Invasive candidiasis (IC) is an emerging opportunistic fungal infection associated with high mortality among hospitalized patients. Although the epidemiology of IC is progressively changing worldwide, the trend in Africa still needs to be established. This review aimed to evaluate the epidemiology of IC in Western region of Africa. A comprehensive literature search was performed on major electronic databases to identify relevant articles. DerSimonian and Laird random-effects model was used to pool overall prevalence and estimated incidence data. We identified 1975 articles, among which 23 met our inclusion criteria for the systematic review. Available data showed that only 50% (8/16) of West African countries were reported data on IC and only 25% reported at least one laboratory confirmed IC case. The global prevalence of candidemia and non-candidemic deep-seated candidiasis were 0.35% [95% CI 0.23; 0.47] and 0.32% [95% CI 0.00; 2.03], respectively. Among clinical IC cases, only 5.21% were reported before 2010, while 50.08% were reported in the past 5 years. The pooled estimated incidence was 5.55/100,000 [95% CI 5.46; 5.64] and 1.15/100,000 [95% CI 1.11; 1.19, 95% CI]/inhabitants for candidemia, and Candida peritonitis, respectively. The case fatality rate was 57.58%. Low gestational age, exposure to broad-spectrum antibiotics and invasive procedures were associated with a higher risk of IC in newborn patients. Candida albicans (32.98%) was the most common causative species of IC followed by C. tropicalis (11.34%) and C. parapsilosis (6.19%). This study showed the scarcity of IC data in western region of Africa and the existence of undiagnosed IC cases.
References
[1]
Pappas, P.G., Lionakis, M.S., Arendrup, M.C., Ostrosky-Zeichner, L. and Kullberg, B.J. (2018) Invasive Candidiasis. NatureReviewsDiseasePrimers, 4, Article No. 18026. https://doi.org/10.1038/nrdp.2018.26
[2]
Tumbarello, M., Fiori, B., Trecarichi, E.M., Posteraro, P., Losito, A.R., De Luca, A., etal. (2012) Risk Factors and Outcomes of Candidemia Caused by Biofilm-Forming Isolates in a Tertiary Care Hospital. PLOS ONE, 7, e33705. https://doi.org/10.1371/journal.pone.0033705
[3]
Poissy, J., Damonti, L., Bignon, A., Khanna, N., Von Kietzell, M., Boggian, K., etal. (2020) Risk Factors for Candidemia: A Prospective Matched Case-Control Study. CriticalCare, 24, Article No. 109. https://doi.org/10.1186/s13054-020-2766-1
[4]
Afzal, M., Abbas, E., Hamid, M., Nasir, H., Laeeq, A. and Hanif, A. (2020) Risk Factors for Candidemia in Neonates with Sepsis in a Tertiary Care Hospital in Pakistan. Journal of the Pakistan Medical Association, 70, 1568-1571.
[5]
Thomas-Rüddel, D.O., Schlattmann, P., Pletz, M., Kurzai, O. and Bloos, F. (2022) Risk Factors for Invasive Candida Infection in Critically Ill Patients. CHEST, 161, 345-355. https://doi.org/10.1016/j.chest.2021.08.081
[6]
Denning, D.W. (2024) Global Incidence and Mortality of Severe Fungal Disease. TheLancetInfectiousDiseases, 24, e428-e438. https://doi.org/10.1016/s1473-3099(23)00692-8
[7]
Magill, S.S., Edwards, J.R., Bamberg, W., Beldavs, Z.G., Dumyati, G., Kainer, M.A., etal. (2014) Multistate Point-Prevalence Survey of Health Care-Associated Infections. NewEnglandJournalofMedicine, 370, 1198-1208. https://doi.org/10.1056/nejmoa1306801
Pappas, P.G., Kauffman, C.A., Andes, D.R., Clancy, C.J., Marr, K.A., Ostrosky-Zeichner, L., et al. (2015) Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. ClinicalInfectiousDiseases, 62, e1-e50. https://doi.org/10.1093/cid/civ933
[12]
Yerbanga, I.W., Diallo, S.N., Rouamba, T., Ouedraogo, D.F., Lagrou, K., Oladele, R., etal. (2024) Epidemiology, Clinical Features and Antifungal Resistance Profile of Candida auris in Africa: Systematic Review. JournalofBiosciencesandMedicines, 12, 126-149. https://doi.org/10.4236/jbm.2024.121012
[13]
Okoye, C.A., Nweze, E. and Ibe, C. (2022) Invasive Candidiasis in Africa, What Is the Current Picture? PathogensandDisease, 80, ftac012. https://doi.org/10.1093/femspd/ftac012
[14]
World Health Organization (2022) WHO Fungal Priority Pathogens List to Guide Research, Development and Public Health Action.
