Opportunistic Fungal Infections in Sub-Saharan Africa

Opportunistic fungal infections are a major cause of morbidity and mortality in sub-Saharan Africa. The high prevalence of advanced HIV disease, limited surveillance and reporting of fungal disease, and lack of access to healthcare lead to a disproportionate number of fungal-related deaths in this region. This review explores selected fungal pathogens associated with the highest mortality rates: Cryptococcus neoformans and Pneumocystis jirovecii, as well as endemic dimorphic fungal pathogens Histoplasma spp. and Emergomyces africanus, which are underreported in the region. Recent advances in our understanding of pathogenesis and how this knowledge may be exploited for the development of novel antifungals and therapies are discussed. We reflect on the risk factors unique to sub-Saharan Africa and on the diagnostic and treatment challenges, and we highlight the current research priorities that are needed to reduce the burden of fungal disease in this endemic region.