Estimated Burden of Serious Fungal Infections in Ghana

Fungal infections are increasingly becoming common and yet often neglected in developing countries. Information on the burden of these infections is important for improved patient outcomes. The burden of serious fungal infections in Ghana is unknown. We aimed to estimate this burden. Using local, regional, or global data and estimates of population and at-risk groups, deterministic modelling was employed to estimate national incidence or prevalence. Our study revealed that about 4% of Ghanaians suffer from serious fungal infections yearly, with over 35,000 affected by life-threatening invasive fungal infections. Incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia, and disseminated histoplasmosis cases in AIDS was estimated at 6275, 12,610 and 724, respectively. Oral and esophageal candidiasis collectively affect 27,100 Ghanaians and 42,653 adult asthmatics are estimated to have fungal asthma. We estimate a prevalence of 12,620 cases of chronic pulmonary aspergillosis (CPA and an incidence of 1254 cases of invasive aspergillosis (IA). Estimated cases of candidemia and candida peritonitis cases were 1446 and 217, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) and tinea capitis was 442,621 and 598,840, respectively. Mucormycosis and fungal keratitis each may affect 58 and 810 Ghanaians. These data highlight the urgent need for intensified awareness to improve diagnosis and management.

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The Burden of Fungal Infections in Ethiopia

Journal of Fungi ◽

10.3390/jof5040109 ◽

2019 ◽

Vol 5 (4) ◽

pp. 109 ◽

Cited By ~ 4

Author(s):

Tufa ◽

Denning

Keyword(s):

Tinea Capitis ◽

Fungal Infections ◽

Allergic Bronchopulmonary Aspergillosis ◽

Chronic Obstructive ◽

Pneumocystis Jirovecii Pneumonia ◽

Obstructive Pulmonary Disease ◽

Incidence Data ◽

Patients At Risk ◽

Chronic Pulmonary Aspergillosis ◽

Candida Peritonitis

The burden of severe fungal infections (FIs) is not well addressed in Ethiopia. We have estimated the burden of FIs from multiple demographic sources and by searching articles from PubMed. Opportunistic FIs were estimated using modelling and 2017 national HIV data. The burdens of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) were estimated by using the prevalence of asthma, chronic obstructive pulmonary disease, and annual the incidence of tuberculosis. Of the 105,000,000 estimated Ethiopian population, 610,000 are thought to have HIV infection. Our estimation of HIV-related FIs were: 9900 cryptococcal meningitis (CM), 12,700 Pneumocystis jirovecii pneumonia (PCP), 76,300 oral and 56,000 oesophageal candidiasis cases. A remarkable 7,051,700 4–14-year-olds probably have tinea capitis and 1,469,000 women probably have recurrent Candida vaginitis. There were 15,200 estimated CPA cases (prevalence) and 11,500 invasive aspergillosis (IA) cases (incidence). Data are scant, but we estimated 5300 candidaemia and 800 Candida peritonitis cases. In conclusion, approximately 8% of Ethiopians suffer from FIs annually, mostly schoolchildren with tinea capitis. IA, CM and PCP are the major causes of fungal deaths. The absence of CD4 count is challenging the identification of HIV patients at risk of opportunistic FIs. There is a pressing need to improve FI diagnosis, probably including national surveillance.

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Point of care tests for invasive fungal infections: a blueprint for increasing availability in Africa

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211034266 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110342

Author(s):

Iriagbonse Iyabo Osaigbovo ◽

Felix Bongomin

Keyword(s):

