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Barclay-Korboi YM, Adeel A, Ajami I, Dickson FH, Wachekwa I, Vaye NAF, Levitz SM. Use of sequential lateral flow assays to diagnose cryptococcal infection among people living with HIV in Monrovia, Liberia. PLoS Negl Trop Dis 2025; 19:e0013008. [PMID: 40198673 PMCID: PMC12011301 DOI: 10.1371/journal.pntd.0013008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 04/21/2025] [Accepted: 03/24/2025] [Indexed: 04/10/2025] Open
Abstract
Cryptococcal meningitis is one of the top causes of morbidity and mortality in people living with HIV/AIDS. In high prevalence regions, current recommendations are to screen individuals with blood CD4+ T cell counts less than 200 cells/µl for serum cryptococcal antigen (CrAg) and then preemptively treat those who test positive for presumed cryptococcosis. However, in many low-resource settings, including Monrovia, Liberia, flow cytometric CD4 assays are not readily available. We tested subjects with known HIV infection using a lateral flow assay (LFA), which provides a semi-quantitative determination of whether the blood CD4+ T cell count is ≤200 cells/µl. Subjects with counts ≤200 cells/µl were then tested with an LFA that detects CrAg. Of the 500 HIV+ subjects tested, 201 (40.2%) had blood CD4+ T cell count ≤200. Of those, 82/201 (40.7%) were serum CrAg+. Subjects who were serum CrAg+ were more likely to have a Glasgow Coma Score <15, whereas subjects who were CrAg- were more likely to be HIV-2+. Lumbar punctures were performed on 61 serum CrAg+ subjects; 30/61 (49.2%) subjects were cerebrospinal fluid CrAg+. Thus, sequential point-of-care testing enabled the diagnosis of cryptococcosis in HIV+ individuals with blood CD4 T cell counts ≤200 cells/µl. As diagnostic testing informs life-saving therapies, it is imperative that these assays are made readily available in resource-poor settings.
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Affiliation(s)
- Yassah M. Barclay-Korboi
- Department of Internal Medicine, John F. Kennedy Memorial Hospital, Monrovia, Liberia
- Faculty of Internal Medicine, A. M. Dogliotti College of Medicine, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Alina Adeel
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Ibrahim Ajami
- Department of Internal Medicine, John F. Kennedy Memorial Hospital, Monrovia, Liberia
| | | | - Ian Wachekwa
- Department of Internal Medicine, John F. Kennedy Memorial Hospital, Monrovia, Liberia
- Faculty of Internal Medicine, A. M. Dogliotti College of Medicine, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Nyenyakar A. F. Vaye
- Department of Internal Medicine, John F. Kennedy Memorial Hospital, Monrovia, Liberia
| | - Stuart M. Levitz
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
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Miguel CB, Vilela GP, Almeida LM, Moreira MA, Silva GP, Miguel-Neto J, Martins-de-Abreu MC, Agostinho F, Lazo-Chica JE, Cardoso MS, Soares SDC, Góes-Neto A, Rodrigues WF. Adaptative Divergence of Cryptococcus neoformans: Phenetic and Metabolomic Profiles Reveal Distinct Pathways of Virulence and Resistance in Clinical vs. Environmental Isolates. J Fungi (Basel) 2025; 11:215. [PMID: 40137253 PMCID: PMC11943092 DOI: 10.3390/jof11030215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Revised: 02/26/2025] [Accepted: 02/27/2025] [Indexed: 03/27/2025] Open
Abstract
Cryptococcus neoformans is a life-threatening fungal pathogen that primarily affects immunocompromised individuals. While antiretroviral therapy has reduced incidence in developed nations, fluconazole-resistant strains and virulent environmental isolates continue to pose challenges, especially because they have many mechanisms of adaptability, supporting their survival. This study explores the phenetic and metabolomic adaptations of C. neoformans in clinical and environmental contexts to understand the factors influencing pathogenicity and resistance. METHODS An in silico observational study was conducted with 16 C. neoformans isolates (6 clinical, 9 environmental, and 1 reference) from the NCBI database. Molecular phenetic analysis used MEGA version 11.0.13 and focused on efflux pump protein sequences. Molecular phenetic relationships were assessed via the UPGMA clustering method with 1000 bootstrap replicates. The enzymatic profiling of glycolytic pathways was conducted with dbCAN, and metabolomic pathway enrichment analysis was performed in MetaboAnalyst 6.0 using the KEGG pathway database. RESULTS Molecular phenetic analysis revealed distinct clustering patterns among isolates, reflecting adaptations associated with clinical and environmental niches. Clinical isolates demonstrated enriched sulfur metabolism and glutathione pathways, likely adaptations to oxidative stress in host environments, while environmental isolates favored methane and glyoxylate pathways, suggesting adaptations for survival in carbon-rich environments. CONCLUSION Significant phenetic and metabolomic distinctions between isolates reveal adaptive strategies for enhancing virulence and antifungal resistance, highlighting potential therapeutic targets.
