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Deng R, Chen X, Zheng D, Xiao Y, Dong B, Cao C, Ma L, Tong Z, Zhu M, Liu Z, Lu S, Fu M, Jin Y, Yin B, Li F, Li X, Abliz P, Liu H, Zhang Y, Yu N, Wu W, Xiong X, Zeng J, Huang H, Jiang Y, Chen G, Pan W, Sang H, Wang Y, Guo Y, Shi D, Yang J, Ran Y, Hu J, Yang L, Bai S, Yu J, Wang X, Li R. Epidemiologic features and therapeutic strategies of kerion: A nationwide multicentre study. Mycoses 2024; 67:e13751. [PMID: 38825584 DOI: 10.1111/myc.13751] [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: 02/20/2024] [Revised: 04/13/2024] [Accepted: 05/26/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Kerion is a severe type of tinea capitis that is difficult to treat and remains a public health problem. OBJECTIVES To evaluate the epidemiologic features and efficacy of different treatment schemes from real-world experience. METHODS From 2019 to 2021, 316 patients diagnosed with kerion at 32 tertiary Chinese hospitals were enrolled. We analysed the data of each patient, including clinical characteristics, causative pathogens, treatments and outcomes. RESULTS Preschool children were predominantly affected and were more likely to have zoophilic infection. The most common pathogen in China was Microsporum canis. Atopic dermatitis (AD), animal contact, endothrix infection and geophilic pathogens were linked with kerion occurrence. In terms of treatment, itraconazole was the most applied antifungal agent and reduced the time to mycological cure. A total of 22.5% of patients received systemic glucocorticoids simultaneously, which reduced the time to complete symptom relief. Furthermore, glucocorticoids combined with itraconazole had better treatment efficacy, with a higher rate and shorter time to achieving mycological cure. CONCLUSIONS Kerion often affects preschoolers and leads to serious sequelae, with AD, animal contact, and endothrix infection as potential risk factors. Glucocorticoids, especially those combined with itraconazole, had better treatment efficacy.
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Affiliation(s)
- Ruixin Deng
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xiaoqing Chen
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Dongyan Zheng
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuanyuan Xiao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Bilin Dong
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
| | - Cunwei Cao
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhongsheng Tong
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
| | - Min Zhu
- Department of Dermatology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zehu Liu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meng Fu
- Department of Dermatology, Xijing Hospital, Xi'an, China
| | - Yun Jin
- Department of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, China
| | - Bin Yin
- Department of Dermatology, Chengdu Second People's Hospital, Chengdu, China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China
| | - Xiaofang Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Palida Abliz
- Department of Dermatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hongfang Liu
- Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Nan Yu
- Department of Dermatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Weiwei Wu
- Department of Dermatology, The Fifth People's Hospital of Hainan Province, Haikou, China
| | - Xincai Xiong
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingsi Zeng
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaiqiu Huang
- Department of Dermatology and Venereology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanping Jiang
- Department of Dermatology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guanzhi Chen
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weihua Pan
- Department of Dermatology, Shanghai Changzheng Hospital, Naval Military Medical University, Shanghai, China
| | - Hong Sang
- Department of Dermatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ying Wang
- Department of Dermatology, Changhai Hospital of Shanghai, Shanghai, China
| | - Yun Guo
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dongmei Shi
- Department of Dermatology, Jining First People's Hospital, Jining, China
| | - Jianxun Yang
- Department of Dermatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuping Ran
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Hu
- Department of Dermatology, The Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | | | - Shuang Bai
- The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, China
| | - Jin Yu
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xiaowen Wang
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