[15]
Douglas, L.J. (2003) Candida Biofilms and Their Role in Infection. TrendsinMicrobiology, 11, 30-36. https://doi.org/10.1016/s0966-842x(02)00002-1
[16]
Li, W., Chen, Y., Kuo, S., Chen, F. and Lee, C. (2018) The Impact of Biofilm Formation on the Persistence of Candidemia. FrontiersinMicrobiology, 9, Article 1196. https://doi.org/10.3389/fmicb.2018.01196
[17]
Lamoth, F., Lockhart, S.R., Berkow, E.L. and Calandra, T. (2018) Changes in the Epidemiological Landscape of Invasive Candidiasis. Journal of Antimicrobial Chemotherapy, 73, i4-i13. https://doi.org/10.1093/jac/dkx444
[18]
Oladele, R., Otu, A.A., Olubamwo, O., Makanjuola, O.B., Ochang, E., Ejembi, J.A., etal. (2020) Evaluation of Knowledge and Awareness of Invasive Fungal Infections Amongst Resident Doctors in Nigeria. PanAfricanMedicalJournal, 36, Article 297. https://doi.org/10.11604/pamj.2020.36.297.23279
[19]
Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., etal. (2021) The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
[20]
DerSimonian, R. and Laird, N. (1986) Meta-Analysis in Clinical Trials. ControlledClinicalTrials, 7, 177-188. https://doi.org/10.1016/0197-2456(86)90046-2
[21]
Nyaga, V.N., Arbyn, M. and Aerts, M. (2014) Metaprop: A Stata Command to Perform Meta-Analysis of Binomial Data. ArchivesofPublicHealth, 72, Article No. 39. https://doi.org/10.1186/2049-3258-72-39
[22]
Higgins, J.P.T. and Thompson, S.G. (2002) Quantifying Heterogeneity in a Meta‐Analysis. StatisticsinMedicine, 21, 1539-1558. https://doi.org/10.1002/sim.1186
[23]
Sterne, J.A.C., Sutton, A.J., Ioannidis, J.P.A., Terrin, N., Jones, D.R., Lau, J., etal. (2011) Recommendations for Examining and Interpreting Funnel Plot Asymmetry in Meta-Analyses of Randomised Controlled Trials. BMJ, 343, d4002. https://doi.org/10.1136/bmj.d4002
[24]
Nwadike, V, Onwah, A.L., Owolabi, T.A. and Ogunnaike-Quaye, T.B. (2013) Candidemia in the Immunocompromised: A Case for Early Diagnosis/Detection and Treatment. Jos Journal of Medicine, 7, 38-40.
[25]
Oladele, R., Uwanibe, J.N., Olawoye, I.B., Ettu, A.O., Meis, J.F. and Happi, C.T. (2022) Emergence and Genomic Characterization of Multidrug Resistant Candida auris in Nigeria, West Africa. JournalofFungi, 8, Article 787. https://doi.org/10.3390/jof8080787
[26]
Sanni, U.A., Lawal, T.O., Na’uzo, A.M. and Audu, L.I. (2023) Invasive Fungal Infection Presenting as Early-Onset Neonatal Sepsis: A Case Report from Northern Nigeria. JournalofClinicalNeonatology, 12, 38-41. https://doi.org/10.4103/jcn.jcn_98_22
[27]
Sanya, E., Ameen, N. and Onile, B. (2007) Candida Meningitis in a Suspected Immunosuppressive Patient—A Case Report. WestAfricanJournalofMedicine, 25, 79-81. https://doi.org/10.4314/wajm.v25i1.28251
[28]
Ukekwe, F., Nwajiobi, C., Agbo, M., Ebede, S. and Eni, A. (2015) Candidiasis, a Rare Cause of Gastric Perforation: A Case Report and Review of Literature. AnnalsofMedicalandHealthSciencesResearch, 5, 314-316. https://doi.org/10.4103/2141-9248.160187
[29]
Vugia, D.J., Kiehlbauch, J.A., Yeboue, K., N'Gbichi, J.M., Lacina, D., Maran, M., etal. (1993) Pathogens and Predictors of Fatal Septicemia Associated with Human Immunodeficiency Virus Infection in Ivory Coast, West Africa. JournalofInfectiousDiseases, 168, 564-570. https://doi.org/10.1093/infdis/168.3.564
[30]
Eholie, S.P., Adou-Brynh, D., Domoua, K., Kakou, A., Ehui, E., Gouamene, A., etal. (2000) Adult Non-Viral Lymphocytic Meningitis in Abidjan (Côte d’Ivoire). Bulletin de la Société de PathologieExotique, 93, 50-54.
