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Invasive candidiasis in Africa, what is the current picture?
Chinonyelum A Okoye1, Emeka Nweze2, Chibuike Ibe1
1Department of Microbiology, Faculty of Biological Sciences, Abia State University, Uturu, Abia State, Nigeria.
Abstract:
Invasive candidiasis is a serious, progressive, and potentially deadly infection that can affect the brain, heart, bones, eyes, and other parts of the body. It is associated with risk factors such as the use of indwelling medical devices, prolonged hospital stay, and broad-spectrum antibiotics use. It is especially seen in immunocompromised individuals such as patients with prolonged hospital stay, gastrointestinal surgery, haematological malignancies, and respiratory diseases. We have conducted a systematic search of literature using a select group of databases and appropriate search words and found that in Africa, there are 18 293 documented/reported cases of invasive candidiasis in the last few decades (1976-2021) and 16 636(91%) were cases of candidaemia. South Africa had the highest number of reported cases-15 002(82%), which may be due to underreporting of cases in other countries. HIV positive persons with invasive candidiasis in Africa accounted for 1 052(5.8%). Candida albicans was the most frequently isolated species 6 328(32.6%), followed by Candida parapsilosis 5 910(30.4%), and Candida auris 1 505(7.8%). Due to the affordability and availability of blood culture, it was used for diagnosis in most of the studies examined, while a few studies combined other techniques and just three studies from two countries used serological tests. Echinocandins are recommended as first-line therapy but are only available in 12 countries and are highly priced. The use of fluconazole, because of its availability and relatively inexpensive nature, has led to increased resistance of Candida species to the drug.
Insights
Invasive candidiasis, a severe fungal infection, is increasingly reported in Africa, with Candidaemia being the most common form. Rising fluconazole resistance is a concern, impacting treatment options.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Public Health in Africa
Background:
- Invasive candidiasis is a life-threatening infection affecting multiple organs, particularly in immunocompromised individuals.
- Risk factors include indwelling devices, prolonged hospitalization, and broad-spectrum antibiotics.
- The incidence and epidemiology in Africa require further investigation.
Purpose of the Study:
- To systematically review and report the documented cases of invasive candidiasis in Africa from 1976 to 2021.
- To identify the most common Candida species and their prevalence.
- To assess diagnostic methods and treatment challenges in the African context.
Main Methods:
- Systematic literature search across selected databases using specific keywords.
- Data extraction and analysis of reported invasive candidiasis cases, including candidaemia.
- Review of isolated Candida species, diagnostic techniques, and therapeutic recommendations.
Main Results:
- Over 18,000 cases of invasive candidiasis reported in Africa (1976-2021), with 91% being candidaemia.
- South Africa reported the highest number of cases (82%).
- Candida albicans, Candida parapsilosis, and Candida auris were the most frequent species; HIV-positive individuals represented 5.8% of cases.
Conclusions:
- Invasive candidiasis, particularly candidaemia, is a significant public health issue in Africa.
- Limited availability and high cost of echinocandins, coupled with rising fluconazole resistance, pose treatment challenges.
- Standardized diagnostic and therapeutic strategies are crucial for managing invasive candidiasis in Africa.