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Bongomin F, Kwizera R, Namusobya M, van Rhijn N, Andia-Biraro I, Kirenga BJ, Meya DB, Denning DW. Re-estimation of the burden of serious fungal diseases in Uganda. Ther Adv Infect Dis 2024; 11:20499361241228345. [PMID: 38328511 PMCID: PMC10848809 DOI: 10.1177/20499361241228345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
Background It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. Objective We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Methods Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. Results With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Conclusion Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Kwizera
- Infectious Diseases Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Namusobya
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Norman van Rhijn
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Bruce J. Kirenga
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David W. Denning
- Manchester Fungal Infection Group, CTF Building, The University of Manchester, Grafton Street, Manchester M13 9NT, UK
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Ali AI, Aden AI, Mohamud AK. Dermoscopic findings in Tinea Capitis among under 18 children in dermatology polyclinic patients: a hospital-based cross-sectional study. Ann Med Surg (Lond) 2024; 86:121-126. [PMID: 38222710 PMCID: PMC10783287 DOI: 10.1097/ms9.0000000000001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/11/2023] [Indexed: 01/16/2024] Open
Abstract
Background Tinea capitis is a fungal infection that affects the scalp. It is caused by a group of fungi known as dermatophytes, which thrive in warm and moist environments. In Somalia, there is a data shortage regarding dermatological conditions, especially in Mogadishu, the most populous city in the country. Tinea capitis has gone unreported despite its high prevalence in Somali dermatology clinics and the Somali diaspora in Western countries. The absence of up-to-date information hampers the capability to diagnose, treat, and prevent Tinea capitis. Therefore, the study aims to evaluate dermoscopic signs about isolated organisms and potassium hydroxide (KOH) examination. Method A hospital-based cross-sectional study was implemented between January and April 2023 in Mogadishu, Somalia. All eligible Tinea capitis-infected children were included in the study. Microscopically, analysis was conducted by adding 10% of KOH in fungal elements. Data were analyzed using descriptive statistics and the χ2 test at P value less than 0.05. Results A total of 76 tinea capitis-infected children participated in the study; 56% were age group between 5-9 years old, 68.4% were male, and 92.1% showed KOH positivity. Trichophyton violaceum (65.8%) and Trichophyton sudanense (14.5%) were the most common fungal organisms detected in the culture. comma hairs (93.10%), scales (40.80%), and corkscrews (32.90%) were the most common dermoscopic signs of tinea capitis. The demographical characteristics and dermoscopic signs of tinea capitis significantly associated with the positivity of KOH examination were age, sex, comma hairs, corkscrew hairs, broken hair, Scales, and Zigzag hair. Conclusion Children in Mogadishu, Somalia, bear a significant burden of Tinea Capitis infections. Trichophyton violaceum and Trichophyton sudanense were the predominant causative agents identified in the cultures. The most common dermoscopic signs of tinea capitis observed in this study were comma hairs, scales, and corkscrew patterns. Hence, early diagnosis of Tinea Capitis infections and timely, effective treatments with contact tracing are highly needed.
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Affiliation(s)
- Ahmed Isse Ali
- Department of Dermatology, Mogadishu-Somali Turkey Training and Research Hospital
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Deng R, Wang X, Li R. Dermatophyte infection: from fungal pathogenicity to host immune responses. Front Immunol 2023; 14:1285887. [PMID: 38022599 PMCID: PMC10652793 DOI: 10.3389/fimmu.2023.1285887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Dermatophytosis is a common superficial infection caused by dermatophytes, a group of pathogenic keratinophilic fungi. Apart from invasion against skin barrier, host immune responses to dermatophytes could also lead to pathologic inflammation and tissue damage to some extent. Therefore, it is of great help to understand the pathogenesis of dermatophytes, including fungal virulence factors and anti-pathogen immune responses. This review aims to summarize the recent advances in host-fungal interactions, focusing on the mechanisms of anti-fungal immunity and the relationship between immune deficiency and chronic dermatophytosis, in order to facilitate novel diagnostic and therapeutic approaches to improve the outcomes of these patients.
