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Few data are published from Morocco on fungal disease, although numerous case reports attest to a wide range of conditions in the country. Here, we estimate for the first time the incidence and prevalence of serious fungal diseases in the country. Detailed literature searches in English and French were conducted for all serious fungal infections. Demographic and individual underlying condition prevalence or annual incidence were obtained from UNAIDS (HIV), WHO (TB) and other international sources. Deterministic modelling was then applied to estimate fungal disease burden. Morocco’s population in 2021 was 36,561,800. Multiple publications describe various fungal diseases, but epidemiological studies are rare. The most frequent serious fungal infections were tinea capitis (7258/100,000) and recurrent vulvovaginal candidiasis (2794/100,000 females). Chronic pulmonary aspergillosis is also common at a prevalence of 19,290 (53/100,000) because of the relatively high rate of tuberculosis. The prevalence of asthma in adults exceeds one million, of whom fungal asthma (including allergic bronchopulmonary aspergillosis (ABPA)) probably affects 42,150 (115/100,000). Data are scant on candidaemia (estimated at 5/100,000), invasive aspergillosis (estimated at 4.1/100,000), HIV-related complications such as cryptococcal meningitis and Pneumocystis pneumonia and mucormycosis. Fungal keratitis is estimated at 14/100,000). Mycetoma and chromoblastomycosis are probably rare. Fungal disease is probably common in Morocco and diagnostic capacity is good in the teaching hospitals. These estimates need confirmation with methodologically robust epidemiological studies.

BackgroundFungal lung diseases are global in distribution and require specific tests for diagnosis. We report a survey of diagnostic service provision in Africa.MethodsA written questionnaire was followed by a video conference call with each respondent(s) and external validation. To disseminate the questionnaire, a snowball sample was used.ResultsData were successfully collected from 50 of 51 African countries with populations >1 million. The questionnaire was completed by respondents affiliated to 72 health facilities, of whom 33 of 72 respondents (45.8%) reported data for the whole country while others reported data for a specific region/province. In the public sector, chest X-ray and CT scan are done often or occasionally in 49 (98%) and 37 (74%) countries, and less often in the private sector. Bronchoscopy and spirometry were often or occasionally done in 28 (56%) and 18 (36%) of countries in the tertiary health facilities of public sector. The most conducted laboratory diagnostic assay is fungal culture (often or occasionally) in 29 (58%) countries.ConclusionThis survey has found a huge disparity of diagnostic test capability across the African continent. Some good examples of good diagnostic provision and very high-quality care were seen, but this is unusual. The unavailability of essential testing such as spirometry was noted which has high impact in lung diseases diagnosis. It is important for countries to implement tests basing on the WHO Essential Diagnostic List.

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