somalia
| | | | - Sarah A Ahmed
- Center of Expertise in Mycology Radboudumc, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | | | | | - Emma Orefuwa
- Global Action For Fungal Infections (GAFFI), Geneva, Switzerland
| | - David W Denning
- Global Action For Fungal Infections (GAFFI), Geneva, Switzerland
- Manchester Fungal Infection Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Diongue K, Dembélé B, Ndiaye M, Seck MC, Diallo MA, Badiane AS, Ndiaye D, Ranque S. Evaluation of knowledge and experience of fungal infections (mycoses) among clinical doctors in Senegal. J Mycol Med 2023; 33:101408. [PMID: 37307640 DOI: 10.1016/j.mycmed.2023.101408] [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: 01/19/2023] [Revised: 05/08/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
In order to assess the knowledge and experience of fungal infections (FIs) among clinicians in Senegal, a cross-sectional survey was carried out among medical practitioners in Senegal via a questionnaire designed with "Google Forms" between 24 January and 24 April 2022. A total of 100 clinicians responded to the questionnaire. Clinicians in the 31- 40-year-old age group formed the majority of respondents (51%). Male respondents were predominant (72%). Forty-one percent of respondents were general practitioners, 40% were specialist doctors, and the rest were residents. Dermatologists were the most common at 15% (6/40). In terms of clinicians' general knowledge of fungi, FIs and their therapeutic management, an average of 70% correct answers was recorded. The majority (70%) of respondents cared for between two to four different categories of patients at risk of invasive FIs (IFIs) at a time, with diabetes predominating. Eighty percent confirmed that they had been confronted with FIs, including 43% with superficial FIs, 3% with subcutaneous FIs and 5% with IFIs. Thirty-four percent of doctors stated that they had never suspected an IFI. Candidiasis was the most commonly mentioned mycosis by doctors. To support the diagnosis of these FIs, 22% of the clinicians said that they had recourse only to the clinical diagnosis. In total, 79% of clinicians responded that they had never used an antifungal chemoprophylaxis. In addition, 28% and 22% of practicing physicians chose a combination of antifungals for the chemoprophylaxis of invasive candidiasis and invasive aspergillosis, respectively. This survey shows that both clinicians' knowledge and experience of fungi, antifungals, FIs and their therapeutic management, as well as chemoprophylaxis, need to be improved. Indeed, half of the clinicians seem to be unaware of the incidence of FIs, in particular IFIs, which, nevertheless, represent some of the deadliest infectious diseases in the world.
Collapse
Affiliation(s)
- Khadim Diongue
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar 3001, Senegal; Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar 10700, Senegal; Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar, Dakar 16477, Senegal.
| | - Boubou Dembélé
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar 3001, Senegal
| | - Mouhamadou Ndiaye
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar 3001, Senegal; Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar 10700, Senegal; Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar, Dakar 16477, Senegal
| | - Mame Cheikh Seck
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar 3001, Senegal; Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar 10700, Senegal; Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar, Dakar 16477, Senegal
| | - Mamadou Alpha Diallo
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar 3001, Senegal; Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar, Dakar 16477, Senegal
| | - Aïda Sadikh Badiane
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar 3001, Senegal; Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar 10700, Senegal; Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar, Dakar 16477, Senegal
| | - Daouda Ndiaye
- Laboratory of Parasitology and Mycology, Aristide Le Dantec University Hospital, Dakar 3001, Senegal; Service of Parasitology-Mycology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University of Dakar, Dakar 10700, Senegal; Centre International de Recherche et de Formation en Génomique Appliquée, et de Surveillance Sanitaire (CIGASS), Cheikh Anta Diop University of Dakar, Dakar 16477, Senegal
| | - Stéphane Ranque
- Aix-Marseille Université, AP-HM, IRD, SSA, VITROME, 13005 Marseille, France; IHU Méditerranée Infection, 13005 Marseille, France
| |
Collapse
|
5
|
Doumbo SN, Cissoko Y, Dama S, Niangaly A, Garango A, Konaté A, Koné A, Traoré B, Thera M, Djimde A, Denning DW. The estimated burden of fungal diseases in Mali. J Mycol Med 2023; 33:101333. [PMID: 36270216 DOI: 10.1016/j.mycmed.2022.101333] [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: 07/11/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