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Affiliation(s)
- Ruixin Deng
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xiaowen Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
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Majeed A, Mahmood S, Tahir AH, Ahmad M, Shabbir MAB, Ahmad W, Iqbal A, Mushtaq RMZ, Aroosa S, Ahmed HS, Rasool N, Ramish W. Patterns of Common Dermatological Conditions among Children and Adolescents in Pakistan. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1905. [PMID: 38003954 PMCID: PMC10673470 DOI: 10.3390/medicina59111905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Dermatological disorders are highly prevalent among children in Pakistan. The present cross-sectional study aims to identify the spectrum of dermatological conditions among children and adolescents in Pakistan. Materials and Methods: A total of 582 patients (50.9% males; 49.1% females) were included in the study based on their age (5.7 ± 4.1 years), dermatological condition, and epidemiology. The youngest patient was aged ten days, whereas the eldest was seventeen. Age criteria were further stratified into three categories: infants and toddlers (≤5 years), children (≥5 to <12 years), and adolescents (≥12 to <18 years). Amongst them, the majority was from Punjab (81.6%), while the other regions included were Azad Jammu and Kashmir (14.4%), Islamabad (3.3%), and Khyber Pakhtunkhwa (0.7%). Results: Scabies was the highest reported skin condition with 281 (45.55%) patients, followed by 114 (19.6%) with eczema, 60 (10.3%) with dermatitis, 33 (5.7%) with tinea capitis, 17 (2.9%) with tinea corporis, 16 (2.7%) with impetigo, and 15 (2.6%) with folliculitis. Other conditions include urticaria, burns, infections, pediculosis, tinea inguinalis, tinea faciei, nappy rashes, alopecia, warts, tinea incognito, tinea cruris, and acne vulgaris. The chi-squared test showed a high prevalence of tinea corporis and acne among adolescents (12-17 years), whereas eczema, dermatitis, and impetigo were more prevalent among infants and toddlers. Conclusions: Pets or livestock and poor hygiene were found to be highly reported risk factors for many dermatological conditions like scabies and fungal infections. Dermatological conditions are common in younger individuals, but unfortunately, many children do not receive the desired medical assistance.
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Affiliation(s)
- Arfa Majeed
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Sammina Mahmood
- Department of Botany, Division of Science and Technology, Bank Road Campus, University of Education, Lahore 54000, Pakistan
| | - Adnan Hassan Tahir
- Department of Clinical Sciences, Faculty of Veterinary and Animal Sciences, PMAS—Arid Agriculture University, Rawalpindi 46300, Pakistan
| | - Mehmood Ahmad
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
- Department of Pharmacology and Toxicology, Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan
| | | | - Waqas Ahmad
- Department of Pathology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Asif Iqbal
- Department of Parasitology, Riphah International University, Lahore 54000, Pakistan
| | | | - Sadaf Aroosa
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Hafiz Saleet Ahmed
- Department of Livestock Management, Faculty of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan
| | - Naeem Rasool
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Wajeeha Ramish
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
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Song G, Zhang M, Kong X, Liu W, Liang G. Tinea Capitis in Children Younger than Two Years Old: A Retrospective Study and Treatment Recommendations. Mycopathologia 2023; 188:461-478. [PMID: 36581775 DOI: 10.1007/s11046-022-00703-z] [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: 07/29/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Tinea capitis (TC) is a dermatophytosis of the scalp and hair, which occurs less common in children younger than two years of age, and the data of TC in this age group are still unknown. OBJECTIVES We aimed to reveal the epidemiological, clinical and mycological characteristics of TC in children under two years old. METHODS We retrospectively analyzed all reported cases of TC in children in their first two years of life from 1991 to 2022, by searching PubMed, Embase, Web of Science, CNKI, Wanfang and Weipu databases. RESULTS A total of 47 articles involving 126 cases of pediatric TC were enrolled in this study. The sex ratio (M/F) was 1.28:1. The age of the children ranged from ten days old to two years old with a median age of three months. The main clinical manifestations were alopecic patches (40 cases, 31.7%) and scaling (39 cases, 31.0%) on the scalp, and 29 infants (23.0%) appeared kerion. The most common sources of contagion were animals (35 cases, 27.78%) and humans (31 cases, 24.60%). The leading pathogens were Microsporidium canis (64 cases, 50.79%), followed by Trichophyton violaceum (13 cases, 10.32%), T. mentagrophytes complex (12 cases, 9.52%) and T. tonsurans (10 cases, 7.94%). Ninety-five children (75.40%) were treated with systemic antifungal drugs and 22 patients (17.46%) were only treated with topical therapy. Except for 10 patients with unknown final prognosis, all the other cases were cured after treatment. There was one child (0.79%) relapsed after treatment with griseofulvin and one case (0.79%) presented with gastrointestinal symptoms from griseofulvin. CONCLUSION The principal clinical symptoms of TC in children less than two years old were alopecic patches and scaling. The top four pathogens were M. canis, T. violaceum, T. mentagrophytes complex and T. tonsurans. Oral treatment for pediatric TC had achieved good therapeutic effects, and topical therapy can be an alternative choice.