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Affiliation(s)
- Camila Botelho Miguel
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
- Postgraduate Program in Tropical Medicine and Infectious Diseases, Federal University of the Triângulo Mineiro—UFTM, Uberaba 38025-180, MG, Brazil;
| | - Geovana Pina Vilela
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
| | - Lara Mamede Almeida
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
| | - Mariane Andrade Moreira
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
| | - Glicélia Pereira Silva
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
| | - Jamil Miguel-Neto
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
| | - Melissa Carvalho Martins-de-Abreu
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
| | - Ferdinando Agostinho
- Faculty of Physiotherapy, University of Rio Verde, UniRv, Rio Verde 75901-970, GO, Brazil;
| | - Javier Emilio Lazo-Chica
- Laboratory of Cell Biology, Department of Structural Biology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba 38061-500, MG, Brazil;
| | - Mariana Santos Cardoso
- Molecular and Computational Biology of Fungi Laboratory, Department of Microbiology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (M.S.C.); (A.G.-N.)
| | - Siomar de Castro Soares
- Postgraduate Program in Tropical Medicine and Infectious Diseases, Federal University of the Triângulo Mineiro—UFTM, Uberaba 38025-180, MG, Brazil;
| | - Aristóteles Góes-Neto
- Molecular and Computational Biology of Fungi Laboratory, Department of Microbiology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (M.S.C.); (A.G.-N.)
| | - Wellington Francisco Rodrigues
- Multidisciplinary Laboratory of Scientific Evidence, University Center of Mineiros (Unifimes), Mineiros 75833-130, GO, Brazil; (C.B.M.); (G.P.V.); (L.M.A.); (M.A.M.); (G.P.S.); (J.M.-N.); (M.C.M.-d.-A.)
- Postgraduate Program in Tropical Medicine and Infectious Diseases, Federal University of the Triângulo Mineiro—UFTM, Uberaba 38025-180, MG, Brazil;
- Laboratory of Cell Biology, Department of Structural Biology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba 38061-500, MG, Brazil;
- Molecular and Computational Biology of Fungi Laboratory, Department of Microbiology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (M.S.C.); (A.G.-N.)
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Fuchs F, Frickmann H, Hahn A, Balczun C, Hagen RM, Feldt T, Sarfo FS, Di Cristanziano V, Loderstädt U, Ehrhardt S, Schoppen S, Tagbor H, Eberhardt KA. Absence of measurable quantities of Candida auris and Cryptococcus spp. in the gut microbiota of Ghanaian individuals with and without HIV infection as confirmed by applying multiple real-time PCR assays. J Med Microbiol 2024; 73. [PMID: 39392223 DOI: 10.1099/jmm.0.001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
Introduction. Fungal infections are relevant health risks for individuals with acquired immunodeficiency in the resource-limited tropics, but available surveillance data are scarce. For Candida auris and Cryptococcus spp., the evolution from environmental reservoirs to human pathogens causing life-threatening diseases is currently discussed as a public health concern in the context of climate change and limited treatment options.Gap statement. Uncovering the gastrointestinal tract as an epidemiological niche of fungi emerging from the environment into individuals for whom fungal infections are not diagnosed.Aim. To contribute to data on the local epidemiology of C. auris and Cryptococcus spp. in Western African Ghana by analysing gastrointestinal samples of Ghanaian individuals.Methodology. Four real-time PCR assays targeting C. auris and five real-time PCR assays targeting Cryptococcus spp. were applied with stool samples of 875 non-age-stratified Ghanaian HIV patients and 30 Ghanaian control individuals without known HIV infection. Also, 664 samples from Ghanaian children under 2 years of age were investigated. The true abundance of the target micro-organism was considered as unlikely in the case of one or fewer positive signals, likely in the case of two to three positive signals and highly likely in the case of four or more positive signals per sample in the real-time PCR assays.Results. The combined application of sensitive, target-specific real-time PCR assays indicates that neither C. auris, Cryptococcus neoformans complex nor Cryptococcus gattii complex were part of the gut microbiota of Ghanaian individuals with or without HIV infection.Conclusion. Despite the significant disease burden from these pathogens in immunosuppressed Ghanaian individuals, detection from gastrointestinal samples was unlikely, which should be taken into account when discussing screening strategies for these fungi of public health concern. In contrast, the detection of these fungi from such samples should not routinely be considered as commensal colonization flora.
