Abstract：
Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
摘要：
侵袭性真菌病(IFD)在资源有限的环境中备受关注，尤其是在非洲，由于IFD的诊断设备不可用，从而使明确的诊断具有挑战性。IFD具有与更频繁的疾病重叠的非特异性系统性表现，如肺结核，艾滋病毒,以及与HIV相关的机会性感染和恶性肿瘤。因此,IFD通常未被诊断或误诊。我们批判性地审查了有关非洲IFD的现有文献，以更好地了解其流行病学，疾病负担，以指导未来的研究和干预。隐球菌病是非洲遇到最多的IFD，占撒哈拉以南非洲地区艾滋病毒相关死亡的大多数。侵袭性曲霉病,虽然有些未被诊断和/或误诊为结核病，越来越多的报道对艾滋病毒感染者有类似的偏好。最近的流行病学研究也报道了更多的组织胞浆菌病病例，特别是来自西非，在推定结核病患者和艾滋病毒感染者中显示出很高的患病率。肺囊虫肺炎的负担已显著减少，这可能是由于非洲艾滋病毒感染者接受抗逆转录病毒疗法的增加，和全球。毛霉菌病,塔拉真菌病,真菌病,芽生菌病,和球菌病也有报道，但文献研究很少。正如其他地区报道的那样，非洲对大多数可用抗真菌药物的耐药性的出现仍然引起了极大的关注。非洲的IFD比看起来更常见，并且对发病率和死亡率有很大贡献。需要巨大的投资来推动意识和真菌相关研究，特别是在诊断和抗真菌治疗方面。
