Search

Invasive fungal infections (IFIs) and medical mycology receive little attention in Ghana. However, the present evolution of biomarker assays for IFIs, offers an opportunity for an increased access to fungal laboratory testing in resource-limited settings, and probably make a case for availability of essential antifungal agents. Using surveys and personal communications, the state of medical mycology and IFI in Ghana were highlighted. Inadequate awareness and insufficient access to fungal diagnostics and therapeutics were identified as the key challenges, the establishment of the Ghana Medical Mycology Society was discussed, and recommendations were made to improve the status quo.

Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis.

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). [...]

The gram-negative, soil-dwelling bacterium Burkholderia pseudomallei is the causative agent of melioidosis, which is an important cause of lethal community-acquired sepsis throughout the tropics (1). Melioidosis is predicted to be [...]

Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had undiagnosed CPA. In October 2016, the Global Action Fund for Fungal Infections convened an international expert panel to develop a case definition of CPA for resource-constrained settings. This panel defined CPA as illness for >3 months and all of the following: 1) weight loss, persistent cough, and/or hemoptysis; 2) chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and 3) a positive Aspergillus IgG assay result or other evidence of Aspergillus infection. The proposed definition will facilitate advancements in research, practice, and policy in lower- and middle-income countries as well as in resource-constrained settings.

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]

On May 30th and 31st, 2023, delegates representing various African subregions, together with global representatives from the International Society of Human and Animal Mycology (ISHAM), the European Confederation of Medical Mycology (ECMM), the United States Centre for Disease Control and Prevention (CDC), and Global Action for Fungal Infections (GAFFI), convened in Nairobi, Kenya under the aegis of the Pan African Mycology Working Group, a working group of ISHAM. The meeting objectives were, amongst others, to deliberate on a continental response to the World Health Organisation Fungal Priority Pathogen List and facilitate interaction between global and regional leaders. Country delegates and international speakers addressed Africa's fungal disease burden; capacity for diagnosis and management; ongoing surveillance; knowledge gaps and trends in invasive fungal diseases such as Candida auris , mucormycosis, aspergillosis, and Acquired Immune Deficiency Syndrome (AIDS)-related mycoses; and current laboratory practice. During the technical sessions, expert panels deliberated on establishing and financing of national/regional surveillance networks for mycoses; establishing and sustaining African-led collaborations; expanding on existing laboratory and point-of-care diagnostic capacity as well as planning a mycology reference laboratory service and network in Africa. The meeting also highlighted successful African-led collaborations, capacity building, and clinical trial initiatives. The meeting conclusions informed the resolutions of the Nairobi Declaration calling for improved awareness; strong collaborations between clinical and laboratory teams across Africa; improved fungal disease surveillance within the continent; access to antifungals and diagnostics; and leveraging qualified human resources for mycology present within and outside Africa to facilitate trainings, collaborations, and exchanges. [ABSTRACT FROM AUTHOR]

The non-neoformans Cryptococci are increasingly causing opportunistic infections in both immunocompetent and immunocompromised individuals worldwide. Non. neoformans Cryptococci are skin and mucous membrane colonizers as well as environmental fungi. Cryptococcus laurentii and Cryptococcus albidus cause more than 80% of non-neoformans Cryptococcal infections are gaining recognition as human pathogens because of the advancements in diagnostic techniques. Here, we report 2 cases of C. laurentii fungaemia in an immunocompetent adult and a preterm neonate in Nigeria. The first case was a 51-year-old man with 31% second-degree mixed-thickness burns. He fully recovered with the addition of fluconazole early in its treatment. The second case was a preterm neonate in whom fungaemia was diagnosed after a fatal outcome had occurred. These two cases highlight that the new identification and susceptibility diagnostic techniques allow for earlier diagnosis and better treatment of unusual fungal infections. However, the timely and early commencement of empirical antifungal drugs improves patient outcomes. [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]

Sphingomonas paucimobilis is an opportunistic pathogen that occurs naturally in the environment. It has been implicated in both community acquired and healthcare associated infections. Sphingomonas paucimobilis septicaemia is commonly associated with contamination from the environment, the use of hospital and laboratory equipment, indwelling urinary catheters and intravenous cannula. Literature search for Sphingomonas paucimobilis septicaemia revealed several case reports documented globally with only a single case report from Nigeria detected by VITEK 2. We report a case of Sphingomonas paucimobilis septicaemia in 38-yearold unbooked 21 woman, P1+2(1A), admitted into the accident and emergency unit of Lagos University Teaching Hospital, Lagos, Nigeria, with complaints of fever, abdominal pain and distension, generalized body pain and difficulty in breathing, of six days post Caesarean section. Blood culture yielded Sphingomonas paucimobilis. Antibiotics were commenced at admission and exploratory laparotomy done seven days post presentation. However, patient died on day fourteen due to cardiopulmonary arrest. [ABSTRACT FROM AUTHOR]

Summary: Most African countries have poorly funded and overburdened health systems. Additionally, a high prevalence of HIV in Sub‐Saharan Africa contributes to a high burden of opportunistic fungal infections. Data generated by GAFFI from 15 of 57 African countries revealed that an estimated 47 million Africans suffer from fungal diseases, of whom an estimated 1.7 million suffer from a serious fungal infection annually. Almost all African countries lack a surveillance system for fungal infections with the exception of South Africa. South Africa is also the only African country with a national mycology reference laboratory. Across the continent, there is a pervasive picture of inadequate/poor diagnostic capacity, low level of awareness among healthcare workers and policymakers and unavailability and non‐accessibility to essential antifungal medications. Recent outreach efforts by the International Society for Human and Animal Mycology (ISHAM) and the European Confederation of Medical Mycology (ECMM) have aimed to increase involvement of African countries and experts in global initiatives such as "One World One Guideline" and also the ECMM Academy. Recently, under the auspices of ISHAM, the African sub‐region created a network of mycology experts whose goal is to organise and engage African leaders in the field of medical mycology. The aim of this ISHAM Working Group was to facilitate interaction and synergy among regional leaders in order to develop educational programmes for capacity building to aid in the diagnosis and care of patients with fungal infections in Africa. The working group will also encourage country initiatives to develop clinical guidelines, to support surveys and to support the establishment of reference mycology laboratories. [ABSTRACT FROM AUTHOR]