Mali is a developing country facing several health challenges with a high rate of tuberculosis (TB) and a moderate HIV infection burden. Little is known or done about fungal diseases, yet they represent a significant public health problem in certain populations. The aim of this study was to estimate the national burden of fungal disease, and summarize data, diagnostic and treatment gaps. We used national demographics and PubMed searches to retrieve articles on published data on these infections and at-risk populations (pulmonary TB, HIV/AIDS patients, patients receiving critical care etc.) in Mali. The estimated Malian population was 21,251,000 in 2020 (UN), of which 45% were children <14 years. Among HIV patients, we estimate an annual incidence of 611 cryptococcosis, 1393 Pneumocystis pneumonia, 180 histoplasmosis and >5,700 esophageal candidiasis and some microsporidiosis cases. Our prevalence estimates for tinea capitis are 2.3 million, for recurrent vulvovaginal candidiasis 272,460, ∼60,000 fungal asthma and 7,290 cases of chronic pulmonary aspergillosis (often mistaken for TB). Less common acute fungal infections are probably invasive aspergillosis (n=1230), fungal keratitis (n=2820), candidaemia (>1,060) and mucormycosis (n=43). Histoplasmin was found in 6% in general population. A few cases of mycetoma are described in Mali. Many WHO Essential medicines and Diagnostics are not available in Mali. This shows a marked disparity in documented and estimated cases of fungal diseases in Mali. These infections are underestimated due to the lack of accurate diagnosis tools and lack of support for fungal diseases diagnosis and management.
Collapse
Affiliation(s)
- Safiatou Niaré Doumbo
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali.
| | - Yacouba Cissoko
- Infectious disease and tropical medicine Unit, CHU Point G Bamako, Mali
| | - Souleymane Dama
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - Amadou Niangaly
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - Adam Garango
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - Ahmed Konaté
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - Abdoulaye Koné
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - Boubacar Traoré
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - Mahamadou Thera
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - Abdoulaye Djimde
- Department of epidemiology in parasitic diseases, University of Science, Techniques and Technologies of Bamako, Mali
| | - David W Denning
- Manchester Fungal Infection Group, Core Technology Facility Grafton Street, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Global Action for Fungal Infections, Geneva, Switzerland
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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
|
8
|
Dorkenoo AM, Adjetey-Toglozombio AK, Ocansey BK, Sossou E, Lack F, Denning DW. Estimated burden of serious fungal infections in Togo. Mycoses 2021; 64:1535-1541. [PMID: 34596932 DOI: 10.1111/myc.13377] [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: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the years, the focus of infectious diseases in many African countries has been mainly on viral, bacterial and parasitic infections. Serious fungal infections (SFIs) with comparable morbidity rate in these countries remain neglected. OBJECTIVES To estimate the burden of SFI in Togo and to stimulate efforts for improved attention. METHODS Literature was thoroughly searched for epidemiological data on SFI in Togo. Incidence and/or prevalence of SFI was estimated using socio-demographics, health system's information, risk-groups data and SFI rates obtained from national and international studies. RESULTS About 5.29% of the 7,265,286 Togolese population is estimated to suffer from SFI annually. Among HIV patients, 1,342, 1,650 and 330 may develop cryptococcal meningitis, Pneumocystis pneumonia and disseminated histoplasmosis respectively per year. Oral and oesophageal candidiasis may annually affect 19,800 and 7,535 persons, respectively, living with HIV. Estimated incidence of invasive aspergillosis (IA) was 283 cases. Prevalence of chronic pulmonary aspergillosis (CPA) was estimated at 191 cases. The annual incidence of allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) was 4,577 and 6,042 cases, respectively. Tinea capitis and recurrent Candida vaginitis presumably affect 232,271 children and 108,979 women respectively. Candidaemia incidence is estimated at 5 cases per 100, 000 inhabitants and fungal keratitis may affect 981 persons annually. CONCLUSIONS SFIs in Togo are probably more significant than expected. These findings underscore the need to increase awareness among healthcare professionals, enhance diagnostic and therapeutic capacities and intensify epidemiological studies for effective management of fungal infections in Togo.