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Affiliation(s)
- Frieder Fuchs
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Andreas Hahn
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Carsten Balczun
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Ralf Matthias Hagen
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Bonn, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Ulrike Loderstädt
- Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen, Göttingen, Germany
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Stefanie Schoppen
- Department of Health and Social Science, Hochschule Fresenius, Hamburg, Germany
| | - Harry Tagbor
- Department of Community Health, School of Medicine, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana
| | - Kirsten Alexandra Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center, Hamburg, Germany
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Omer I, Khalil I, Abdalmumin A, Molefe PF, Sabeel S, Farh IZA, Mohamed HA, Elsharif HA, Mohamed ALAH, Awad‐Elkareem MA, Salih M. Design of an epitope-based peptide vaccine against Cryptococcus neoformans. FEBS Open Bio 2024; 14:1471-1489. [PMID: 39020466 PMCID: PMC11492362 DOI: 10.1002/2211-5463.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/11/2024] [Accepted: 06/21/2024] [Indexed: 07/19/2024] Open
Abstract
Cryptococcus neoformans is the highest-ranked fungal pathogen in the Fungal Priority Pathogens List (FPPL) released by the World Health Organization (WHO). In this study, through in silico simulations, a multi-epitope vaccine against Cryptococcus neoformans was developed using the mannoprotein antigen (MP88) as a vaccine candidate. Following the retrieval of the MP88 protein sequences, these were used to predict antigenic B-cell and T-cell epitopes via the bepipred tool and the artificial neural network, respectively. Conserved B-cell epitopes AYSTPA, AYSTPAS, PASSNCK, and DSAYPP were identified as the most promising B-cell epitopes. While YMAADQFCL, VSYEEWMNY, and FQQRYTGTF were identified as the best candidates for CD8+ T-cell epitopes; and YARLLSLNA, ISYGTAMAV, and INQTSYARL were identified as the most promising CD4+ T-cell epitopes. The vaccine construct was modeled along with adjuvant and peptide linkers and the expasy protparam tool was used to predict the physiochemical properties. According to this, the construct vaccine was predicted to be antigenic, nontoxic, nonallergenic, soluble, stable, hydrophilic, and thermostable. Furthermore, the three-dimensional structure was also used in docking analyses with Toll-like receptor (TLR4). Finally, the cDNA of vaccine was successfully cloned into the E. coli pET-28a (+) expression vector. The results presented here could contribute towards the design of an effective vaccine against Cryptococcus neoformans.