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Affiliation(s)
- Ge Song
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Meijie Zhang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Xue Kong
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Nanjing, 210042, China.
- CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
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7
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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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8
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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: 0] [Impact Index Per Article: 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.
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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
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Ahmed SA, Ismail M, Albirair M, Nail AMA, Denning DW. Fungal infections in Sudan: An underestimated health problem. PLoS Negl Trop Dis 2023; 17:e0011464. [PMID: 37656764 PMCID: PMC10501601 DOI: 10.1371/journal.pntd.0011464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/14/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.
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Affiliation(s)
- Sarah A. Ahmed
- Center of Expertise in Mycology Radboudumc / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Mawahib Ismail
- Mycology Reference laboratory, faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed Albirair
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington State, United States of America
| | - Abdelsalam Mohamed Ahmed Nail
- Tropical Diseases Teaching Hospital, Khartoum, Sudan
- Department of Internal Medicine, Faculty of Medicine and Health Sciences (OIU), Khartoum, Sudan
| | - David W. Denning
- Manchester Fungal Infection Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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10
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Birhanu MY, Temesgen H, ketema DB, Desta M, Getaneh T, Bekele GM, Zeleke B, Jemberie SS. Tinea capitis among schoolchildren in Ethiopia: A systematic review and meta analysis. PLoS One 2023; 18:e0280948. [PMID: 36763601 PMCID: PMC9916598 DOI: 10.1371/journal.pone.0280948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Tinea capitis accounts for25 to 30% of all fungal infections, but it is often ignored because it is not life threatening in nature. It is more common among schoolchildren particularly in developing countries. Due to the presence of significant variability among the previous studies, this study was conducted to provide a pooled prevalence and associated factors of tinea capitis in Ethiopian schoolchildren. METHOD We conducted a systematic search in five major databases for articles similar to our topic. This review included school-based cross-sectional studies that were reported in English and conducted from 2006 through 2022. The data were extracted using Microsoft Excel and further analysis was done using StataTM Version 17.0 statistical software. Forest plots were used to assess the presence of heterogeneity with 95% confidence intervals. A random effects meta- analysis model was used to pool primary estimates. To declare the presence or absence of association, 95% confidence interval with odds ratio was used. RESULTS Fourteen studies with a total of 9465 schoolchildren were included. The pooled prevalence was 29.03% (95%CI: 15.37-42.71). There was observed heterogeneity, which could be explained by publication bias (P = 0.04). Family history of tinea capitis (OR: 9.18, 95%CI: 3.5-24.02), under the age of 10 years (OR: 1.65, 95%CI: 1.17-2.33) were factors increasing the development of tinea capitis among schoolchildren and schoolchildren who had hair wash at least once a week (OR: 0.31, 95%CI: 0.24-0.42) was significantly associated with reduced risk for tinea capitis. CONCLUSION One of the most prevalent childhood health condition in Ethiopia is tinea capitis, which affects over one in every four schoolchildren. Schoolchildren who had family history of tinea capitis and under the age of 10 years were the identified risk factors but they had hair wash at least once a week was the protective factor of tinea capitis among schoolchildren. Clinical and public engagement activities are needed to overcome the burden of the disease.