[31]
Eholie, S.P., N’gbocho, L., Bissagnene, E., Coulibaly, M., Ehui, E., Kra, O., etal. (1997) Deep Mycoses in AIDS in Abidjan (Côte d’Ivoire). Bulletinde la SocietedePathologieExotique, 90, 307-311.
[32]
Howie, S.R.C., Ebruke, B.E., McLellan, J.L., Deloria Knoll, M., Dione, M.M., Feikin, D.R., etal. (2021) The Etiology of Childhood Pneumonia in the Gambia: Findings from the Pneumonia Etiology Research for Child Health (PERCH) Study. PediatricInfectiousDiseaseJournal, 40, S7-S17. https://doi.org/10.1097/inf.0000000000002766
[33]
Obeng-Nkrumah, N., Labi, A., Acquah, M.E. and Donkor, E.S. (2015) Bloodstream Infections in Patients with Malignancies: Implications for Antibiotic Treatment in a Ghanaian Tertiary Setting. BMCResearchNotes, 8, Article No. 742. https://doi.org/10.1186/s13104-015-1701-z
[34]
Labi, A., Obeng-Nkrumah, N., Bjerrum, S., Enweronu-Laryea, C. and Newman, M.J. (2016) Neonatal Bloodstream Infections in a Ghanaian Tertiary Hospital: Are the Current Antibiotic Recommendations Adequate? BMCInfectiousDiseases, 16, Article No. 598. https://doi.org/10.1186/s12879-016-1913-4
[35]
Ezenwa, B., Oladele, R., Akintan, P., Fajolu, I., Oshun, P., Oduyebo, O., etal. (2017) Invasive Candidiasis in a Neonatal Intensive Care Unit in Lagos, Nigeria. NigerianPostgraduateMedicalJournal, 24, 150-154. https://doi.org/10.4103/npmj.npmj_104_17
[36]
Ojogba, O., Grace, A., Bose, T., Esther, E., Inyang, O., Abel, I., etal. (2020) Neonatal Fungal Sepsis in Jos North-Central Nigeria. JournalofMedicineintheTropics, 22, 80-85. https://doi.org/10.4103/jomt.jomt_29_19
[37]
Oladele, R.O., Bakare, R.A., Petrou, M.A., Oduyebo, O.O. and Richardson, M. (2014) Candidaemia in a Tertiary Hospital in Nigeria. AfricanJournalofLaboratoryMedicine, 3, a89. https://doi.org/10.4102/ajlm.v3i1.89
[38]
Omene, J.A., Odita, J.C. and Okolo, A.A. (1984) Neonatal Osteomyelitis in Nigerian Infants. PediatricRadiology, 14, 318-322. https://doi.org/10.1007/bf01601884
[39]
Olubiyo, R., Chukwumeze, F., Lawal, A.M., Oloruntuyi, G., Musoka, H., Augustine, N.A., etal. (2023) Retrospective Analysis of Fungemia among Children in Anka General Hospital, Nigeria, from October 2018 to November 2021: A Case Series. OxfordMedicalCaseReports, 2023, omad071. https://doi.org/10.1093/omcr/omad071
[40]
Bamba, S., Zida, A., Sangaré, I., Cissé, M., Denning, D. and Hennequin, C. (2018) Burden of Severe Fungal Infections in Burkina Faso. JournalofFungi, 4, Article 35. https://doi.org/10.3390/jof4010035
[41]
Koffi, D., Bonouman, I.V., Toure, A.O., Kouadjo, F., N’Gou, M.R.E., Sylla, K., etal. (2021) Estimates of Serious Fungal Infection Burden in Côte d’Ivoire and Country Health Profile. JournalofMedicalMycology, 31, Article 101086. https://doi.org/10.1016/j.mycmed.2020.101086
[42]
Ocansey, B.K., Pesewu, G.A., Codjoe, F.S., Osei-Djarbeng, S., Feglo, P.K. and Denning, D.W. (2019) Estimated Burden of Serious Fungal Infections in Ghana. JournalofFungi, 5, Article 38. https://doi.org/10.3390/jof5020038
[43]
Oladele, R.O. and Denning, D.W. (2014) Burden of Serious Fungal Infection in Nigeria. WestAfricanJournalofMedicine, 33, 107-114.