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Affiliation(s)
- Ibtihal Omer
- Department of Therapeutic Drug Monitoring LaboratoryNational Center for Kidney Diseases and SurgeryKhartoumSudan
| | - Isra Khalil
- Department of Microbiology, Faculty of Medical Laboratory ScienceSudan University of Science and TechnologyKhartoumSudan
| | - Ahmed Abdalmumin
- Biomedical Research InstituteSudan National UniversityKhartoumSudan
| | - Philisiwe Fortunate Molefe
- Hair and Skin Research Laboratory, Department of Medicine, Division Dermatology, Groote Schuur HospitalUniversity of Cape TownCape TownSouth Africa
| | - Solima Sabeel
- Department of Pathology, Faculty of Health Sciences, Institute of Infectious Diseases and Molecular Medicine (IDM)University of Cape TownSouth Africa
| | | | - Hanaa Abdalla Mohamed
- Department of Microbiology, Faculty of Medical Laboratory ScienceSudan University of Science and TechnologyKhartoumSudan
| | - Hajr Abdallha Elsharif
- General Administration of Quarantine and Animal HealthRegional Training InstituteKhartoumSudan
| | | | | | - Mohamed Salih
- Department of BiotechnologyAfrica City of TechnologyKhartoumSudan
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5
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de Andrade IB, Alves V, Pereira L, Miranda B, Corrêa-Junior D, Galdino Figueiredo-Carvalho MH, Santos MV, Almeida-Paes R, Frases S. Effect of rapamycin on Cryptococcus neoformans: cellular organization, biophysics and virulence factors. Future Microbiol 2023; 18:1061-1075. [PMID: 37721517 DOI: 10.2217/fmb-2023-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background: Cryptococcus neoformans is an opportunistic fungal pathogen that causes infections mainly in immunosuppressed individuals, such as transplant recipients. Aims: This study investigated the effects of rapamycin, an immunosuppressant drug, on the cellular organization, biophysical characteristics, and main virulence factors of C. neoformans. Methods: Morphological, structural, physicochemical and biophysical analyses of cells and secreted polysaccharides of the reference H99 C. neoformans strain were investigated under the effect of subinhibitory concentrations of rapamycin. Results: Rapamycin at a minimum inhibitory concentration of 2.5 μM reduced C. neoformans cell viability by 53%, decreased capsule, increased cell size, chitin and lipid body formation, and changed peptidase and urease activity. Conclusion: Further studies are needed to assess how rapamycin affects the virulence factors and pathogenicity of C. neoformans.
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Affiliation(s)
- Iara Bastos de Andrade
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vinicius Alves
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiza Pereira
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruna Miranda
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dario Corrêa-Junior
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcos Vinicius Santos
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Rede Micologia - FAPERJ, Rio de Janeiro, Brazil
| | - Susana Frases
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Rede Micologia - FAPERJ, Rio de Janeiro, Brazil
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Bongomin F, Ekeng BE, Kwizera R, Salmanton-García J, Kibone W, van Rhijn N, Govender NP, Meya DB, Osaigbovo II, Hamer DH, Oladele R, Denning DW. Fungal diseases in Africa: Closing the gaps in diagnosis and treatment through implementation research and advocacy. J Mycol Med 2023; 33:101438. [PMID: 38358796 PMCID: PMC11103624 DOI: 10.1016/j.mycmed.2023.101438] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 02/16/2024]
Abstract
Fungal diseases impose an escalating burden on public health in Africa, exacerbated by issues such as delayed diagnosis, inadequate therapy, and limited access to healthcare resources, resulting in significant morbidity and mortality. Effectively tackling these challenges demands a comprehensive approach encompassing research, training, and advocacy initiatives. Recent clinical mycology surveys conducted by Global Action for Fungal Infection (GAFFI) and the European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) have underscored gaps in fungal diagnostics and the availability and accessibility of antifungal therapy in Africa. The World Health Organization (WHO) Fungal Priority Pathogens List (FPPL) identifies fungi of critical or high importance to human health, providing a roadmap for action and highlighting the urgent need for prioritizing fungal diseases and developing targeted interventions within the African context. To enhance diagnosis and treatment, it is imperative to invest in comprehensive training programs for healthcare workers across all levels and disciplines. Equipping them with the necessary knowledge and skills will facilitate early detection, accurate diagnosis, and appropriate management of fungal infections. Moreover, implementation science research in medical mycology assumes a pivotal role in bridging the gap between knowledge and practice. By identifying the barriers and facilitators that influence the adoption of diagnostic techniques and public health interventions, tailored strategies can be formulated to improve their implementation within healthcare settings. Advocacy plays a critical role in raising awareness regarding the profound impact of fungal diseases on public health in Africa. Engaging policymakers, healthcare providers, researchers, industry experts and communities underscore the importance of addressing these diseases and galvanize efforts for change. Substantial investment in surveillance, research and development specifically focused on fungal diseases is indispensable for advancing our understanding of local epidemiology, developing effective interventions, and ultimately improving patient outcomes. In conclusion, closing the gaps in diagnosing and treating fungal diseases in Africa demands concerted research and advocacy initiatives to ensure better healthcare delivery, reduced mortality rates, and improved public health outcomes.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda; Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
| | - Bassey E Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Norman van Rhijn
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Nelesh P Govender
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David B Meya
- Infectious Diseases Institute, Department of medicine, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda
| | - Iriagbonse I Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin 300213, Nigeria
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, United States; Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, United States of America; National Emerging Infectious Disease Laboratory, Boston, United States; Center for Emerging Infectious Diseases Policy & Research, Boston University, Boston, MA, United States
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos 101017, Nigeria
| | - David W Denning
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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7
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Mukaremera L. Why I care about Cryptococcus neoformans. Nat Microbiol 2023; 8:1373-1375. [PMID: 37528180 DOI: 10.1038/s41564-023-01438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Liliane Mukaremera
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK.