Fungal Infections ◽

Point Of Care ◽

Invasive Fungal Infections ◽

Antigen Test ◽

Pulmonary Aspergillosis ◽

Middle Income ◽

Middle Income Countries ◽

Disseminated Histoplasmosis ◽

Chronic Pulmonary Aspergillosis ◽

Point Of Care Tests

Invasive fungal infections (IFIs) such as cryptococcosis, disseminated histoplasmosis, and chronic pulmonary aspergillosis are significant causes of morbidity and mortality in Africa. Lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology hamper prompt detection and management of IFIs on the continent. Point-of-care tests (POCT) obviate the need for complex infrastructure, skilled technicians, and stable electricity and have had major impacts on the diagnosis of bacterial, viral, and parasitic infections in low- and middle-income countries. Over the last 10 years, POCTs for IFIs have become increasingly available and they have the potential to revolutionize the management of these infections if scaled up in Africa. At the beginning of 2021, the World Health Organization (WHO) Essential Diagnostic List (EDL) included a cryptococcal antigen test for the diagnosis of cryptococcosis, Histoplasma antigen test for the diagnosis of disseminated histoplasmosis, and Aspergillus-specific test for the diagnosis of chronic pulmonary aspergillosis. All of these are available in formats that may be used as POCTs and it is hoped that this will improve the diagnosis of these life-threatening IFIs, especially in low- and middle-income countries. This perspective review discusses commercially available POCTs and outlines strategies of a blueprint to achieve their roll-out in Africa. The strategies include raising awareness, conducting research that uncovers the exact burden of IFIs, increasing advocacy, integrating diagnosis of IFIs into existing public health programs, adoption of the WHO EDL at country levels, and improving logistics and supply chains.

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Human Fungal Infections in Kuwait—Burden and Diagnostic Gaps

Journal of Fungi ◽

10.3390/jof6040306 ◽

2020 ◽

Vol 6 (4) ◽

pp. 306

Author(s):

Wadha Alfouzan ◽

Faten Al-Wathiqi ◽

Haya Altawalah ◽

Mohammad Asadzadeh ◽

Ziauddin Khan ◽

...

Keyword(s):

At Risk ◽

Fungal Infections ◽

Allergic Bronchopulmonary Aspergillosis ◽

Risk Groups ◽

Epidemiological Studies ◽

Public Health Issue ◽

Chronic Obstructive ◽

Disease Epidemiology ◽

Populations At Risk ◽

Candida Peritonitis

Fungal infections are an increasingly important public health issue, yet accurate statistics on fungal burden worldwide and in Kuwait are scarce. Here we estimate the incidence and prevalence of fungal infections in Kuwait. Population statistics from 2018 collected by the Public Authority for Civil Information were used, as well as data from the Ministry of Health. A literature search for Kuwait data on mycotic diseases and population at risk (chronic obstructive pulmonary disease, HIV infection/AIDS, cancer, and transplant patients) was conducted. The population in 2018 was estimated at 4,226,920 million people: 1,303,246 million Kuwaitis and 2,923,674 million expatriates. We determined the annual burden of serious fungal infections number (per 100,000) from high to low based on earlier reported fungal rates for populations at risk: recurrent Candida vaginitis 54,842 (2595); severe asthma with fungal sensitisation 10,411 (246); allergic bronchopulmonary aspergillosis, 7887 (187); chronic pulmonary aspergillosis 995 (21.3); invasive aspergillosis 704 (16.7); fungal keratitis 654 (15.5); candidaemia 288 (6.8); Candida peritonitis 63 (3.5) and oesophageal candidiasis in HIV 33 (0.8). Besides identifying rising new risk groups and expanding reports on antifungal resistance, surveillance programs and further epidemiological studies are needed to achieve more precise assessments of fungal disease epidemiology and correlated morbidity and mortality.

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Itraconazole: Precautions Regarding Drug Interactions and Bioavailability

Canadian Journal of Infectious Diseases ◽

10.1155/1994/612027 ◽

1994 ◽

Vol 5 (4) ◽

pp. 179-183 ◽

Cited By ~ 3

Author(s):

Michael PE Puttick ◽

Peter Phillips

Keyword(s):

Treatment Failure ◽

Drug Interactions ◽

Chart Review ◽

Fungal Infections ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Teaching Hospitals ◽