Collapse
Affiliation(s)
- Ameyo M Dorkenoo
- Département de Parasitologie-Mycologie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.,Ministère de la Santé et de l'Hygiène Publique, Lomé, Togo
| | | | - Bright K Ocansey
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Efoe Sossou
- Ministère de la Santé et de l'Hygiène Publique, Lomé, Togo
| | - Fiali Lack
- Ministère de la Santé et de l'Hygiène Publique, Lomé, Togo
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
9
|
Pfavayi LT, Denning DW, Baker S, Sibanda EN, Mutapi F. Determining the burden of fungal infections in Zimbabwe. Sci Rep 2021; 11:13240. [PMID: 34168204 PMCID: PMC8225815 DOI: 10.1038/s41598-021-92605-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023] Open
Abstract
Zimbabwe currently faces several healthcare challenges, most notably HIV and associated infections including tuberculosis (TB), malaria and recently outbreaks of cholera, typhoid fever and COVID-19. Fungal infections, which are also a major public health threat, receive considerably less attention. Consequently, there is dearth of data regarding the burden of fungal diseases in the country. We estimated the burden of fungal diseases in Zimbabwe based on published literature and 'at-risk' populations (HIV/AIDS patients, survivors of pulmonary TB, cancer, chronic obstructive pulmonary disease, asthma and patients receiving critical care) using previously described methods. Where there was no data for Zimbabwe, regional, or international data was used. Our study revealed that approximately 14.9% of Zimbabweans suffer from fungal infections annually, with 80% having tinea capitis. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in HIV/AIDS were estimated at 41/100,000 and 63/100,000, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) was 2,739/100,000. The estimated burden of fungal diseases in Zimbabwe is high in comparison to other African countries, highlighting the urgent need for increased awareness and surveillance to improve diagnosis and management.
Collapse
Affiliation(s)
- Lorraine T. Pfavayi
- grid.4991.50000 0004 1936 8948Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG UK ,grid.4305.20000 0004 1936 7988Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL UK ,grid.4305.20000 0004 1936 7988NIHR Global Health Research Unit Tackling Infections To Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, UK
| | - David W. Denning
- grid.5379.80000000121662407Manchester Fungal Infection Group, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen Baker
- grid.5335.00000000121885934University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW UK ,grid.5335.00000000121885934Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 2QQ UK
| | - Elopy N. Sibanda
- Asthma Allergy and Immunology Clinic, Twin Palms Medical Centre, Harare, Zimbabwe ,grid.4305.20000 0004 1936 7988TIBA Zimbabwe, NIHR Global Health Research Unit Tackling Infections To Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK ,grid.440812.bDepartment of Pathology, National University of Science and Technology (NUST) Medical School, Bulawayo, Zimbabwe
| | - Francisca Mutapi
- grid.4305.20000 0004 1936 7988Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Charlotte Auerbach Road, Edinburgh, EH9 3FL UK ,grid.4305.20000 0004 1936 7988NIHR Global Health Research Unit Tackling Infections To Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, UK
| |
Collapse
|
10
|
Kwizera R, Bongomin F, Olum R, Meya DB, Worodria W, Bwanga F, Fowler SJ, Gore R, Denning DW, Kirenga BJ. Fungal asthma among Ugandan adult asthmatics. Med Mycol 2021; 59:923-933. [PMID: 33945622 DOI: 10.1093/mmy/myab023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
Fungal sensitization is associated with poor asthma control. We aimed to determine the prevalence and factors associated with fungal asthma among Ugandan adults. Individuals aged ≥18 years with a new diagnosis of asthma in the last 12 months participating in the African Severe Asthma Program constituted the study population. Skin prick test results, clinical and demographic data were retrieved from the database, and serum Aspergillus fumigatus specific antibodies and total IgE were measured in stored blood. We enrolled 374 patients, median (IQR) age 34 (25-45) years, 286 (76.5%) females and 286 (76.5%) with severe asthma. Prevalence of Aspergillus fumigatus sensitization was 42.0% (95% CI: 37.1-47.0%), allergic bronchopulmonary aspergillosis (ABPA) 3.2% (1.8-5.5%), severe asthma with fungal sensitization (SAFS) 16% (12.7-20.1%) and allergic bronchopulmonary mycosis (ABPM) 2.9% (1.7-5.2%). Older age (55-64 years) (crude odds ratio (cOR) = 2.6), sensitization to at least one allergen (cOR = 9.38) and hypertension (cOR = 1.99) were significantly associated with Aspergillus sensitization, whereas tertiary education level (cOR = 0.29), severe depression (cOR = 0.15) and strong emotions (cOR = 0.47) were not. High occupational exposure to Aspergillus (cOR = 4.26) and contact with moulds (cOR = 14.28) were significantly associated with ABPA. Palpitations (cOR = 5.54), uncontrolled asthma (cOR = 3.54), eczema/dermatitis (cOR = 3.07), poor lung function (cOR = 2.11) and frequent exacerbations (cOR = 1.01) were significantly associated with SAFS. Eczema/dermatitis (cOR = 1.55) was significantly associated with ABPM, but cold weather trigger (cOR = 0.24) was not. Fungal asthma is a significant problem among Ugandans with asthma and should be particularly considered in individuals who remain uncontrolled despite optimal standard of care for asthma, as it is responsive to available and affordable oral antifungal therapy. LAY SUMMARY This study showed that fungal asthma is a significant problem among Ugandans with asthma with a high prevalence. Fungal asthma should be considered in patients with uncontrolled asthma despite receiving optimal standard of care. This is the first modern attempt to define these endotypes of asthma in Africa.
