Invasive fungal infections in the Nigerian paediatric population: A systematic review

Invasive fungal infections (IFIs) are life-threatening affecting all age groups. Several studies on IFIs in Nigeria are documented, but reviews describing their occurrence in the paediatric population are lacking in the literature. We conducted a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using the PubMed database, we identified case reports, series, and observational studies reporting IFIs in the Nigerian paediatric population from inception to December 2024. We identified a total of 114 cases of IFIs from 35 articles published between 1964 and 2023. Eight IFIs were identified including invasive candidiasis (59.6 %, n = 68), histoplasmosis (16.7 %, n = 19), pneumocystis pneumonia (2.6 %, n = 3), aspergillosis (2.6 %, n = 3), cryptococcosis (5.3 %, n = 6), entomophthoromycosis (7.9 %, n = 9), mucormycosis (2.6 %, n = 3) and eumycetoma (0.9 %, n = 1). Two (1.8 %) cases were reported as phycomycosis, and it was unclear whether these were cases of entomophthoromycosis or mucormycosis, as the fungal cultures were unsuccessful. Diagnosis was predominantly by culture (n = 59, 51.8 %) and histopathology (n = 30, 26.3 %). Outcomes were stated in 72 cases: 47 (41.2 %) recovered, 23 (20.2 %) died, one (0.9 %) lost to follow up and one (0.9 %) left against medical advice. Fatal outcomes were associated with delayed diagnosis and the lack of appropriate antifungals. IFIs are severely underdiagnosed in Nigerian children with significant gaps in the management of cases, including a low index of suspicion, delayed diagnosis, lack of diagnostics, especially the non-culture-based assays and poor accessibility to appropriate antifungal agents. Collaborative efforts to drive awareness and active surveillance of IFIs with funding for research targeted at the Nigerian paediatric population will mitigate these gaps.