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8
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Li H, Han X, Du W, Meng Y, Li Y, Sun T, Liang Q, Li C, Suo C, Gao X, Qiu Y, Tian W, An M, Zhang H, Fu Y, Li X, Lan T, Yang S, Zhang Z, Geng W, Ding C, Shang H. Comparative miRNA transcriptomics of macaques and mice reveals MYOC is an inhibitor for Cryptococcus neoformans invasion into the brain. Emerg Microbes Infect 2022; 11:1572-1585. [PMID: 35621025 PMCID: PMC9176638 DOI: 10.1080/22221751.2022.2081619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cryptococcal meningoencephalitis (CM) is emerging as an infection in HIV/AIDS patients shifted from primarily ARTnaive to ART-experienced individuals, as well as patients with COVID-19 and immunocompetent hosts. This fungal infection is mainly caused by the opportunistic human pathogen Cryptococcus neoformans. Brain or central nervous system (CNS) dissemination is the deadliest process for this disease; however, mechanisms underlying this process have yet to be elucidated. Moreover, illustrations of clinically relevant responses in cryptococcosis are currently limited due to the low availability of clinical samples. In this study, to explore the clinically relevant responses during C. neoformans infection, macaque and mouse infection models were employed and miRNA-mRNA transcriptomes were performed and combined, which revealed cytoskeleton, a major feature of HIV/AIDS patients, was a centric pathway regulated in both infection models. Notably, assays of clinical immune cells confirmed an enhanced macrophage “Trojan Horse” in patients with HIV/AIDS, which could be shut down by cytoskeleton inhibitors. Furthermore, myocilin, encoded by MYOC, was found to be a novel enhancer for the macrophage “Trojan Horse,” and an enhanced fungal burden was achieved in the brains of MYOC-transgenic mice. Taken together, the findings from this study reveal fundamental roles of the cytoskeleton and MYOC in fungal CNS dissemination, which not only helps to understand the high prevalence of CM in HIV/AIDS but also facilitates the development of novel therapeutics for meningoencephalitis caused by C. neoformans and other pathogenic microorganisms.