[44]
Lakoh, S., Orefuwa, E., Kamara, M.N., Jiba, D.F., Kamara, J.B., Kpaka, S., etal. (2021) The Burden of Serious Fungal Infections in Sierra Leone: A National Estimate. TherapeuticAdvancesinInfectiousDisease, 8. https://doi.org/10.1177/20499361211027996
[45]
Dorkenoo, A.M., Adjetey‐Toglozombio, A.K., Ocansey, B.K., Sossou, E., Lack, F. and Denning, D.W. (2021) Estimated Burden of Serious Fungal Infections in Togo. Mycoses, 64, 1535-1541. https://doi.org/10.1111/myc.13377
[46]
Doumbo, S.N., Cissoko, Y., Dama, S., Niangaly, A., Garango, A., Konaté, A., etal. (2023) The Estimated Burden of Fungal Diseases in Mali. JournalofMedicalMycology, 33, 101333. https://doi.org/10.1016/j.mycmed.2022.101333
[47]
Bongomin, F., Gago, S., Oladele, R. and Denning, D. (2017) Global and Multi-National Prevalence of Fungal Diseases—Estimate Precision. JournalofFungi, 3, Article 57. https://doi.org/10.3390/jof3040057
[48]
Koehler, P., Stecher, M., Cornely, O.A., Koehler, D., Vehreschild, M.J.G.T., Bohlius, J., etal. (2019) Morbidity and Mortality of Candidemia in Europe: An Epidemiologic Meta-Analysis. ClinicalMicrobiologyandInfection, 25, 1200-1212. https://doi.org/10.1016/j.cmi.2019.04.024
[49]
Badiane, A.S., Ndiaye, D. and Denning, D.W. (2015) Burden of Fungal Infections in Senegal. Mycoses, 58, 63-69. https://doi.org/10.1111/myc.12381
[50]
Clancy, C.J. and Nguyen, M.H. (2013) Finding the “Missing 50%” of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care. ClinicalInfectiousDiseases, 56, 1284-1292. https://doi.org/10.1093/cid/cit006
[51]
Fortun, J., Meije, Y., Buitrago, M.J., Gago, S., Bernal-Martinez, L., Peman, J., etal. (2014) Clinical Validation of a Multiplex Real-Time PCR Assay for Detection of Invasive Candidiasis in Intensive Care Unit Patients. JournalofAntimicrobialChemotherapy, 69, 3134-3141. https://doi.org/10.1093/jac/dku225
[52]
Nashwa, M.A., Nermein, A.E.K., Mohammed, M. and Maysaa, E.S.Z. (2017) Evaluation of Semi-Nested Polymerase Chain Reaction (PCR) and Mannan Antigen Detection Compared to Blood Culture for Diagnosis of Candidemia. AfricanJournalofMicrobiologyResearch, 11, 1061-1068. https://doi.org/10.5897/ajmr2017.8613
[53]
Held, J., Kohlberger, I., Rappold, E., Busse Grawitz, A. and Häcker, G. (2013) Comparison of (1→3)-β-D-Glucan, Mannan/Anti-Mannan Antibodies, and Cand-Tec Candida Antigen as Serum Biomarkers for Candidemia. JournalofClinicalMicrobiology, 51, 1158-1164. https://doi.org/10.1128/jcm.02473-12
[54]
Lass-Flörl, C., Kanj, S.S., Govender, N.P., Thompson, G.R., Ostrosky-Zeichner, L. and Govrins, M.A. (2024) Invasive Candidiasis. NatureReviewsDiseasePrimers, 10, Article No. 20. https://doi.org/10.1038/s41572-024-00503-3
[55]
Ma, C., Li, F., Shi, L., Hu, Y., Wang, Y., Huang, M., etal. (2013) Surveillance Study of Species Distribution, Antifungal Susceptibility and Mortality of Nosocomial Candidemia in a Tertiary Care Hospital in China. BMCInfectiousDiseases, 13, Article No. 337. https://doi.org/10.1186/1471-2334-13-337
