Invasive Fungal Diseases in Africa: A Critical Literature Review

Abstract

Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.

Isolated renal and urinary tract aspergillosis: a systematic review

“…Besides invasive candidiasis, this finding is consistent with previous studies of other invasive fungal infections, including pulmonary aspergillosis. 26 , 89 – 91 Consequently, male sex has also been shown to be significantly associated with mortality, although this was not significant in our study. Besides underlying comorbidities and behavioural risk factors, there may exist the role of genetics and gender-specific immunological differences that may render males more susceptible, which necessitates further research studies into the mechanisms.…”

Re-estimation of the burden of serious fungal diseases in Uganda

“…We used an estimate of candidemia rate of 5/100,000 population, probably a conservative estimate based on other resource-constrained countries. 53 , 54 Many will be undiagnosed as blood cultures are only done in major hospitals, 73 , 74 and in any case are only ~40% sensitive for invasive candidiasis. Without local data, we cannot summarize the species distribution of Candida and other yeasts in bloodstream infections.…”

Fungal infections in Sudan: An underestimated health problem

“…However, the lack of awareness and training among the physicians and laboratory personnel is probably the main reasons for under-reporting and under recognition of cases. Of note that CM, PCP, and histoplasmosis are increasingly reported in Africa [ 104 , 105 ]. A recent study from Nigeria found that 7.7% of HIV patients with low CD4 counts tested positive for Histoplasma antigen [ 104 ].…”