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Histoplasmosis, an invasive fungal infection endemic in the Americas, Africa, and Asia, with a few cases reported among immigrants to Europe, was classified as an AIDS-defining disease in 1987 (1,2). [...]

Candida auris is a World Health Organization critical priority fungal pathogen. We conducted a systematic review to describe its epidemiology in Africa. PubMed and Google scholar databases were searched between January 2009 and September 2023 for clinical studies on C. auris cases and/or isolates from Africa. Reviews were excluded. We included 19 studies, involving at least 2529 cases from 6 African countries with the most, 2372 (93.8%), reported from South Africa. Whole-genome sequencing of 127 isolates identified 100 (78.7%) as clade III. Among 527 isolates, 481 (91.3%) were resistant to fluconazole, 108 (20.5%) to amphotericin B, and 9 (1.7%) to micafungin. Ninety of 211 (42.7%) patients with clinical outcomes died. C. auris is associated with high mortality and antifungal resistance, yet this critical pathogen remains underreported in Africa. Collaborative surveillance, fungal diagnostics, antifungals, and sustainable infection control practices are urgently needed for containment. [ABSTRACT FROM AUTHOR]

Disseminated histoplasmosis (DH) is the most severe clinical presentation of histoplasmosis, commonly associated with the advanced HIV disease (AHD) population. Our case report highlights the need for the deployment of point of care test kits for the diagnosis of histoplasmosis in resource limited settings including Africa and Nigeria in particular. Our case is a 56-year-old HIV positive (CD4 count of < 200 cells/microliter) Nigerian woman with complaints of cough, weight loss and easy fatigability all of several month's duration, who had self-interrupted her care prior to the onset of presenting complaints. The anti-TB regimen was commenced based on chest CT and chest X-ray findings despite negative GeneXpert results while awaiting urine Histoplasma antigen assay results. A positive Histoplasma antigen assay was communicated to the attending clinician 2 weeks after patient's demise. Delays in the diagnosis of disseminated histoplasmosis in our locality is a major factor contributing to fatal outcomes. The availability of point of care kits for the detection of Histoplasma in our facilities will aid in prompt diagnosis and invariably avert preventable deaths. [ABSTRACT FROM AUTHOR]

Background: Most of the study reviews on Histoplasma capsulatum var duboisii (Hcd) infection have been limited to case reports from few African countries despite having cases reported outside Africa. We aimed at providing an update on the global epidemiology of histoplasmosis caused by Hcd, its diagnostic challenges and recommendations for improved diagnosis. Materials and methods: We conducted a retrospective review of case reports and case series on Hcd infection published "between 1st January 1950 to 31st December 2021" using PubMed, Google Scholar and African Journals Online. The following search terms: "African histoplasmosis" and "Histoplasma duboisii" AND/OR "diagnosis of African histoplasmosis" were used. Publications on histoplasmosis caused by H. capsulatum var. capsulatum (Hcc) were excluded. Data extracted from each case included: age, gender, disease type (single organ vs. disseminated disease), sites of infection, clinical features, HIV status, diagnostic tests, treatment, and patient outcome. Results: We identified 415 cases of Hcd infection reported globally (1950 - 2021); 359 (86.5%) cases from Africa, while 56 (13.5%) were from other geographical regions. Hcd infection was misdiagnosed as other clinical entities including tuberculosis, malignancies, osteomyelitis, neurofibromatosis, and cystic lesions. Out of the 415 cases, diagnostic modality was specified in 307 (74%) cases, with histopathology (n=270, 87.9%) as the predominant diagnostic method followed by culture (n=59, 19.2%). Conclusion: Like classical histoplasmosis, the clinical presentation of Hcd infection mimics other diseases, hence a high index of suspicion by the attending clinician would be invaluable in making a prompt diagnosis and invariably improve clinical outcomes. In addition, there is a need to build capacity in molecular diagnostics and antigen assay specific for detecting Hcd infection as classical diagnostic methods have been proven to be inadequate. [ABSTRACT FROM AUTHOR]

Background: Fungal contamination of hospital water distribution systems has been implicated in outbreaks of healthcare-associated infections., Objectives: To evaluate the prevalence of fungi in the water distribution system of a tertiary hospital in Nigeria., Design: This was a descriptive cross-sectional study., Methods: Swabs and water samples were collected from taps and faucets in the hospital categorized into low (Accidents and Emergency Unit, Children Emergency Unit, Acute Stroke Unit and the 24 in-patient hospital wards) and high-risk (Renal Dialysis Unit, Central Sterile Services Department, Theatres and Intensive Care Units (ICUs)) units based on the vulnerability of patients being managed there. The membrane filtration method for water analysis was used. Where possible, isolates cultured were identified to species level. In total, 105 water and 49 swab samples were collected for analysis., Results: All analysed water samples grew fungi. A total of 289 (high-risk; n  = 178; low-risk; n  = 111) and 76 fungi isolates were recorded from water and swab samples, respectively, with 31 different species identified. Aspergillus was the most predominant genus with five different species: Aspergillus niger (9.9%), terreus (4.4%), flavus (3.3%), fumigatus (8.8%) and versicolor (2.20%) isolated. Twenty-five and 18 species of fungi were identified in the low and high-risk units, respectively. The labour ward ( n  = 46; 25.8%) and modular theatre ( n  = 47; 42.3%) were the most contaminated units. Cladosporium spp. and Paecilomyces spp. were the most frequently isolated fungi in the low and high-risk units, respectively. The dialysis centre ( n  = 9; 8.1%) and renal transplant theatre ( n  = 7; 6.31%) had the lowest contamination rates in the high-risk units. Aspergillus niger , Cephalosporium curtipes , Penicillium chrysogenum and Penicillium glabrum were each identified in 4/6 units from which swabs were taken. The facility had no documented protocol for its water safety and quality., Conclusion: Our data reveal a high rate of contamination of hospital water sources by fungi, some of which are known to cause life-threatening infections. For better water treatment and water tank cleaning and disinfection, a standard protocol is advised. Ensuring that the water distribution systems in hospital settings are free of fungal contaminants is important to prevent the possibility of waterborne mycosis outbreaks., (© The Author(s), 2024.)