Emerging and re-emerging fungal threats in Africa

Abstract

The emergence of deadly fungal infections in Africa is primarily driven by a disproportionately high burden of human immunodeficiency virus (HIV) infections, lack of access to quality health care, and the unavailability of effective antifungal drugs. Immunocompromised people in Africa are therefore at high risk of infection from opportunistic fungal pathogens such as Cryptococcus neoformans and Pneumocystis jirovecii, which are associated with high morbidity, mortality, and related socioeconomic impacts. Other emerging fungal threats include Emergomyces spp., Histoplasma spp., Blastomyces spp., and healthcare-associated multi-drug resistant Candida auris. Socioeconomic development and the Covid-19 pandemic may influence shifts in epidemiology of invasive fungal diseases on the continent. This review discusses the epidemiology, clinical manifestations, and current management strategies available for these emerging fungal diseases in Africa. We also discuss gaps in knowledge, policy, and research to inform future efforts at managing these fungal threats.

Keywords: dimorphic fungal pathogens; emerging fungi; fungal pathogens; opportunistic fungal infections.

FIGURE 1

Annual incidence of cryptococcal infections in Africa (modified from ¹³ )

FIGURE 2

(A) A 39‐year‐old woman, HIV‐positive, failing antiretroviral therapy: CD4 count 105 cells/mm³, HIV viral load log 5 copies/ml. Presented with weight loss and night sweats, worsening dyspnoea, myalgia, and diarrhoea over prior few days. Started on empiric treatment for PCP which was discontinued when Covid‐19 diagnosis confirmed by PCR the day after admission. There was a good response to corticosteroids and supportive management. Chest x‐ray shows bilateral interstitial infiltrates with lower zone ground glass opacification. (B) 51‐year‐old man, newly diagnosed HIV with CD4 count 49 cells/mm³. P. jirovecii confirmed by immunofluorescent staining of induced sputum. Initial chest x‐ray shows perihilar interstitial infiltrates with areas of confluence.