Collapse
Affiliation(s)
- Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda.,Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology, Faculty of Medicine, Gulu University, P.O. Box, 166, Gulu, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - David B Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - William Worodria
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.,Division of Pulmonology, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Freddie Bwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Stephen J Fowler
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Robin Gore
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Bruce J Kirenga
- Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.,Division of Pulmonology, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| |
Collapse
|
11
|
Bongomin F, Olum R, Nsenga L, Namusobya M, Russell L, de Sousa E, Osaigbovo II, Kwizera R, Baluku JB. Estimation of the burden of tinea capitis among children in Africa. Mycoses 2020; 64:349-363. [PMID: 33251631 DOI: 10.1111/myc.13221] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022]
Abstract
Tinea capitis is a common and endemic dermatophytosis among school age children in Africa. However, the true burden of the disease is unknown in Africa. We aimed to estimate the burden of tinea capitis among children <18 years of age in Africa. A systematic review was performed using Embase, MEDLINE and the Cochrane Library of Systematic Reviews to identify articles on tinea capitis among children in Africa published between January 1990 and October 2020. The United Nation's Population data (2019) were used to identify the number of children at risk of tinea capitis in each African country. Using the pooled prevalence, the country-specific and total burden of tinea capitis was calculated. Forty studies involving a total of 229,086 children from 17/54 African countries were identified and included in the analysis. The pooled prevalence of tinea capitis was 23% (95% CI, 17%-29%) mostly caused by Trichophyton species. With a population of 600 million (46%) children, the total number of cases of tinea capitis in Africa was estimated at 138.1 (95% CI, 102.0-174.1) million cases. Over 96% (132.6 million) cases occur in sub-Saharan Africa alone. Nigeria and Ethiopia with the highest population of children contributed 16.4% (n = 98.7 million) and 8.5% (n = 52.2 million) of cases, respectively. Majority of the participants were primary school children with a mean age of 10 years. Cases are mostly diagnosed clinically. There was a large discrepancy between the clinical and mycological diagnosis. About one in every five children in Africa has tinea capitis making it one of the most common childhood conditions in the region. A precise quantification of the burden of this neglected tropical disease is required to inform clinical and public health intervention strategies.
Collapse
Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lauryn Nsenga
- School of Medicine, Kabale University, Kabale, Uganda
| | - Martha Namusobya
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Laura Russell
- Medical Library, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma de Sousa
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Iriagbonse Iyabo Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | - Richard Kwizera
- Translational Research laboratory, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda.,Department of Programs, Mildmay Uganda, Wakiso, Uganda
| |
Collapse
|
12
|
[Mycoses and antifungals: What is the situation in Senegal in the current context?]. ANNALES PHARMACEUTIQUES FRANÇAISES 2020; 79:440-445. [PMID: 33232707 DOI: 10.1016/j.pharma.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
In the context of increasing incidence of fungal infections worldwide, the availability of antifungal drugs was studied in Senegal, a country with limited resources where diagnosis of invasive fungal infections is not often established by lack of specialists and/or diagnostic tools. After a background on the country's situation with regard to fungal infections and the drug distribution network in Senegal, a compilation of the various available antifungals was presented before concluding with recommendations to prepare for a situation that could allow to treat appropriately invasive mycoses.