Disseminated Histoplasmosis ◽

Life Threatening ◽

Itraconazole Treatment

Objective: To describe patients with fungal infections in whom drug interactions and bioavailability problems were associated with itraconazole treatment failure.Design: Retrospective chart review.Setting: Two tertiary care university-affiliated teaching hospitals.Population Studied: Itraconazole-treated patients between 1990 and 1992.Main Results: Four patients treated with itraconazole were identified in whom suboptimal serum itraconazole levels were associated with relapse of disseminated histoplasmosis, treatment failure of invasive aspergillosis or development of superficial mycoses. Low serum itraconazole levels were associated with concurrent therapy with rifampin or agents inhibiting gastric acid secretion, with administration of itraconazole capsule contents through a nasogastric tube or with the presence ofaids.Conclusions: It is recommended that serum itraconazole levels be measured in patients with potentially life-threatening mycoses if coexistent factors may interfere with itraconazole therapy.

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Estimating the Burden of Serious Fungal Infections in Uruguay

10.20944/preprints201802.0053.v1 ◽

2018 ◽

Author(s):

Marina Macedo-Viñas ◽

David W. Denning

Keyword(s):

Fungal Infections ◽

Oral Candidiasis ◽

Allergic Bronchopulmonary Aspergillosis ◽

Laboratory Diagnosis ◽

Population Characteristics ◽

Pneumocystis Jirovecii Pneumonia ◽

Solid Organ ◽

Hematopoietic Stem ◽

Populations At Risk ◽

Candida Peritonitis

We aimed to estimate for the first time the burden of fungal infections in Uruguay. Data on population characteristics and underlying conditions were extracted from the National Statistics Institute, the World Bank, national registries and published articles. When no data existed, risk populations were used to estimate frequencies extrapolating from the literature. Population structure: total 3,444,006; 73% adults; 35% women younger than 50 years. Size of populations at risk: HIV infected 12,000; acute myeloid leukemia 126; hematopoietic stem cell transplantation 30; solid organ transplants 134; COPD 272,006 (19.7% of older than 40); asthma in adults 223,431 (prevalence 9%); cystic fibrosis in adults 48; tuberculosis 613 (incidence 26.2%), lung cancer 1,400 (ASR incidence 27.4). Annual incidence estimations per 100,000: 22.4 invasive aspergillosis, 16.4 candidaemia, 3.7 Candida peritonitis, 1.62 Pneumocystis jirovecii pneumonia, 0.75 cryptococcosis, severe asthma with fungal sensitisation 217, allergic bronchopulmonary aspergillosis 165, recurrent Candida vaginitis 6,323, oral candidiasis 74.5 and oesophageal candidiasis 25.7. Although some under and overestimations could have been made, we expect that at least 127,525 people suffer from serious fungal infections each year. Sporothrichosis, histoplasmosis, paracoccidioidomycosis and dermatophytosis are known to be frequent but no data are available to make accurate estimations. Given the magnitude of the burden of fungal infections in Uruguay, efforts should be made to improve surveillance, strengthen laboratory diagnosis and warrant access to first line antifungals.

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Reinforcing the Immunocompromised Host Defense against Fungi: Progress beyond the Current State of the Art

Journal of Fungi ◽

10.3390/jof7060451 ◽

2021 ◽

Vol 7 (6) ◽

pp. 451

Author(s):

Georgios Karavalakis ◽

Evangelia Yannaki ◽

Anastasia Papadopoulou

Keyword(s):

Host Defense ◽

Hematopoietic Cell Transplantation ◽

State Of The Art ◽

Fungal Infections ◽

Solid Organ Transplantation ◽

Immunocompromised Host ◽

Antifungal Drugs ◽

Solid Organ ◽

Cell Immunotherapy ◽

Life Threatening

Despite the availability of a variety of antifungal drugs, opportunistic fungal infections still remain life-threatening for immunocompromised patients, such as those undergoing allogeneic hematopoietic cell transplantation or solid organ transplantation. Suboptimal efficacy, toxicity, development of resistant variants and recurrent episodes are limitations associated with current antifungal drug therapy. Adjunctive immunotherapies reinforcing the host defense against fungi and aiding in clearance of opportunistic pathogens are continuously gaining ground in this battle. Here, we review alternative approaches for the management of fungal infections going beyond the state of the art and placing an emphasis on fungus-specific T cell immunotherapy. Harnessing the power of T cells in the form of adoptive immunotherapy represents the strenuous protagonist of the current immunotherapeutic approaches towards combating invasive fungal infections. The progress that has been made over the last years in this field and remaining challenges as well, will be discussed.