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Affiliation(s)
- Hailong Li
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaoxu Han
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wei Du
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Yang Meng
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Yanjian Li
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Tianshu Sun
- Medical Research Centre, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, People's Republic of China
| | - Qiaojing Liang
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Chao Li
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Chenhao Suo
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Xindi Gao
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Yu Qiu
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wen Tian
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Minghui An
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Hui Zhang
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yajing Fu
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaolin Li
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Tian Lan
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Sheng Yang
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Zining Zhang
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Chen Ding
- College of Life and Health Sciences, Northeastern University, Shenyang, People's Republic of China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
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9
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Osaigbovo II, Bongomin F. Point of care tests for invasive fungal infections: a blueprint for increasing availability in Africa. Ther Adv Infect Dis 2021; 8:20499361211034266. [PMID: 34422265 PMCID: PMC8371725 DOI: 10.1177/20499361211034266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/05/2021] [Indexed: 01/17/2023] Open
Abstract
Invasive fungal infections (IFIs) such as cryptococcosis, disseminated histoplasmosis, and chronic pulmonary aspergillosis are significant causes of morbidity and mortality in Africa. Lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology hamper prompt detection and management of IFIs on the continent. Point-of-care tests (POCT) obviate the need for complex infrastructure, skilled technicians, and stable electricity and have had major impacts on the diagnosis of bacterial, viral, and parasitic infections in low- and middle-income countries. Over the last 10 years, POCTs for IFIs have become increasingly available and they have the potential to revolutionize the management of these infections if scaled up in Africa. At the beginning of 2021, the World Health Organization (WHO) Essential Diagnostic List (EDL) included a cryptococcal antigen test for the diagnosis of cryptococcosis, Histoplasma antigen test for the diagnosis of disseminated histoplasmosis, and Aspergillus-specific test for the diagnosis of chronic pulmonary aspergillosis. All of these are available in formats that may be used as POCTs and it is hoped that this will improve the diagnosis of these life-threatening IFIs, especially in low- and middle-income countries. This perspective review discusses commercially available POCTs and outlines strategies of a blueprint to achieve their roll-out in Africa. The strategies include raising awareness, conducting research that uncovers the exact burden of IFIs, increasing advocacy, integrating diagnosis of IFIs into existing public health programs, adoption of the WHO EDL at country levels, and improving logistics and supply chains.
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Affiliation(s)
- Iriagbonse Iyabo Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria, Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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10
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Yamamura D, Xu J. Update on Pulmonary Cryptococcosis. Mycopathologia 2021; 186:717-728. [PMID: 34181160 DOI: 10.1007/s11046-021-00575-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Pulmonary cryptococcosis is a common but underdiagnosed opportunistic fungal infection in both immunocompromised and immunocompetent patients. The causal agents include at least eight evolutionary distinct haploid lineages as well as their hybrids of the human pathogenic Cryptococcus complex. In this update, we review recent advances in epidemiology, mode of transmission, risk factors, diagnostic methods, and therapy of pulmonary cryptococcosis. Our review suggests significant challenges and opportunities for research, from bedside to benchside and back to bedside.
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Affiliation(s)
- Deborah Yamamura
- Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton General Hospital, Hamilton, ON, L8L 2X2, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, L8S 4K1, Canada
| | - Jianping Xu
- Department of Biology, McMaster University, Hamilton, L8S 4K1, Canada.
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11
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Silva JT, Fernández-Ruiz M, Grossi PA, Hernández-Jimenez P, López-Medrano F, Mularoni A, Prista-Leão B, Santos L, Aguado JM. Reactivation of latent infections in solid organ transplant recipients from sub-Saharan Africa: What should be remembered? Transplant Rev (Orlando) 2021; 35:100632. [PMID: 34130253 DOI: 10.1016/j.trre.2021.100632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/07/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
International migration from Sub-Saharan African countries to the European Union and the United States has significantly increased over the past decades. Although the vast majority of these immigrants are young and healthy people, a minority can be affected by chronic conditions eventually leading to solid organ transplantation (SOT). Importantly, these candidates can bear geographically restricted fungal and parasitic latent infections that can reactivate after the procedure. An appropriate evaluation before transplantation followed by treatment, whenever necessary, is essential to minimize such risk, as covered in the present review. In short, infection due to helminths (Schistosoma spp. and Strongyloides stercoralis) and intestinal protozoa (Entamoeba histolytica, Giardia lamblia or Cyclospora cayetanensis) can be diagnosed by multiple direct stool examination, serological assays and stool antigen testing. Leishmaniasis can be assessed by means of serology, followed by nucleic acid amplification testing (NAAT) if the former test is positive. Submicroscopic malaria should be ruled out by NAAT. Screening for Histoplasma spp. or Cryptococcus spp. is not routinely indicated. Consultation with an Infectious Diseases specialist is recommended in order to adjust preemptive treatment among Sub-Saharan African SOT candidates and recipients.
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Affiliation(s)
- Jose Tiago Silva
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain.
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Pilar Hernández-Jimenez
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Alessandra Mularoni
- Department of Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy
| | - Beatriz Prista-Leão
- Department of Infectious Diseases, University Hospital Center "São João", School of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Department of Infectious Diseases, University Hospital Center "São João", School of Medicine, University of Porto, Porto, Portugal
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
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