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Pfavayi LT, Sibanda EN, Mutapi F. The Pathogenesis of Fungal-Related Diseases and Allergies in the African Population: The State of the Evidence and Knowledge Gaps. Int Arch Allergy Immunol 2020; 181:257-269. [PMID: 32069461 DOI: 10.1159/000506009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022] Open
Abstract
The prevalence of allergic diseases in the African continent has received limited attention with the allergic diseases due to fungal allergens being among the least studied. This lead to the opinion being that the prevalence of allergic disease is low in Africa. Recent reports from different African countries indicate that this is not the case as allergic conditions are common and some; particularly those due to fungal allergens are increasing in prevalence. Thus, there is need to understand both the aetiology and pathogenies of these diseases, particularly the neglected fungal allergic diseases. This review addresses currently available knowledge of fungal-induced allergy, disease pathogenesis comparing findings from human versus experimental mouse studies of fungal allergy. The review discusses the potential role of the gut mycobiome and the extent to which this is relevant to fungal allergy, diagnosis and human health.
Collapse
Affiliation(s)
- Lorraine Tsitsi Pfavayi
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Oxford, United Kingdom, .,Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom,
| | - Elopy Nimele Sibanda
- Asthma Allergy and Immunology Clinic, Twin Palms Medical Centre, Harare, Zimbabwe.,Department of Pathology, National University of Science and Technology Medical School, Bulawayo, Zimbabwe.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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.
Collapse
|
17
|
[Genome detection of dermatophytes : Current findings from the external quality assessment test]. Hautarzt 2019; 70:627-637. [PMID: 31165909 DOI: 10.1007/s00105-019-4435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In addition to morphological diagnostics, molecular methods have become available for the diagnosis of suspected dermatophytoses. Since March 2016, INSTAND e. V., in cooperation with the National Reference Laboratory for Dermatophytes, has provided an external quality assessment (EQA) test for the genome detection of dermatophytes twice a year. More than half of the participants used commercial kits for the analysis of the samples. All kits with a high level of accuracy correctly determined the presence of Trichophyton rubrum or no dermatophytes. In species diagnostics beyond Trichophyton rubrum there are large differences between the kits. These are examined in more detail based on clinical studies and the results of the EQA test.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Hassan MIA, Voigt K. Pathogenicity patterns of mucormycosis: epidemiology, interaction with immune cells and virulence factors. Med Mycol 2019; 57:S245-S256. [PMID: 30816980 PMCID: PMC6394756 DOI: 10.1093/mmy/myz011] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Abstract
Fungi of the basal lineage order Mucorales are able to cause infections in animals and humans. Mucormycosis is a well-known, life-threatening disease especially in patients with a compromised immune system. The rate of mortality and morbidity caused by mucormycosis has increased rapidly during the last decades, especially in developing countries. The systematic, phylogenetic, and epidemiological distributions of mucoralean fungi are addressed in relation to infection in immunocompromised patients. The review highlights the current achievements in (i) diagnostics and management of mucormycosis, (ii) the study of the interaction of Mucorales with cells of the innate immune system, (iii) the assessment of the virulence of Mucorales in vertebrate and invertebrate infection models, and (iv) the determination of virulence factors that are key players in the infection process, for example, high-affinity iron permease (FTR1), spore coat protein (CotH), alkaline Rhizopus protease enzyme (ARP), ADP-ribosylation factor (ARF), dihydrolipoyl dehydrogenase, calcineurin (CaN), serine and aspartate proteases (SAPs). The present mini-review attempts to increase the awareness of these difficult-to-manage fungal infections and to encourage research in the detection of ligands and receptors as potential diagnostic parameters and drug targets.
Collapse
Affiliation(s)
- Mohamed I Abdelwahab Hassan
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Adolf-Reichwein-Strasse 23, 07745 Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Faculty of Biological Sciences, University of Jena, Neugasse 25, 07743 Jena, Germany
- Pests and Plant Protection Department, National Research Centre, 33rd El Buhouth Street (Postal code: 12622) Dokki, Giza, Egypt
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Adolf-Reichwein-Strasse 23, 07745 Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Faculty of Biological Sciences, University of Jena, Neugasse 25, 07743 Jena, Germany
| |
Collapse
|
20
|
Oladele RO, Osaigbovo II, Ayanlowo OO, Otu AA, Hoenigl M, Cornely OA, Chakrabarti A, Denning DW. The role of medical mycology societies in combating invasive fungal infections in low- and middle-income countries: A Nigerian model. Mycoses 2018; 62:16-21. [PMID: 30184285 DOI: 10.1111/myc.12845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022]
Abstract
The discipline of medical mycology has become increasingly relevant in the face of the rising incidence of invasive fungal infections (IFI), which pose diagnostic and therapeutic challenges for contemporary medical practice. While firmly established in developed countries, medical mycology remains obscure in many low- and middle-income countries (LMICs). With a teeming vulnerable populace and an incidence rate of 11.8%, Nigeria has one of the highest estimated burdens of invasive fungal infections (IFIs) in the world. Regardless, the scourge of IFIs has remained silent due to a combination of factors principal amongst which are a lack of awareness and dearth in personnel skilled in diagnosis. The present narrative examines the status of medical mycology practice in Nigeria and chronicles the journey to change the status quo spurred by the Leading International Fungal Education (LIFE)-facilitated burden estimate paper and culminating in the birth of the Medical Mycology Society of Nigeria (MMSN), the pioneer national medical mycology society in Africa. The prospects of tackling the IFI challenge are highlighted from the perspective of the nascent society.
