Invasive candidiasis in Africa, what is the current picture?

The author discusses the management of invasive candidiasis in Africa and associated setbacks. 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.

Automated summary

The author discusses the management and challenges of invasive candidiasis in Africa. A systematic search of literature revealed 18,293 documented cases of invasive candidiasis in Africa between 1976 and 2021, with 91% of cases being candidemia. South Africa accounted for the highest number of reported cases, potentially due to underreporting in other countries. Candida albicans was the most frequently isolated species, followed by Candida parapsilosis and Candida auris. Blood culture was the most commonly used diagnostic method, while serological tests were used in only a few studies. Echinocandins were recommended as first-line therapy but limited in availability and high in cost, leading to increased resistance to fluconazole.