Basidiobolomycosis in Togo: clinico-pathological study of a series of 12 presumed cases

Fungal diseases in Africa: Closing the gaps in diagnosis and treatment through implementation research and advocacy

Fungal diseases impose an escalating burden on public health in Africa, exacerbated by issues such as delayed diagnosis, inadequate therapy, and limited access to healthcare resources, resulting in significant morbidity and mortality. Effectively tackling these challenges demands a comprehensive approach encompassing research, training, and advocacy initiatives. Recent clinical mycology surveys conducted by Global Action for Fungal Infection (GAFFI) and the European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) have underscored gaps in fungal diagnostics and the availability and accessibility of antifungal therapy in Africa. The World Health Organization (WHO) Fungal Priority Pathogens List (FPPL) identifies fungi of critical or high importance to human health, providing a roadmap for action and highlighting the urgent need for prioritizing fungal diseases and developing targeted interventions within the African context. To enhance diagnosis and treatment, it is imperative to invest in comprehensive training programs for healthcare workers across all levels and disciplines. Equipping them with the necessary knowledge and skills will facilitate early detection, accurate diagnosis, and appropriate management of fungal infections. Moreover, implementation science research in medical mycology assumes a pivotal role in bridging the gap between knowledge and practice. By identifying the barriers and facilitators that influence the adoption of diagnostic techniques and public health interventions, tailored strategies can be formulated to improve their implementation within healthcare settings. Advocacy plays a critical role in raising awareness regarding the profound impact of fungal diseases on public health in Africa. Engaging policymakers, healthcare providers, researchers, industry experts and communities underscore the importance of addressing these diseases and galvanize efforts for change. Substantial investment in surveillance, research and development specifically focused on fungal diseases is indispensable for advancing our understanding of local epidemiology, developing effective interventions, and ultimately improving patient outcomes. In conclusion, closing the gaps in diagnosing and treating fungal diseases in Africa demands concerted research and advocacy initiatives to ensure better healthcare delivery, reduced mortality rates, and improved public health outcomes.

Estimated burden of serious fungal infections in Togo

BACKGROUND

Over the years, the focus of infectious diseases in many African countries has been mainly on viral, bacterial and parasitic infections. Serious fungal infections (SFIs) with comparable morbidity rate in these countries remain neglected.

OBJECTIVES

To estimate the burden of SFI in Togo and to stimulate efforts for improved attention.

METHODS

Literature was thoroughly searched for epidemiological data on SFI in Togo. Incidence and/or prevalence of SFI was estimated using socio-demographics, health system's information, risk-groups data and SFI rates obtained from national and international studies.

RESULTS

About 5.29% of the 7,265,286 Togolese population is estimated to suffer from SFI annually. Among HIV patients, 1,342, 1,650 and 330 may develop cryptococcal meningitis, Pneumocystis pneumonia and disseminated histoplasmosis respectively per year. Oral and oesophageal candidiasis may annually affect 19,800 and 7,535 persons, respectively, living with HIV. Estimated incidence of invasive aspergillosis (IA) was 283 cases. Prevalence of chronic pulmonary aspergillosis (CPA) was estimated at 191 cases. The annual incidence of allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) was 4,577 and 6,042 cases, respectively. Tinea capitis and recurrent Candida vaginitis presumably affect 232,271 children and 108,979 women respectively. Candidaemia incidence is estimated at 5 cases per 100, 000 inhabitants and fungal keratitis may affect 981 persons annually.

CONCLUSIONS

SFIs in Togo are probably more significant than expected. These findings underscore the need to increase awareness among healthcare professionals, enhance diagnostic and therapeutic capacities and intensify epidemiological studies for effective management of fungal infections in Togo.

Disseminated and ulcerative basidiobolomycosis simulating a Buruli ulcer in an immunocompetent girl in Southern Benin

Basidiobolomycosis is a subcutaneous mycosis, for which non-specific clinical presentation can be a source of diagnostic wandering. A 5-year-old girl was brought for consultation with chronic ulcers of the pelvic limbs evolving for 8 months. The lesions started when the girl was 18 months old with a painless, pruritic nodule of the right buttock, indurated placard following progressive extension to the pelvic limbs, back and abdomen, and secondarily ulcerated in several places. On examination, there was an alteration of the general condition, a large, indurated and erythematous plaque, with sharp edges. On this plaque, there were nodular lesions and necrotic ulcers, with detached margins. The left knee was blocked in flexion. Ziehl staining and polymerase chain reaction for Mycobacterium ulcerans were negative. The histopathological picture was suggestive of basidiobolomycosis. The evolution was favorable after giving her ketoconazole (100mg per day) for 14 weeks associated with surgery and physiotherapy. This clinical case confirms the difficulties in diagnosing basidiobolomycosis, especially in endemic areas of Buruli ulcer.