Collapse
Affiliation(s)
- Rita O Oladele
- Department of Medical Microbiology, College of Medicine, University of Lagos, Lagos, Nigeria.,Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Iriagbonse I Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | - Olusola O Ayanlowo
- Department of Internal Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Akaninyene A Otu
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.,National Aspergillosis Centre, Manchester Foundation University Trust, Manchester, UK
| | - Martin Hoenigl
- Section of Infectious Diseases & Division of Pulmonology, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, University of California San Diego, San Diego, California
| | - Oliver A Cornely
- Department of Internal Medicine, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Clinical Trials Centre Cologne (ZKS Köln), German Centre for Infection Research (DZIF), Partner Site Cologne-Bonn, University of Cologne, Cologne, Germany
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland.,National Aspergillosis Centre, Manchester Foundation University Trust, Manchester, UK
| |
Collapse
|
21
|
Ashu EE, Xu J. Strengthening the One Health Agenda: The Role of Molecular Epidemiology in Aspergillus Threat Management. Genes (Basel) 2018; 9:genes9070359. [PMID: 30029491 PMCID: PMC6071254 DOI: 10.3390/genes9070359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Abstract
The United Nations’ One Health initiative advocates the collaboration of multiple sectors within the global and local health authorities toward the goal of better public health management outcomes. The emerging global health threat posed by Aspergillus species is an example of a management challenge that would benefit from the One Health approach. In this paper, we explore the potential role of molecular epidemiology in Aspergillus threat management and strengthening of the One Health initiative. Effective management of Aspergillus at a public health level requires the development of rapid and accurate diagnostic tools to not only identify the infecting pathogen to species level, but also to the level of individual genotype, including drug susceptibility patterns. While a variety of molecular methods have been developed for Aspergillus diagnosis, their use at below-species level in clinical settings has been very limited, especially in resource-poor countries and regions. Here we provide a framework for Aspergillus threat management and describe how molecular epidemiology and experimental evolution methods could be used for predicting resistance through drug exposure. Our analyses highlight the need for standardization of loci and methods used for molecular diagnostics, and surveillance across Aspergillus species and geographic regions. Such standardization will enable comparisons at national and global levels and through the One Health approach, strengthen Aspergillus threat management efforts.
Collapse
Affiliation(s)
- Eta E Ashu
- Department of Biology, McMaster University, 1280 Main St. W, Hamilton, Ontario, ON L8S 4K1, Canada.
| | - Jianping Xu
- Department of Biology, McMaster University, 1280 Main St. W, Hamilton, Ontario, ON L8S 4K1, Canada.
- Public Research Laboratory, Hainan Medical University, Haikou, Hainan 571199, China.
| |
Collapse
|
22
|
Mandengue CE, Denning DW. The Burden of Serious Fungal Infections in Cameroon. J Fungi (Basel) 2018; 4:E44. [PMID: 29601494 PMCID: PMC6023387 DOI: 10.3390/jof4020044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 12/24/2022] Open
Abstract
Fungal infections are frequent in Cameroon, and invasive fungal infections are sometimes detected, usually in HIV-infected patients. For these reasons, we have estimated the burden of fungal infections. Using published literature and population estimates for the at-risk group, we used deterministic modelling to derive national incidence and prevalence estimates for the most serious fungal diseases. HIV infection is common and an estimated 120,000 have CD4 counts <200 × 10⁶/mL and commonly present with opportunistic infection. Oesophageal candidiasis in HIV is common, and in poorly controlled diabetics. We estimate 6720 cases of cryptococcal meningitis, 9000 of Pneumocystis pneumonia, 1800 of disseminated histoplasmosis annually complicating AIDS, and 1200 deaths from invasive aspergillosis in AIDS, but there are no data. We found that 2.4% of adults have chronic obstructive pulmonary disease (COPD) and 2.65% have asthma, with "fungal asthma" affecting 20,000. Chronic pulmonary aspergillosis probably affects about 5000 people, predominantly after tuberculosis but also with COPD and other lung diseases. Also, tinea capitis in schoolchildren is frequent. Overall, an estimated 1,235,775 people are affected by a serious fungal infection. There is an urgent need for government and clinician attention, improved laboratory facilities, fungal diagnostic tests, and competent laboratory technicians, as well as all World Health Organization (WHO)-endorsed essential antifungal drugs to be made available, as only fluconazole is registered and available in the country.