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Affiliation(s)
- Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Habtamu Temesgen
- Department of Human Nutrition and Food Science, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Daniel Bekele ketema
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Melaku Desta
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Temesgen Getaneh
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Getamesay Molla Bekele
- Department of Gynecology and Obstetric, School of Medicine, Debre Markos university, Debre Markos, Ethiopia
| | - Balew Zeleke
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Selamawit Shita Jemberie
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Abstract
The burden of fungal infections has been on the rise globally and remains a significant public health concern in Kenya. We estimated the incidence and prevalence of fungal infections using all mycology publications in Kenya up to January 2023, and from neighbouring countries where data lacked. We used deterministic modelling using populations at risk to calculate the disease burden. The total burden of serious fungal infections is estimated to affect 6,328,294 persons which translates to 11.57% of the Kenyan population. Those suffering from chronic infections such as chronic pulmonary aspergillosis are estimated to be 100,570 people (0.2% of the population) and probably nearly 200,000 with fungal asthma, all treatable with oral antifungal therapy. Serious acute fungal infections secondary to HIV (cryptococcal meningitis, disseminated histoplasmosis, pneumocystis pneumonia, and mucosal candidiasis) affect 196,543 adults and children (0.4% of the total population), while cancer-related invasive fungal infection cases probably exceed 2,299 and those in intensive care about 1,230 incident cases, including Candida auris bloodstream infection. The burden of fungal infections in Kenya is high; however, limited diagnostic test availability, low clinician awareness and inadequate laboratory capacity constrain the country's health system in responding to the syndemic of fungal disease in Kenya.
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Affiliation(s)
- Stanley N. Ratemo
- Research Department, Kisii Teaching and Referral Hospital, Kisii, Kenya
- CONTACT Stanley N. Ratemo
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Global Action for Fungal Infections (GAFFI), Geneva, Switzerland
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12
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Werkneh S, Orefuwa E, Denning DW. Current situation of fungal diseases in Eritrea. Mycoses 2022; 65:806-814. [PMID: 35633079 PMCID: PMC9545796 DOI: 10.1111/myc.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
The epidemiology of fungal infections in Eritrea is unknown. Most cases are under‐reported due to a lack of diagnostics. This study estimates the burden of serious fungal infections and highlights treatment and diagnostic gaps in the country. All publications related to fungal infections were identified by searches using PubMed/Medline and Google Scholar. Where no data were available, data from neighbouring countries, then sub‐Saharan African countries, then other parts of the world were considered for deriving estimates. The Eritrea population was 3,546,427 in 2020. In 2020, HIV/AIDS patients numbered 1400 and TB incidence were 2875. The five‐year adult prevalence of asthma (2016–2020) was 41,390, and the total prevalence estimate of chronic obstructive pulmonary disease (COPD) was 308,328. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in AIDS patients was estimated at 96 and 205 cases. Oesophageal candidiasis incidence is 715 HIV‐infected patients. Chronic pulmonary aspergillosis prevalence, including post‐tuberculosis cases, was estimated at 1399 (39/100,000). Fungal asthma has a prevalence of 1035 and 1366 in adults. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 59,391 and 342,585, respectively. There are no data on candidaemia, but it is estimated at 5/100,000 (177 cases annually). Invasive aspergillosis in leukaemia, lung cancer, COPD and HIV is estimated at 540 cases and fungal keratitis in 514 cases annually. Serious fungal infections are prevalent in Eritrea with approximately 408,164 people (11.5%) affected annually. Studies on fungal diseases to improve diagnosis and treatment are required with the implementation of a national surveillance program.
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Affiliation(s)
- Sara Werkneh
- Global Action For Fungal Infections, Geneva, Switzerland
| | - Emma Orefuwa
- Global Action For Fungal Infections, Geneva, Switzerland
| | - David W Denning
- Global Action For Fungal Infections, Geneva, Switzerland.,Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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13
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Drerup KA, Brasch J. Tinea capitis bei Kindern – ein buntes Krankheitsbild. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungBei der Tinea capitis (TC) handelt es sich um eine Infektion der behaarten Kopfhaut durch Dermatophyten, ganz überwiegend durch anthropophile und zoophile Arten. Hauptsächlich sind Kinder betroffen. Die Inzidenz der TC nimmt in Deutschland aktuell aufgrund verschiedener Ursachen zu, wie z. B. der Migrationsbewegung aus Afrika und Reisen. Auch das Erregerspektrum verändert sich. Da das klinische Bild einer TC sehr unterschiedlich sein kann, sind initiale Fehldiagnosen häufig. Um diagnostische Irrtümer und unwirksame Therapieversuche zu vermeiden, sollten Pädiater:innen mit allen Aspekten der TC vertraut sein. Dazu werden die Klinik sowie die Erreger der TC erläutert; des Weiteren werden die Diagnostik sowie leitliniengerechte Therapie der TC dargestellt. Darüber hinaus werden Maßnahmen zur Verhinderung von Reinfektionen oder Infektionen anderer Kinder erklärt.
