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McMullan B, Kim HY, Alastruey-Izquierdo A, Tacconelli E, Dao A, Oladele R, Tanti D, Govender NP, Shin JH, Heim J, Ford NP, Huttner B, Galas M, Nahrgang SA, Gigante V, Sati H, Alffenaar JW, Morrissey CO, Beardsley J. Features and global impact of invasive fungal infections caused by Pneumocystis jirovecii: A systematic review to inform the World Health Organization fungal priority pathogens list. Med Mycol 2024; 62:myae038. [PMID: 38935910 PMCID: PMC11210620 DOI: 10.1093/mmy/myae038] [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: 09/11/2023] [Revised: 02/15/2024] [Accepted: 04/27/2024] [Indexed: 06/29/2024] Open
Abstract
This systematic review evaluates the current global impact of invasive infections caused by Pneumocystis jirovecii (principally pneumonia: PJP), and was carried out to inform the World Health Organization Fungal Priority Pathogens List. PubMed and Web of Science were used to find studies reporting mortality, inpatient care, complications/sequelae, antifungal susceptibility/resistance, preventability, annual incidence, global distribution, and emergence in the past 10 years, published from January 2011 to February 2021. Reported mortality is highly variable, depending on the patient population: In studies of persons with HIV, mortality was reported at 5%-30%, while in studies of persons without HIV, mortality ranged from 4% to 76%. Risk factors for disease principally include immunosuppression from HIV, but other types of immunosuppression are increasingly recognised, including solid organ and haematopoietic stem cell transplantation, autoimmune and inflammatory disease, and chemotherapy for cancer. Although prophylaxis is available and generally effective, burdensome side effects may lead to discontinuation. After a period of decline associated with improvement in access to HIV treatment, new risk groups of immunosuppressed patients with PJP are increasingly identified, including solid organ transplant patients.
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Affiliation(s)
- Brendan McMullan
- Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Hannah Yejin Kim
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Western Sydney LHD, North Parramatta, New South Wales, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Evelina Tacconelli
- Department of Diagnostics and Public Health, Verona University, Verona, Italy
| | - Aiken Dao
- Sydney Infectious Diseases Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Hospital, Western Sydney LHD, North Parramatta, New South Wales, Australia
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Daniel Tanti
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Sydney, New South Wales, Australia
- Discipline of Paediatrics, Faculty of Medicine and Health, University of NSW, Sydney, Australia
| | - Nelesh P Govender
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Infection and Immunity, St George’s University of London, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Jong-Hee Shin
- Department of Laboratory Medicine, Chonnam National University School of Medicine, Gwangju, South Korea
| | - Jutta Heim
- Scientific Advisory Committee, Helmholtz Centre for Infection Research, Germany
| | - Nathan Paul Ford
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Marcelo Galas
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washingdom, District of Columbia, USA
| | - Saskia Andrea Nahrgang
- Antimicrobial Resistance Programme, World Health Organization European Office, Copenhagen, Denmark
| | | | | | - Jan Willem Alffenaar
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Western Sydney LHD, North Parramatta, New South Wales, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Monash University, Clayton, Victoria, Australia
| | - Justin Beardsley
- Sydney Infectious Diseases Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Hospital, Western Sydney LHD, North Parramatta, New South Wales, Australia
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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.
