Endemic mycoses in South Africa, 2010-2020: A decade-long description of laboratory-diagnosed cases and prospects for the future.
Endemic mycoses in South Africa, 2010-2020: A decade-long description of laboratory-diagnosed cases and prospects for the future.
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DOI：
10.1371/journal.pntd.0010737
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发表时间：
2022-09
影响因子：
3.8
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芽生菌病、组织胞浆菌病、孢子丝菌病和芽生菌病是南部非洲的地方病；前两种是与艾滋病相关的真菌病。我们描述了十多年来南非地方性和输入性真菌病的实验室诊断病例，并讨论了可用的诊断工具、当前病例估计不足的原因以及改进病例查明的未来策略。我们分析了 2010 年至 2020 年南非所有公共实验室和一个大型私人实验室的电子病理实验室数据。还包括在国家真菌学参考实验室处理的诊断标本。我们根据识别方法将案件分为已证实的、可能的和可能的。我们发现了 682 例病例，其中 307 例已确诊，279 例为疑似病例，96 例为可能病例。在 307 例培养确诊病例中，168 例通过表型方法加测序鉴定，128 例仅通过表型方法鉴定，11 例通过直接 PCR 鉴定。在 279 例疑似病例中，176 例在组织学上观察到酵母菌，100 例组织胞浆菌抗原检测呈阳性，3 例泛二态性 PCR 检测呈阳性。所有 96 例可能的病例都具有与皮肤组织组织学上炎症浸润相一致的临床综合征。大多数病例患有未明确的地方性真菌病（207/682，30.4％），其次是孢子丝菌病（170/682，24.9％），芽生菌病（154/682，22.6％），组织胞浆菌病（133/682，19.5％），芽生菌病（14/682，2.1％）和踝部真菌病（4/682，0.6%）。考虑到估计有大量人口处于危险之中，这项研究报告的病例数在十年内相对较低，这表明很大一部分病例可能仍未得到诊断。有必要提高医护人员的认识，开发快速的护理点诊断工具并使其广泛使用。芽生菌病、组织胞浆菌病、孢子丝菌病和芽生菌病是严重的真菌病，发生在南部非洲免疫系统健康或薄弱的人群中。这些真菌疾病可能会被忽视，因为它们模仿其他疾病，与掩盖其存在的其他疾病一起发生，或者根本没有被医护人员考虑到。可用的简单诊断测试很少，大多数非洲国家不进行真菌病监测。我们描述了 2010 年至 2020 年在南非实验室诊断的这些真菌病病例。根据现有的临床和实验室信息，我们发现了 682 例病例，其中 307 例已确诊，279 例为可能病例，96 例为可能病例。大多数病例不能归入四种疾病类型中的一种，被归类为非特异性地方性真菌病（30.4%）。其余为孢子丝菌病 (24.9%)、芽生菌病 (22.3%)、组织胞浆菌病 (19.5%)、芽生菌病 (2.1%) 和旅行相关感染踝部真菌病 (0.6%)。考虑到高危人群，我们发现的病例相对较少。我们认为，这可能是由于上述问题和诊断实验室专业知识不足造成的。有必要提高医护人员的认识，开发快速的护理点诊断工具并使其广泛使用。
Emergomycosis, histoplasmosis, sporotrichosis and blastomycosis are endemic to southern Africa; the first two are AIDS-related mycoses. We described laboratory-diagnosed cases of endemic and imported mycoses in South Africa over a decade and discuss available diagnostic tools, reasons for the current under-estimation of cases and future strategies to improve case ascertainment. We analysed electronic pathology laboratory data from all public laboratories and one large private laboratory in South Africa from 2010–2020. Diagnostic specimens processed at the national mycology reference laboratory were also included. We classified cases as proven, probable and possible based on the method of identification. We identified 682 cases, of which 307 were proven, 279 were probable and 96 were possible. Of 307 culture-confirmed cases, 168 were identified by phenotypic methods plus sequencing, 128 by phenotypic methods alone and 11 by direct PCR. Of 279 probable cases, 176 had yeasts observed on histology, 100 had a positive Histoplasma antigen test and 3 a positive pan-dimorphic PCR test. All 96 possible cases had compatible clinical syndrome with inflammatory infiltrates on skin tissue histology. A majority of cases had an unspecified endemic mycosis (207/682, 30.4%), followed by sporotrichosis (170/682, 24.9%), emergomycosis (154/682, 22.6%), histoplasmosis (133/682, 19.5%), blastomycosis (14/682, 2.1%) and talaromycosis (4/682, 0.6%). This study reports a relatively low number of cases over a decade considering an estimated large population at risk, suggesting that a substantial fraction of cases may remain undiagnosed. There is a need to increase awareness among healthcare workers and to develop rapid point-of-care diagnostic tools and make these widely accessible. Emergomycosis, histoplasmosis, sporotrichosis and blastomycosis are serious fungal diseases which occur in southern Africa among people with either healthy or weakened immune systems. These fungal diseases may be missed because they mimic other diseases, occur together with other conditions that mask their presence or are simply not considered by healthcare workers. There are very few available simple diagnostic tests and most African countries do not conduct fungal disease surveillance. We described cases of these fungal diseases, which had been diagnosed in South African laboratories, from 2010–2020. We identified 682 cases, of which 307 were proven, 279 were probable and 96 were possible based on the available clinical and laboratory information. A majority of cases could not be allocated to one of the four disease types and were classified as unspecific endemic mycoses (30.4%). The remainder were sporotrichosis (24.9%), emergomycosis (22.3%), histoplasmosis (19.5%), blastomycosis (2.1%) and a travel-associated infection, talaromycosis (0.6%). We found relatively few cases considering the large population at risk. We believe that this could be due to the above-mentioned issues and insufficient expertise in diagnostic laboratories. There is a need to increase awareness among healthcare workers and to develop rapid point-of-care diagnostic tools and make these widely accessible.
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