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Kiconco P, Achan B, Sanya M, Najjingo I, Okeng A, Bwanga F. Pulmonary dimorphic fungal infections among HIV/AIDS non-TB patients with chronic cough in Kampala, Uganda. Mycoses 2024; 67:e13726. [PMID: 38644511 DOI: 10.1111/myc.13726] [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: 07/22/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Dimorphic fungi cause infection following the inhalation of spores into the pulmonary system. In the lower respiratory tract, the conidia transform into yeasts, which are engulfed by alveolar macrophages and may be destroyed without disease manifestation. However, in some immunocompromised individuals, they may persist and cause active fungal disease characterized by formation of granulomas in the infected tissues, which may mimic Mycobacterium tuberculosis (MTB). OBJECTIVE To determine the prevalence of pulmonary dimorphic fungal infections among HIV/AIDS patients with non-TB chronic cough at Mulago National Referral and Teaching Hospital in Kampala, Uganda. METHODS Sputum samples were collected from 175 consented HIV/AIDS patients attending the immuno-suppression syndrome (ISS) clinic at the hospital. Upon Xpert MTB/RIF sputum testing, 21 patients tested positive for MTB, and these were excluded from further analysis. The other 154 sputum negative samples were then subjected to PCR for dimorphic fungi at MBN Clinical Laboratories. Singleplex PCR was used to detect the target sequences in selected respective genes of each dimorphic fungal species of interest. DNA amplicons were detected based on gel electrophoresis. RESULTS Dimorphic fungi were detected in 16.2% (25/154) of the studied population. Of these 9.1% (14/154) had Blastomyces dermatitidis and 7.1% (11/154) had Talaromyces marneffei. The remaining 84% of the studied participants had no dimorphic fungi. Histoplasma capsulatum, Coccidioides immitis and Paracoccidioides brasiliensis were not detected in any of the participants. CONCLUSION Dimorphic fungi (B. dermatitidis and T. marneffei) were found in 16.2% of the HIV/AIDS patients with non-TB chronic cough in Kampala, Uganda. We recommend routine testing for these pathogens among HIV/AIDS patients with chronic cough.
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Affiliation(s)
- Prossy Kiconco
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- MBN Clinical Laboratories, Kampala, Uganda
| | - Beatrice Achan
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Irene Najjingo
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Freddie Bwanga
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- MBN Clinical Laboratories, Kampala, Uganda
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Zeeshan M, Memon S, Malick A, Naqvi SF, Farooqi J, Ghanchi NK, Jabeen K. Fluconazole-resistant Candida parapsilosis complex candidemia and analysis of mutations in the ERG11 gene from Pakistan. Mycoses 2024; 67:e13677. [PMID: 37990393 DOI: 10.1111/myc.13677] [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: 07/24/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Recent reports of the emergence of fluconazole resistance in Candida parapsilosis species complex poses a challenge, more specifically in settings where echinocandin-based treatment regime is not feasible. OBJECTIVE This study reported emergence of fluconazole resistance in C. parapsilosis species complex strains isolated from blood cultures. MATERIALS AND METHODS This retrospective observational study was conducted from 2018 to 2020 at a tertiary care laboratory from Pakistan. Fluconazole-resistant C. parapsilosis species complex fungemia cases were identified from laboratory database and clinical details were collected. Identification of C. parapsilosis species complex was done using API 20C AUX and Cornmeal Tween80 agar morphology. Minimum inhibitory concentrations (MICs) were determined using Sensititre YeastONE and interpretation was done with CLSI M60 ED1:2017. ERG11 gene region was amplified and sequenced by Sanger sequencing and analysed by MEGA 11 Software. RESULTS A total of 13 (8.5%) fluconazole-resistant isolates were identified from 152 C. parapsilosis species complex candidemia cases. Fluconazole MICs of resistant isolates ranged between 8 and 256 μg/mL. Analysis of ERG11 gene revealed nonsynonymous mutations at position Y132F in 86% of the fluconazole-resistant isolates. Diabetes and hospitalization were important risk factors for candidemia with fluconazole-resistant C. parapsilosis complex. CONCLUSION This is the first report of the emergence and molecular mechanisms of fluconazole resistance in C. parapsilosis species complex from Pakistan. Y132F mutation in the ERG11 gene was the most common mutation in fluconazole-resistant strains. These findings are concerning and necessitate better diagnostics, newer antifungals, ongoing surveillance and further insights on resistance mechanisms in the country.
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Affiliation(s)
- Mohammad Zeeshan
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Saba Memon
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Ayesha Malick
- Aga Khan University Medical College, Karachi, Pakistan
| | - Syed Faheem Naqvi
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Joveria Farooqi
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Najia Karim Ghanchi
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kauser Jabeen
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Sati H, Alastruey-Izquierdo A, Perfect J, Govender NP, Harrison TS, Chiller T, Sorrell TC, Bongomin F, Oladele R, Chakrabarti A, Wahyuningsih R, Colombo AL, Rodriguez-Tudela JL, Beyrer C, Ford N. HIV and fungal priority pathogens. Lancet HIV 2023; 10:e750-e754. [PMID: 37827187 PMCID: PMC7615271 DOI: 10.1016/s2352-3018(23)00174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 10/14/2023]
Abstract
The burden of invasive fungal infections associated with opportunistic fungal pathogens is a persistent challenge, particularly among people with advanced HIV disease. In October, 2022, WHO published the Fungal Priority Pathogens List (FPPL)-the first global effort to systematically prioritise fungal pathogens. Of the 19 pathogens in the WHO FPPL, four opportunistic pathogens in particular cause invasive diseases in people living with HIV: Cryptococcus neoformans, Histoplasma spp, Pneumocystis jirovecii, and Talaromyces marneffei. These four fungal pathogens are major causes of illness and death in people with advanced HIV and overwhelmingly affect those in low-income and middle-income countries. Access to diagnostics, improved surveillance, targeted support for innovation, and an enhanced public health focus on these diseases are needed in the effort to reduce HIV-associated deaths.
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Affiliation(s)
- Hatim Sati
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - John Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Nelesh P Govender
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Tom S Harrison
- Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tania C Sorrell
- Sydney Infectious Disease Institute, University of Sydney, Sydney, NSW, Australia
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Retno Wahyuningsih
- Department of Parasitology, Universitas Indonesia and Universitas Kristen Indonesia, Indonesia
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil
| | | | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nathan Ford
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland; Centre for Infectious Disease and Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Mennechet F, Andreoletti L, Cappelli G, Fokam J, Kuiate JR, Moussa AM, Simporé J, Takoudjou Dzomo R, Torimiro J, Ndembi N, Colizzi V. Launch of the Laboratory for Major Tropical Epidemics (LAGET) in Chad: Strengthening the capacity for epidemiological surveillance, monitoring and diagnosis of endemic or emerging infectious diseases in Central Africa. J Public Health Afr 2023. [DOI: 10.4081/jphia.2022.2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
In an increasingly interconnected world, with the devastating effects of climate changes and humanitarian crises, pandemics and emerging infectious diseases are more likely to become our daily reality. When it comes to health care, sub-Saharan Africa faces more challenges than most other regions of the world, including lack of funds, precarity and poor infrastructures. Yet, these areas are most often on the front lines of infectious threats.
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