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14
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Bongomin F, Kibone W, Okot J, Nsenga L, Olum R, Baluku JB. Fungal diseases in Africa: epidemiologic, diagnostic and therapeutic advances. Ther Adv Infect Dis 2022; 9:20499361221081441. [PMID: 35281765 PMCID: PMC8905202 DOI: 10.1177/20499361221081441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
- Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, Uganda
| | - Winnie Kibone
- School of Medicine, Makerere University, Kampala, Uganda
| | - Jerom Okot
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Lauryn Nsenga
- School of Medicine, Kabale University, Kabale, Uganda
| | - Ronald Olum
- Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, UgandaSchool of Medicine, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Non-communicable and Infectious Diseases Research (NIDER) Platform, Kampala, Uganda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda; Makerere University Lung Institute, Kampala, Uganda
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15
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The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey. THE LANCET MICROBE 2022; 3:e464-e470. [DOI: 10.1016/s2666-5247(21)00190-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/12/2021] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
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Amare HH, Lindtjorn B. Risk factors for scabies, tungiasis, and tinea infections among schoolchildren in southern Ethiopia: A cross-sectional Bayesian multilevel model. PLoS Negl Trop Dis 2021; 15:e0009816. [PMID: 34613968 PMCID: PMC8494366 DOI: 10.1371/journal.pntd.0009816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background Skin problems cause significant sickness in communities with poor living conditions, but they have received less attention in national or global health studies because of their low mortality rates. In many developing regions, the prevalence of parasitic skin diseases among schoolchildren is not reported. Previous studies thus have attempted to identify risk factors for these conditions using the frequentist approach. This study aimed to assess the occurrence and risk factors of skin infections among rural schoolchildren in southern Ethiopia by combining a frequentist and a Bayesian approach. Methodology/Principal findings Using three-stage random sampling, we assessed 864 schoolchildren aged 7–14 years from the Wonago district in southern Ethiopia. We detected potential risk factors for scabies, tungiasis, and tinea infections and recorded their hygienic practices and socio-demographic information. The frequentist model revealed a clustering effect of 8.8% at the classroom level and an insignificant effect at the school level. The Bayesian model revealed a clustering effect of 16% at the classroom level and 5.3% at the school level. Almost three-fourths of the sample had at least one type of skin problem, and boys were at higher overall risk than girls (adjusted odds ratio [aOR] 1.55 [95% Bayesian credible interval [BCI] 1.01, 2.28). Risk factors included unclean fingernails (aOR 1.85 [95% BCI 1.08, 2.97]); not washing the body (aOR 1.90 [95% BCI 1.21, 2.85]) and hair (aOR 3.07 [95% BCI 1.98, 4.57]) with soap every week; sharing a bed (aOR 1.97 [95% BCI 1.27, 2.89]), clothes (aOR 5.65 [95% BCI 3.31, 9.21]), or combs (aOR 3.65 [95% BCI 2.28, 5.53]); and living in a poor household (aOR 1.76 [95% BCI 1.03, 2.83]). Washing legs and feet with soap daily was identified as a protective factor for each of the three skin diseases (aOR 0.23 [95% BCI 0.15, 0.33]). Conclusions/Significance We observed high variation in skin problems at the classroom level, indicating the presence of shared risk factors in these locations. The findings suggest the need to improve children’s personal hygiene via health education by schoolteachers and health workers. Skin problems are common disorders in resource poor settings. Scabies and tungiasis are neglected tropical diseases causing significant sickness in communities with poor living conditions. Scabies is dermatosis caused by a burrowing mite, Sarcoptes scabiei var. hominis. Tungiasis is caused by a flea, Tunga penetrans, infesting the skin, usually on the feet or hands. Tinea infection is a fungal dermatophyte infection of the skin and the most common dermatological problem among schoolchildren in Ethiopia, especially tinea capitis. Application of a Bayesian approach to identify possible risk factors for these problems has seldom been used. We found that compared to the frequentist model, the Bayesian model better explained school- and classroom-level variations in skin problems among schoolchildren. Our findings also suggest that transmission of skin infections, especially fungal and scabies infections, frequently occurs in schools and classrooms. We identified several risk factors for these conditions, including low socioeconomic status; unclean fingernails; not washing with soap at least every week; and sharing beds, clothes, and combs. Thus, it is important to improve the personal hygiene of schoolchildren through education. Regular checkups by teachers also can improve skin health and related morbidity in rural schoolchildren in southern Ethiopia.