Collapse
Affiliation(s)
- Christine E Mandengue
- Department of Internal Medicine (Dermatology), Université des Montagnes, Bangangté P.O. Box 208, Cameroon (Central Africa).
| | - David W Denning
- National Aspergillosis Centre, Wythenshawe Hospital and The University of Manchester, Manchester M13 9PL, UK.
| |
Collapse
|
23
|
Abstract
Because of the limited access to more powerful diagnostic tools, there is a paucity of data regarding the burden of fungal infections in Burkina Faso. The aim of this study was to estimate the incidence and prevalence of serious fungal infections in this sub-Saharan country. We primarily used the national demographic data and performed a PubMed search to retrieve all published papers on fungal infections from Burkina Faso and its surrounding West African countries. Considering the prevalence of HIV infection (0.8% of the population) and a 3.4% incidence of cryptococcosis in hospitals, it is estimated that 459 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 1013 new cases occur every year. Taking into account the local TB frequency (population prevalence at 0.052%), we estimate the prevalence of chronic pulmonary aspergillosis at 1120 cases. Severe forms of asthma with fungal sensitization and allergic bronchopulmonary aspergillosis are estimated to affect 7429 and 5628 cases, respectively. Vulvovaginal candidiasis may affect 179,000 women, and almost 1,000,000 children may suffer from tinea capitis. Globally, we estimate that roughly 1.4 million people in Burkina Faso (7.51% of the population) suffer from a serious fungal infection. These data should be used to drive future epidemiological studies, diagnostic approaches, and therapeutic strategies.
Collapse
|
24
|
Wadi J, Denning DW. Burden of Serious Fungal Infections in Jordan. J Fungi (Basel) 2018; 4:E15. [PMID: 29371507 PMCID: PMC5872318 DOI: 10.3390/jof4010015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To estimate the burden of fungal infections in Jordan for the first time. MATERIAL AND METHODS Population data was from UN 2011 statistics and TB cases from WHO in 2012. Fewer than 100 patients with HIV were recorded in Jordan in 2013. Approximately 100 renal transplants and eight liver transplants are performed annually. There were 12,233 major surgical procedures in Jordan in 2013, of which 5.3% were major abdominal surgeries; candidemia was estimated in 5% of the population based on other countries, with 33% occurring in the ICU. Candida peritonitis/intra-abdominal candidiasis was estimated to affect 50% of the number of ICU candidemia cases. No adult asthma rates have been recorded for Jordan, so the rate from the Holy Land (8.54% clinical asthma) from To et al. has been used. There are an estimated 49,607 chronic obstructive pulmonary disease (COPD) patients in Jordan, with 64% symptomatic, 25% Gold stage 3% or 4%, and 7% (3472) are assumed to be admitted to hospital each year. No cystic fibrosis cases have been recorded. Literature searches on fungal infections revealed few data and no prevalence data on fungal keratitis or tinea capitis, even though tinea capitis comprised 34% of patients with dermatophytoses in Jordan. RESULTS Jordan has 6.3 million inhabitants (65% adults, 6% are >60 years old). The current burden of serious fungal infections in Jordan was estimated to affect ~119,000 patients (1.9%), not including any cutaneous fungal infections. Candidemia was estimated at 316 cases and invasive aspergillosis in leukemia, transplant, and COPD patients at 84 cases. Chronic pulmonary aspergillosis prevalence was estimated to affect 36 post-TB patients, and 175 in total. Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) prevalence in adults with asthma were estimated at 8900 and 11,748 patients. Recurrent vulvovaginal candidiasis was estimated to affect 97,804 patients, using a 6% rate among women 15-50 years of age. CONCLUSION Based on local data and literature estimates of the frequency of mycoses in susceptible populations, at least 1.9% of Jordanians have some form of serious fungal disease.
