Deep fungal infections diagnosed by histology in Uganda: a 70-year retrospective study
Deep fungal infections diagnosed by histology in Uganda: a 70-year retrospective study
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DOI：
10.1093/mmy/myaa018
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发表时间：
2020-11-01
期刊：
影响因子：
2.9
通讯作者：
Lukande, Robert
中科院分区：
文献类型：
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作者：
Kwizera, Richard;Bongomin, Felix;Lukande, Robert
真菌感染导致大量的发病率和死亡率。然而，乌干达并没有很好地描述深部真菌感染的负担。我们的目的是估计乌干达组织学诊断的深部真菌感染的负担和病因。我们回顾性审查了 1950 年 1 月至 2019 年 9 月乌干达坎帕拉麦克雷雷大学病理学系病理参考实验室的组织学报告，以确定任何以真菌感染作为诊断的报告。在研究期间，共发现 697 例深部真菌感染病例，平均发病率为每十年 0.73/10 万人。发现的病例数量普遍下降。病例的中位年龄为 28 岁（IQR：11-40），大多数（59%）为男性。 0-10岁年龄段受影响最大。脚是身体受影响最严重的部位（26%）。已发现的深部真菌病包括真菌肿（32%）、皮下藻菌病（26%）、组织胞浆菌病（9.2%）、着色芽生菌病（4.6%）、曲霉菌病（3.3%）、隐球菌病（3.3%）、芽生菌病（1.6%）、皮下真菌病（1.4%）、皮肤真菌病（1.3%）、球孢子菌病（0.6%）、毛霉菌病（0.6%）和孢子丝菌病（0.1%）。组织胞浆菌是最常见的病原体 (9.2%)，其次是曲霉属 (3.4%) 和隐球菌属 (3.3%)，而 81% 的真菌病原体未鉴定到属/种水平。只有31%的病例临床诊断为深部真菌感染。乌干达存在着由多种真菌病原体引起的深部真菌感染的巨大负担。需要建设当地的真菌学能力，以提高临床怀疑指数和诊断能力。
Fungal infections cause substantial morbidity and mortality. However, the burden of deep fungal infections is not well described in Uganda. We aimed to estimate the burden and etiology of histologically diagnosed deep fungal infections in Uganda. We retrospectively reviewed histology reports at the Pathology Reference Laboratory, Department of Pathology, Makerere University, Kampala, Uganda from January 1950 to September 2019 to identify any reports that had a fungal infection as the diagnosis. Over the study period, 697 cases of deep fungal infections were identified with an average incidence of 0.73/100,000 persons per decade. There was a general decline in the number of cases detected. Median age of the cases was 28 years (IQR: 11-40) and majority (59%) were male. The age group of 0-10 years were the most affected. The foot was the most affected part of the body (26%). Deep mycoses identified include eumycetoma (32%), subcutaneous phycomycosis (26%), histoplasmosis (9.2%), chromoblastomycosis (4.6%), aspergillosis (3.3%), cryptococcosis (3.3%), blastomycosis (1.6%), subcutaneous mycosis (1.4%), dermatomycosis (1.3%), coccidioidomycosis (0.6%), mucormycosis (0.6%), and sporotrichosis (0.1%). Histoplasma was the commonest causative agent (9.2%) followed by Aspergillus (3.4%) and Cryptococcus (3.3%), while 81% of the fungal pathogens were not identified to genus/species level. Only 31% of the cases were diagnosed clinically as deep fungal infections. There is a substantial burden of deep fungal infections caused by multiple fungal pathogens in Uganda. There is need to build local capacity for mycology so as to improve on the index of clinical suspicion and diagnostic capabilities.