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Affiliation(s)
- Hiwot Hailu Amare
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | - Bernt Lindtjorn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
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Lakoh S, Orefuwa E, Kamara MN, Jiba DF, Kamara JB, Kpaka S, Denning DW. The burden of serious fungal infections in Sierra Leone: a national estimate. Ther Adv Infect Dis 2021; 8:20499361211027996. [PMID: 34262759 PMCID: PMC8252340 DOI: 10.1177/20499361211027996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Sierra Leone is a small, resource-limited country that has a low national prevalence of human immunodeficiency virus (HIV) and a very high burden of tuberculosis (TB). Fungal diseases are probably common, but poorly documented. In this article, we reviewed the existing literature on fungal epidemiology in Sierra Leone using national, regional, and international data, identified knowledge gaps, and propose solutions to address the challenges on the prevention and control of fungal diseases in Sierra Leone and similar countries. In advanced HIV disease, we estimate 300 cryptococcal meningitis, 640 Pneumocystis pneumonia, and over 4000 esophageal candidiasis cases annually. Chronic lung disease is common, with an estimated 6000 cases of chronic pulmonary aspergillosis, many mistaken for TB, 5000 adults with allergic bronchopulmonary aspergillosis complicating asthma, and probably over 6600 cases of severe asthma with fungal sensitization. Invasive aspergillosis is estimated at 478 cases. None of these diagnoses are made in Sierra Leone at present. Major burdens are recurrent vulvovaginal candidiasis (85,400) and tinea capitis in children (266,450). Improvement in fungal disease diagnosis in Sierra Leone will enable better estimates to be made and reduce morbidity and mortality.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
| | - Emma Orefuwa
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Darlinda F Jiba
- University of Sierra Leone Teaching Complex, Ministry of Health and Sanitation, Freetown, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joseph B Kamara
- University of Sierra Leone Teaching Complex, Ministry of Health and Sanitation, Freetown, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sylaju Kpaka
- School of Health Sciences, Njala University, Bo, Sierra Leone
| | - David W Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland
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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.