Collapse
Affiliation(s)
- Jamal Wadi
- The Medical Center, Jordan Hospital and Medical Center, 29 Adeeb Wahbeh Street, 11118 Amman, Jordan.
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M23 9LT, UK.
| |
Collapse
|
25
|
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: 1402] [Impact Index Per Article: 200.3] [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.
Collapse
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.
| |
Collapse
|
26
|
Vidya KM, Rao UK, Nittayananta W, Liu H, Owotade FJ. Oral mycoses and other opportunistic infections in HIV: therapy and emerging problems - a workshop report. Oral Dis 2017; 22 Suppl 1:158-65. [PMID: 27109283 DOI: 10.1111/odi.12437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Oral mycoses and other opportunistic infections are recognized features of HIV infection even after four decades of the epidemic. The therapeutic options, challenges of therapy, and evolving patterns of opportunistic infections were evaluated by the workshop. It was observed that high Candida counts and infection are still more prevalent in HIV-positive individuals even in the era of antiretroviral therapy. Furthermore, one or more non-Candida albicans are present in some HIV-positive individuals. While Candida species are more virulent in HIV infection, similar virulence may be present in other states of immunosuppression. Consequently, the interplay between host factors and virulence ultimately determines the clinical outcomes. Adverse clinical outcomes such as candidemia and other deep fungal infections are on the increase in HIV infection. Disseminated histoplasmosis and penicilliosis have been reported, especially with low CD4 counts. Even with advances in antifungal therapy, mortality and morbidity from deep fungal infections have not changed significantly. In addition, long-term exposure to common antifungal drugs such as fluconazole has led to the development of antifungal resistance in 6% to 36%. Development of new antifungal therapeutic agents and the use of alternative therapies may offer breakthrough. In addition, effective strategies to enhance the host immune status are being explored.
Collapse
Affiliation(s)
- K M Vidya
- Department of Oral and Maxillofacial Pathology and Microbiology, Sathyabama University Dental College, Sathyabama University, Chennai, India
| | - U K Rao
- Ragas Dental College and Hospital, Chennai, India
| | - W Nittayananta
- Excellent Research Laboratory, Phytomedicine and Pharmaceutical Biotechnology Excellence Center, Hat Yai, Songkhla, Thailand.,Natural Products Research Center of Excellence, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, Thailand.,Graduate School, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - H Liu
- Department of Oral Medicine and Traditional Chinese Medicine, Peking University School of Stomatology, Haidian District, Beijing, China
| | - F J Owotade
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
27
|
Hayes GE, Novak-Frazer L. Chronic Pulmonary Aspergillosis-Where Are We? and Where Are We Going? J Fungi (Basel) 2016; 2:jof2020018. [PMID: 29376935 PMCID: PMC5753080 DOI: 10.3390/jof2020018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/19/2016] [Accepted: 06/01/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic pulmonary aspergillosis (CPA) is estimated to affect 3 million people worldwide making it an under recognised, but significant health problem across the globe, conferring significant morbidity and mortality. With variable disease forms, high levels of associated respiratory co-morbidity, limited therapeutic options and prolonged treatment strategies, CPA is a challenging disease for both patients and healthcare professionals. CPA can mimic smear-negative tuberculosis (TB), pulmonary histoplasmosis or coccidioidomycosis. Cultures for Aspergillus are usually negative, however, the detection of Aspergillus IgG is a simple and sensitive test widely used in diagnosis. When a fungal ball/aspergilloma is visible radiologically, the diagnosis has been made late. Sometimes weight loss and fatigue are predominant symptoms; pyrexia is rare. Despite the efforts of the mycology community, and significant strides being taken in optimising the care of these patients, much remains to be learnt about this patient population, the disease itself and the best use of available therapies, with the development of new therapies being a key priority. Here, current knowledge and practices are reviewed, and areas of research priority highlighted.
Collapse
Affiliation(s)
- Gemma E Hayes
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK.
- Manchester Academic Health Science Centre, 46 Grafton Street, Manchester M13 9NT, UK.
- National Aspergillosis Centre, 2nd Floor Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
| | - Lilyann Novak-Frazer
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK.
- Manchester Academic Health Science Centre, 46 Grafton Street, Manchester M13 9NT, UK.
- The University of Manchester, Manchester Academic Health Science Centre, 2nd Floor Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
- Mycology Reference Centre, Manchester, 2nd Floor Education and Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
| |
Collapse
|