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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
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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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Zono Bive B, Kasumba DM, Situakibanza Nani-Tuma H, Bepouka Izizag B, Yambayamba Kapenga M, Nsuka Yanga R, Tshimanga Yona T, Kamangu Ntambwe E, Hayette MP, Mvumbi Lelo G. Cryptococcosis in the Democratic Republic of Congo from 1953 to 2021: a systematic review and meta-analysis. Mycoses 2022; 65:580-589. [PMID: 35363896 DOI: 10.1111/myc.13440] [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: 01/04/2022] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 12/07/2022]
Abstract
Cryptococcosis is a common opportunistic infection associated with HIV/AIDS. The present review systematically describes the clinical and biological aspects of cryptococcosis in the Democratic Republic of Congo (DRC) and estimates its 2020 burden in people living with HIV (PLHIV). Following PRISMA guidelines, we searched online databases for records of cryptococcosis/Cryptococcus spp. in the DRC. Meta-analysis was then performed to estimate summary statistics and the corresponding 95% confidence intervals (CI). A total of 30 studies were included. These included 1,018 cryptococcosis patients, including 80.8% with NMC and predominantly immunocompromised due to HIV/AIDS (97.6%). The NMC mean prevalence was estimated at 9.63% (95% CI: 5.99-14.07). More than one in two patients (52.7%) under treatment died. Monotherapy with fluconazole was the main treatment administered (80.6%). Furthermore, we estimate that about 9,265 (95% CI: 5,763-13,537) PLHIV had cryptococcosis in 2020, in DRC; of which about 4,883 (95% CI: 3,037-7,134) would have died in the same year. Among isolates in all included studies, 74 strains have been characterized. Of these, 82.4% concerned Cryptococcus neoformans sensu lato (s.l) (exclusively of serotype A and mostly of molecular types VNI and VNII) and 17.6% concerned Cryptotoccus gattii s.l (belonging to serotype B and molecular type VGI). Cryptococcosis remains common with an unacceptably high mortality rate. A large number of PLHIV affected by and dying from cryptococcosis in 2020 demonstrates its heavy burden among the Congolese PLHIV. To mitigate this burden, it is important to improve the quality and accessibility of care for all PLHIV.
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Affiliation(s)
- Bive Zono Bive
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo.,Department of Clinical Microbiology, National Reference Center for Mycosis, Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
| | - Dacquin Muhandwa Kasumba
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo
| | - Hippolyte Situakibanza Nani-Tuma
- Department of Internal Medicine/Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo
| | - Ben Bepouka Izizag
- Department of Internal Medicine/Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo
| | - Marc Yambayamba Kapenga
- Department of Epidemiology and Biostatistics, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, the Democratic Republic of Congo
| | - Ruth Nsuka Yanga
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo
| | - Tshimy Tshimanga Yona
- Department of Medical Biology, Higher Institute of Medical Techniques-Kinshasa, Kinshasa, the Democratic Republic of Congo
| | - Erick Kamangu Ntambwe
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo
| | - Marie-Pierre Hayette
- Department of Clinical Microbiology, National Reference Center for Mycosis, Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
| | - Georges Mvumbi Lelo
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of Congo
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The fight against mycoses in Africa: are we making progress? Clin Microbiol Infect 2021; 28:9-12. [PMID: 34537360 DOI: 10.1016/j.cmi.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/30/2021] [Accepted: 09/05/2021] [Indexed: 11/27/2022]
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Kamwiziku GK, Makangara JCC, Orefuwa E, Denning DW. Serious fungal diseases in Democratic Republic of Congo - Incidence and prevalence estimates. Mycoses 2021; 64:1159-1169. [PMID: 34133799 DOI: 10.1111/myc.13339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
A literature review was conducted to assess the burden of serious fungal infections in the Democratic Republic of the Congo (DRC) (population 95,326,000). English and French publications were listed and analysed using PubMed/Medline, Google Scholar and the African Journals database. Publication dates spanning 1943-2020 were included in the scope of the review. From the analysis of published articles, we estimate a total of about 5,177,000 people (5.4%) suffer from serious fungal infections in the DRC annually. The incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia in adults and invasive aspergillosis in AIDS patients was estimated at 6168, 2800 and 380 cases per year. Oral and oesophageal candidiasis represent 50,470 and 28,800 HIV-infected patients respectively. Chronic pulmonary aspergillosis post-tuberculosis incidence and prevalence was estimated to be 54,700. Fungal asthma (allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization) probably has a prevalence of 88,800 and 117,200. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 1,202,640 and 3,551,900 respectively.Further work is required to provide additional studies on opportunistic infections for improving diagnosis and the implementation of a national surveillance programme of fungal disease in the DRC.
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Affiliation(s)
- Guyguy K Kamwiziku
- Department of Microbiology, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Claude C Makangara
- Department of Microbiology, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Emma Orefuwa
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland.,Manchester Fungal Infection Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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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.
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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
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