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Gastrointestinal Histoplasmosis Mimicking Crohn’s Disease

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab249 ◽

2021 ◽

Author(s):

Esfandiar Shojaei ◽

Joanna C Walsh ◽

Nikhil Sangle ◽

Brian Yan ◽

Michael S Silverman ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Antifungal Therapy ◽

Immunocompetent Patient ◽

Immunocompromised Patients ◽

Disseminated Histoplasmosis ◽

Gastrointestinal Histoplasmosis ◽

Life Threatening ◽

Inflammatory Drugs ◽

Tissue Specimens

Abstract Disseminated histoplasmosis is a life-threatening disease usually seen in immunocompromised patients living in endemic areas. We present an apparently immunocompetent patient with gastrointestinal histoplasmosis who was initially diagnosed as biopsy-proven Crohn’s disease. Following discontinuation of anti-inflammatory drugs and institution of antifungal therapy, his GI illness completely improved. Specific fungal staining should be routinely included in histopathologic assessment of tissue specimens diagnosed as Crohn’s disease.

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Systemic Diseases Associated with Nasal Symptoms

American Journal of Rhinology ◽

10.2500/105065887781390390 ◽

1987 ◽

Vol 1 (1) ◽

pp. 33-44 ◽

Cited By ~ 2

Author(s):

Guy A. Settipane

Keyword(s):

Differential Diagnosis ◽

Fungal Infections ◽

Systemic Disease ◽

Systemic Diseases ◽

Proper Treatment ◽

Csf Rhinorrhea ◽

Nasal Symptoms ◽

Appropriate Treatment ◽

Life Threatening ◽

Careful History

Many systemic diseases are associated with nasal symptoms, Rhinitis associated with asthma is probably the most common with leprosy and fungal infections being the rarest. A careful history and nasal examination in a patient with rhinitis may lead to the discovery of more significant systemic diseases. Proper treatment of systemic disease will often cure or improve the associated rhinitis. Similarly, appropriate treatment of the rhinitis/sinusitis may reduce systemic complaints such as asthma. At times, identification of the cause of rhinitis as in CSF rhinorrhea, Wegeners’ syndrome, etc., alerts one to a life-threatening entity. Thus, it is apparent that the nose is an excellent mirror of some systemic diseases and identifying and understanding the differential diagnosis of nasal symptoms may be a tremendous help in diagnosing the disease and treating the whole patient.

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The p47phox mouse knock-out model of chronic granulomatous disease.

Journal of Experimental Medicine ◽

10.1084/jem.182.3.751 ◽

1995 ◽

Vol 182 (3) ◽

pp. 751-758 ◽

Cited By ~ 375

Author(s):

S H Jackson ◽

J I Gallin ◽

S M Holland

Keyword(s):

Nadph Oxidase ◽

Chronic Granulomatous Disease ◽

Fungal Infections ◽

Critical Role ◽

Granulomatous Inflammation ◽

Mammalian Host ◽

Granulomatous Disease ◽

Knock Out ◽

Phagocyte Nadph Oxidase ◽

Life Threatening

Chronic granulomatous disease (CGD) is caused by a congenital defect in phagocyte reduced nicotinamide dinucleotide phosphate (NADPH) oxidase production of superoxide and related species. It is characterized by recurrent life-threatening bacterial and fungal infections and tissue granuloma formation. We have created a mouse model of CGD by targeted disruption of p47phox, one of the genes in which mutations cause human CGD. Identical to the case in human CGD, leukocytes from p47phox-/- mice produced no superoxide and killed staphylococci ineffectively. p47phox-/- mice developed lethal infections and granulomatous inflammation similar to those encountered in human CGD patients. This model mirrors human CGD and confirms a critical role for the phagocyte NADPH oxidase in mammalian host defense.

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