PDF(Pubmed)
Abstract：
BACKGROUND: Fungal infections are common in HIV-infected individuals and significantly contribute to mortality. However, a substantial number of cases are undiagnosed before death.
OBJECTIVE: To determine the frequency of fungal pathogens in autopsy studies of people who died with HIV in Africa.
METHODS: We conducted a scoping review of autopsy studies conducted in Africa.
METHODS: PubMed, Scopus, Web of Science, Embase, Google Scholar, and African Journal Online.
METHODS: The review encompasses studies published from inception to September 2023, and no language restrictions were imposed during the search process. We included studies that reported histopathological or microbiological evidence for the diagnosis of fungal infections and other pathogens.
RESULTS: Data were summarized using descriptive statistics and no meta-analysis was performed.
RESULTS: We examined 30 articles reporting studies conducted between 1991 and 2019, encompassing a total of 13 066 HIV-infected decedents across ten African countries. In five studies, the autopsy type was not specified. Among those studies with specified autopsy types, 20 involved complete diagnostic autopsies, whereas 5 were categorized as partial or minimally invasive autopsies. There were 2333 pathogens identified, with 946 (40.5%) being mycobacteria, 856 (36.7%) fungal, 231 (3.8%) viral, 208 (8.9%) parasitic, and 92 (3.9%) bacterial. Of the 856 fungal pathogens identified, 654 (28.0%) were Cryptococcus species, 167 (7.2%) Pneumocystis jirovecii, 16 (0.69%) Histoplasma species, 15 (0.64%) Aspergillus species, and 4 (0.17%) Candida species. Other major non-fungal pathogens identified were cytomegalovirus 172 (7.37%) and Toxoplasma gondii 173 (7.42%).
CONCLUSIONS: Invasive fungal infections occur in over one-third of people who succumb to HIV in Africa. In addition to cryptococcosis and Pneumocystis jirovecii pneumonia, integrating other priority fungal pathogen detection and management strategies into the broader framework of HIV care in Africa is recommended. This involves increasing awareness regarding the impact of fungal infections in advanced HIV disease and strengthening diagnostic and treatment capacity.
OBJECTIVE: To determine the frequency of fungal pathogens in autopsy studies of people who died with HIV in Africa.
METHODS: We conducted a scoping review of autopsy studies conducted in Africa.
METHODS: PubMed, Scopus, Web of Science, Embase, Google Scholar, and African Journal Online.
METHODS: The review encompasses studies published from inception to September 2023, and no language restrictions were imposed during the search process. We included studies that reported histopathological or microbiological evidence for the diagnosis of fungal infections and other pathogens.
RESULTS: Data were summarized using descriptive statistics and no meta-analysis was performed.
RESULTS: We examined 30 articles reporting studies conducted between 1991 and 2019, encompassing a total of 13 066 HIV-infected decedents across ten African countries. In five studies, the autopsy type was not specified. Among those studies with specified autopsy types, 20 involved complete diagnostic autopsies, whereas 5 were categorized as partial or minimally invasive autopsies. There were 2333 pathogens identified, with 946 (40.5%) being mycobacteria, 856 (36.7%) fungal, 231 (3.8%) viral, 208 (8.9%) parasitic, and 92 (3.9%) bacterial. Of the 856 fungal pathogens identified, 654 (28.0%) were Cryptococcus species, 167 (7.2%) Pneumocystis jirovecii, 16 (0.69%) Histoplasma species, 15 (0.64%) Aspergillus species, and 4 (0.17%) Candida species. Other major non-fungal pathogens identified were cytomegalovirus 172 (7.37%) and Toxoplasma gondii 173 (7.42%).
CONCLUSIONS: Invasive fungal infections occur in over one-third of people who succumb to HIV in Africa. In addition to cryptococcosis and Pneumocystis jirovecii pneumonia, integrating other priority fungal pathogen detection and management strategies into the broader framework of HIV care in Africa is recommended. This involves increasing awareness regarding the impact of fungal infections in advanced HIV disease and strengthening diagnostic and treatment capacity.
摘要：
背景：真菌感染在HIV感染的个体中很常见，并且显著导致死亡率。然而,大量病例在死亡前未被确诊。
目的：确定非洲艾滋病毒感染者尸检研究中真菌病原体的发生频率。
方法：我们对在非洲进行的尸检研究进行了范围审查。
方法：PubMed，Scopus,WebofScience,Embase,谷歌学者，非洲杂志在线。
方法：该综述涵盖了从开始到2023年9月发表的研究，并且在搜索过程中没有施加语言限制。我们纳入了报道诊断真菌感染和其他病原体的组织病理学或微生物学证据的研究。
结果：使用描述性统计对数据进行汇总，未进行荟萃分析。
结果：我们检查了30篇报告1991年至2019年之间进行的研究的文章，涵盖了10个非洲国家的13,066名HIV感染者。在五项研究中，没有指定尸检类型.在那些具有特定尸检类型的研究中，20个涉及完整的诊断尸检，而5人被归类为部分或微创尸检。确定了2,333种病原体，946（40.5%）是分枝杆菌，856（36.7%）真菌，231（3.8％）病毒，208（8.9%）寄生，和92（3.9％）细菌。在确定的856种真菌病原体中，654（28.0％）是隐球菌，167例（7.2%）肺孢子虫，16种（0.69%）组织胞浆，15（0.64%）曲霉属，和4种（0.17％）念珠菌。确定的其他主要非真菌病原体是巨细胞病毒172（7.37％）和弓形虫173（7.42％）。
结论：非洲有超过三分之一的艾滋病患者发生侵袭性真菌感染。除了隐球菌病和PCP,建议将其他重点真菌病原体检测和管理策略纳入非洲更广泛的HIV护理框架.这涉及提高对真菌感染对晚期艾滋病毒疾病的影响的认识，并加强诊断和治疗能力。
目的：确定非洲艾滋病毒感染者尸检研究中真菌病原体的发生频率。
方法：我们对在非洲进行的尸检研究进行了范围审查。
方法：PubMed，Scopus,WebofScience,Embase,谷歌学者，非洲杂志在线。
方法：该综述涵盖了从开始到2023年9月发表的研究，并且在搜索过程中没有施加语言限制。我们纳入了报道诊断真菌感染和其他病原体的组织病理学或微生物学证据的研究。
结果：使用描述性统计对数据进行汇总，未进行荟萃分析。
结果：我们检查了30篇报告1991年至2019年之间进行的研究的文章，涵盖了10个非洲国家的13,066名HIV感染者。在五项研究中，没有指定尸检类型.在那些具有特定尸检类型的研究中，20个涉及完整的诊断尸检，而5人被归类为部分或微创尸检。确定了2,333种病原体，946（40.5%）是分枝杆菌，856（36.7%）真菌，231（3.8％）病毒，208（8.9%）寄生，和92（3.9％）细菌。在确定的856种真菌病原体中，654（28.0％）是隐球菌，167例（7.2%）肺孢子虫，16种（0.69%）组织胞浆，15（0.64%）曲霉属，和4种（0.17％）念珠菌。确定的其他主要非真菌病原体是巨细胞病毒172（7.37％）和弓形虫173（7.42％）。
结论：非洲有超过三分之一的艾滋病患者发生侵袭性真菌感染。除了隐球菌病和PCP,建议将其他重点真菌病原体检测和管理策略纳入非洲更广泛的HIV护理框架.这涉及提高对真菌感染对晚期艾滋病毒疾病的影响的认识，并加强诊断和治疗能力。