[56]
Kaur, H. and Chakrabarti, A. (2017) Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries. JournalofFungi, 3, Article 41. https://doi.org/10.3390/jof3030041
[57]
Naik, B., Ahmed, S.M.Q., Laha, S. and Das, S.P. (2021) Genetic Susceptibility to Fungal Infections and Links to Human Ancestry. Frontiers in Genetics, 12, Article 709315. https://doi.org/10.3389/fgene.2021.709315
[58]
Johnson, M.D., Plantinga, T.S., van de Vosse, E., Velez Edwards, D.R., Smith, P.B., Alexander, B.D., etal. (2011) Cytokine Gene Polymorphisms and the Outcome of Invasive Candidiasis: A Prospective Cohort Study. ClinicalInfectiousDiseases, 54, 502-510. https://doi.org/10.1093/cid/cir827
[59]
Arendrup, M.C. (2013) Candida and Candidemia. Susceptibility and Epidemiology. Danish Medical Journal, 60, B4698.
[60]
Chapman, B., Slavin, M., Marriott, D., Halliday, C., Kidd, S., Arthur, I., etal. (2016) Changing Epidemiology of Candidaemia in Australia. Journal of Antimicrobial Chemotherapy, 72, 1103-1108. https://doi.org/10.1093/jac/dkw422
[61]
Seagle, E.E., Jackson, B.R., Lockhart, S.R., Georgacopoulos, O., Nunnally, N.S., Roland, J., etal. (2021) The Landscape of Candidemia during the Coronavirus Disease 2019 (COVID-19) Pandemic. ClinicalInfectiousDiseases, 74, 802-811. https://doi.org/10.1093/cid/ciab562
[62]
Lockhart, S.R., Etienne, K.A., Vallabhaneni, S., Farooqi, J., Chowdhary, A., Govender, N.P., etal. (2016) Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. ClinicalInfectiousDiseases, 64, 134-140. https://doi.org/10.1093/cid/ciw691
[63]
Bongomin, F. and Adetona Fayemiwo, S. (2021) Epidemiology of Fungal Diseases in Africa: A Review of Diagnostic Drivers. CurrentMedicalMycology, 7, 63-70. https://doi.org/10.18502/cmm.7.1.6246
[64]
Kilburn, S., Innes, G., Quinn, M., Southwick, K., Ostrowsky, B., Greenko, J.A., etal. (2022) Antifungal Resistance Trends of Candida auris Clinical Isolates in New York and New Jersey from 2016 to 2020. AntimicrobialAgentsandChemotherapy, 66, e02242-21. https://doi.org/10.1128/aac.02242-21
[65]
Kollef, M., Micek, S., Hampton, N., Doherty, J.A. and Kumar, A. (2012) Septic Shock Attributed to Candida Infection: Importance of Empiric Therapy and Source Control. ClinicalInfectiousDiseases, 54, 1739-1746. https://doi.org/10.1093/cid/cis305
[66]
Puig-Asensio, M., Pemán, J., Zaragoza, R., Garnacho-Montero, J., Martín-Mazuelos, E., Cuenca-Estrella, M., etal. (2014) Impact of Therapeutic Strategies on the Prognosis of Candidemia in the ICU. CriticalCareMedicine, 42, 1423-1432. https://doi.org/10.1097/ccm.0000000000000221
[67]
Andes, D.R., Safdar, N., Baddley, J.W., Playford, G., Reboli, A.C., Rex, J.H., etal. (2012) Impact of Treatment Strategy on Outcomes in Patients with Candidemia and Other Forms of Invasive Candidiasis: A Patient-Level Quantitative Review of Randomized Trials. ClinicalInfectiousDiseases, 54, 1110-1122. https://doi.org/10.1093/cid/cis021