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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
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Getso MI, Hashemi SJ, Ghazvini RD, Yusuf SM, Khodavaisy S, Gerami-Shoar M, Kibiya FS, Aliyu UT, Sarvestani HK, Aliyu M. Determination of dermatophytes isolated from tinea capitis using conventional and ITS-based sequencing methods in Kano, Nigeria. J Mycol Med 2021; 31:101157. [PMID: 34147757 DOI: 10.1016/j.mycmed.2021.101157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tinea capitis is a dermatophyte infection of the scalp and hair that affects a large number of people worldwide. The disease commonly affects children and manifests with varying degrees of hair loss, scalp inflammation, and psychosocial impact. In Nigeria, the burden of tinea capitis is worrisome affecting over 15,000,000 school-age children. Molecular techniques complement the conventional mycological examinations in laboratory diagnosis of tinea capitis. In this study, we identified dermatophytes species causing tinea capitis in Kano, Nigeria, using ITS-based nucleotide sequencing technique in addition to conventional mycological examination. METHODS We collected 112 samples from the scalp of children with clinically diagnosed tinea capitis at the dermatology clinic of Murtala Muhammad Specialist Hospital, Kano, between April and September 2019. The samples were processed and subjected to direct microscopy and mycological culture to isolate dermatophytes species that were identified morphologically and using ITS sequencing. RESULTS Out of the 112 patients investigated, the majority (59.8%) were between the ages 6 and 9 years with a mean age of 7.3 ± 1.9 years. Males (79.5%) were predominantly affected. Black dot (46.4%) was the most common clinical type of tinea capitis followed by gray patch (39.3%) and kerion (1.8%). Favus was not observed. Microsporum audouinii (45.7%) was the predominant etiologic agent followed by Trichophyton soudanense (28.6%), T. violaceum (22.9%), and T. tonsurans (2.9%). CONCLUSION The prominence of anthropophilic dermatophytes as the main causes of tinea capitis in our localities suggests that public health interventions to promote health education and good hygiene practices would minimize the transmission rate of tinea capitis among children in the study area.
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Affiliation(s)
- Muhammad Ibrahim Getso
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano P.M.B 3011, Kano- Nigeria
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shehu Mohammed Yusuf
- Dermatology unit, Department of Medicine, Aminu Kano Teaching Hospital Kano- Nigeria; Consultant Dermatologist, College of Health Sciences, Bayero University Kano P.M.B 3011, Kano- Nigeria
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Gerami-Shoar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Faiza Sadauki Kibiya
- Dermatology unit, Department of Medicine, Aminu Kano Teaching Hospital Kano- Nigeria
| | - Usman Tijjani Aliyu
- Consultant Dermatologist, College of Health Sciences, Bayero University Kano P.M.B 3011, Kano- Nigeria
| | - Hasti Kamali Sarvestani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansur Aliyu
- Department of Medical Microbiology and Parasitology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University Kano P.M.B 3011, Kano- Nigeria
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20
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Orefuwa E, Gangneux JP, Denning DW. The challenge of access to refined fungal diagnosis: An investment case for low- and middle-income countries. J Mycol Med 2021; 31:101140. [PMID: 33971531 DOI: 10.1016/j.mycmed.2021.101140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Emma Orefuwa
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Société Française de Mycologie Médicale (SFMM), Paris, France.
| | - David W Denning
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland; Manchester Fungal Infection Group, The University of Manchester, Manchester, United Kingdom
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21
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Abstract
Trichophyton (T.) tonsurans is considered as the main causative agent of tinea gladiatorum (ringworm) in contact and martial arts worldwide and regularly leads to outbreaks. In the national wrestling squad in Leipzig, dermatophytoses occurred frequently and recurrently in children and adolescents for over a 2-year period. The wrestlers came to the dermatologist's office for clinical examination and sampling. Dermal scales and hair roots as well as smears were examined mycologically with fluorescence optical preparation, fungal culture, and polymerase chain reaction (PCR) for dermatophyte DNA. Sequencing of the dermatophyte rDNA served as culture confirmation test. Environmental investigations in the wrestler training center included contact cultures and smears from surfaces, in particular from the mats. T. tonsurans was culturally and/or with PCR detectable in 21 out of 25 children and adolescents plus one trainer. T. tonsurans grew in one of ten contact cultures of mats and floors in the wrestling training center, and T. interdigitale was found in another culture. Smears from the mats resulted in a culture of T. tonsurans detection twice. The PCR was positive for T. tonsurans three times. Within 14 days, T. tonsurans developed small, flat, radiating, granular and white-colored colonies with a mahogany-brown reverse side on the fungal culture media. The sequencing of the internal transcribed spacer (ITS) region of the rDNA and the translation elongation factor 1 α (TEF 1 α) gene confirmed the species T. tonsurans in all cases. T. interdigitale that was found from a mat was also identified by sequencing. Eight T. tonsurans strains were subjected to in vitro susceptibility testing to terbinafine. All isolates were sensitive to terbinafine in vitro with minimal inhibitory concentrations of ≤ 0.1 µg/ml.
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