Current burden of serious fungal infections in Republic of Congo

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.

Section: Discussioncontrasting

confidence: 46%

Estimation of the burden of tinea capitis among children in Africa

Bongomin

Olum

Nsenga

et al. 2020

“…This climate is conducive to the sustainability of several endemic diseases: Malaria, enteric diseases, TB, cholera and a diverse population of mostly unknown and undiagnosed endemic and opportunistic fungal pathogens 42 . Fungal infections are frequent opportunists in HIV infection and observed clinically in the DRC 60 . The most common are oral and oesophageal candidiasis, PCP, cryptococcal meningoencephalitis and histoplasmosis.…”

Section: Discussionmentioning

confidence: 99%

“…42 Fungal infections are frequent opportunists in HIV infection and observed clinically in the DRC. 60 The most common are oral and oesophageal candidiasis, PCP, cryptococcal meningoencephalitis and histoplasmosis. In addition, TB is the most common predisposing factor for the development of CPA.…”

Section: Discussionmentioning

confidence: 99%

Serious fungal diseases in Democratic Republic of Congo – Incidence and prevalence estimates

Kamwiziku

Makangara

Orefuwa

et al. 2021

Self Cite

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.

“…62 Large-scale causality studies will be of great importance approximately represents 28.7% of all PLHIV who died in the same year (17,000). 7 While this annual incidence is not statistically different to the DRC incident numbers previously reported, 13 these data are slightly higher than the incident cases reported across the borders in the Republic of Congo 64 and Uganda. 65 These numbers are much higher than those reported in Europe 66,67 and Asia.…”

Section: Discussionmentioning

confidence: 61%

Cryptococcosis in the Democratic Republic of Congo from 1953 to 2021: A systematic review and meta‐analysis

Bive

Kasumba

Nani-Tuma

et al. 2022

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 neuromeningeal cryptococcosis (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 characterised. 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/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.