A diverse spectrum of mycoses histologically diagnosed in Ghana: Insights from a 10-year retrospective study

Abstract

In Ghana, most laboratory diagnoses of severe mycoses are based on histopathology findings due to inadequate availability of serology, culture, and molecular tests. The aim of this study was to evaluate the spectrum of mycoses diagnosed in Ghana. We retrospectively reviewed reports from 2012 to 2021 from three major pathology laboratories in Ghana to identify reports indicating the presence of fungal elements and diagnosis of a mycosis, then extracted demographic, clinical history, site of infection, stain(s), used and diagnosed mycosis details. Over the 10-year period, 107 cases were found. No apparent increasing and decreasing trend in the number of cases per year or in a period was observed. The age range of affected patients was from 4 to 86 years. Special stains for fungi were only used in 22 of 107 (20.6%) of cases. The most frequently affected site was the sino-nasal area (34%). Mycosis type was determined for 58 (54.2%) cases, comprising aspergillosis (21), candidiasis (14), dermatophytosis (6), mucormycosis (3), two cases each of chromoblastomycosis, histoplasmosis, eumycetoma, entomophthoromycosis, sporotrichosis, and Malassezia infection and a single case each of cryptococcosis and deep onychomycosis. Of the 53 (49.5%) cases with presumptive diagnosis data, only seven (13.2%) had a pre-biopsy suspicion of mycosis. There is a wide spectrum of mycoses in Ghana, including endemic mycoses not previously reported. Improving the use of special fungal stains could increase yield and mycoses identification. Laboratory diagnostic capacity needs enhancement to complement histopathology investigations with serology, culture, and molecular methods.

Keywords: Ghana; epidemiology; histopathology; mycosis; spectrum.

Figure 1.

Mycoses diagnosed by histopathology from 2012 to 2021.

Figure 2.

Number of cases of different types of mycoses diagnosed.

Figure 3.

H&E-stained section of a left antral mass from a 55-year-old female with epistaxis and chronic headache showing regular acute branching dichotomous septate hyphae typical of Aspergillus species.

Figure 4.

PAS-stained section of a left foot infected ganglion from a 49-year-old male showing a ring of aggregates of pigment-producing and double-contoured spherical structures known as sclerotic bodies which are consistent with chromoblastomycosis.