A Review of Antifungal Resistance in West Africa
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Submitted
2 January 2024
2 January 2024
Published
30 May 2024
30 May 2024
Abstract
Knowledge of local and regional antimicrobial resistance (AMR) is important for clinical decision-making. However, surveillance capacity for fungal infections let alone antifungal resistance is lacking throughout West Africa, and current antifungal resistance data are sparse. We sought to address this gap by summarizing all available high-quality data on antifungal resistance in West Africa. We searched the PubMed database, African Journals Online archives, and free web searches in October and December 2023 using the terms "antifungal resistance" and "West Africa" to find articles published from 2010 onwards. Only 11 articles were included in our analysis most of which were cross-sectional and descriptive in design; relatively high levels of antifungal resistance (AFR) to commonly used antifungals were reported including (24-75%) resistance to fluconazole and ketoconazole, two of the most frequently-prescribed antifungals in this region. There is a high level of resistance to griseofulvin, ketoconazole, cotrimoxazole, and fluconazole among dermatophyte infections (80-100%) with 100% resistance to amphotericin B, ketoconazole, and fluconazole reported by the invasive fungal disease-causing pathogen Cryptococcus neoformans. Resistance to commonly used anti-fungal drugs is prevalent; raising concern that these drugs may no longer be useful for treating moderate or severe fungal infections in West Africa hence calling for countries to promote acceptance of antimicrobial stewardship as a programmatic strategy not just focused on bacterial resistance but also fungal resistance including pharmacy management, laboratory complete mycological investigations and dissemination of standard fungal susceptibility profiles.
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References
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2. Papon N, Bougnoux ME, d'Enfert C. Tracing the Origin of Invasive Fungal Infections. Trends Microbiol. 2020;28(4):240-2. Doi: 10.1016/j.tim.2020.01.007; PMID: 32044130
3. Firacative C. Invasive fungal disease in humans: are we aware of the real impact? Mem Inst Oswaldo Cruz. 2020;115:e200430. DOI: 10.1590/0074-02760200430; PMCID: PMC7546207; PMID: 33053052
4. Lamoth F, Lockhart SR, Berkow EL, Calandra T. Changes in the epidemiological landscape of invasive candidiasis. J Antimicrob Chemother. 2018;73(suppl_1):i4-13. DOI: 10.1093/jac/dkx444; PMID: 29304207
5. Vitiello A, Ferrara F, Boccellino M, Ponzo A, Cimmino C, Comberiati E, et al. Antifungal Drug Resistance: An Emergent Health Threat. Biomedicines. 2023;11(4):1063. DOI: 10.3390/biomedicines11041063; PMCID: PMC10135621; PMID: 37189681
6. Fisher MC, Alastruey-Izquierdo A, Berman J, Bicanic T, Bignell EM, Bowyer P, et al. Tackling the emerging threat of antifungal resistance to human health. Nat Rev Microbiol. 2022;20(9):557-71. DOI: 10.1038/s41579-022-00720-1; PMCID: PMC8962932; PMID: 35352028
7. Ioannidis K, Papachristos A, Skarlatinis I, Kiospe F, Sotiriou S, Papadogeorgaki E, et al. Do we need to adopt antifungal stewardship programmes?. Eur J Hosp Pharm. 2020;27(1):14-8. DOI: 10.1136/ejhpharm-2017-001467; PMCID: PMC6992971; PMID: 32064083
8. Osherov N, Kontoyiannis DP. The anti-Aspergillus drug pipeline: Is the glass half full or empty? Med Mycol. 2017;55(1):118-24. DOI: 10.1093/mmy/myw060; PMID: 27562862
9. Hoenigl M, Sprute R, Egger M, Arastehfar A, Cornely OA, Krause R, et al. The Antifungal Pipeline: Fosmanogepix, Ibrexafungerp, Olorofim, Opelconazole, and Rezafungin. Drugs. 2021;81(15):1703-29. DOI: 10.1007/s40265-021-01611-0; PMCID: PMC8501344; PMID: 34626339
10. Perfect JR. The antifungal pipeline: a reality check. Nat Rev Drug Discov. 2017;16(9):603-16. DOI: 10.1038/nrd.2017.46; PMCID: PMC5760994; PMID: 28496146
11. Denning DW, Bromley MJ. Infectious Disease. How to bolster the antifungal pipeline. Science. 2015;347(6229):1414-6. DOI: 10.1126/science.aaa6097; PMID: 25814567
12. Rayens E, Norris KA. Prevalence and Healthcare Burden of Fungal Infections in the United States, 2018. Open Forum Infect Dis. 2022;9(1):ofab593. DOI: 10.1093/ofid/ofab593; PMCID: PMC8754384; PMID: 35036461
13. Köhler JR, Hube B, Puccia R, Casadevall A, Perfect JR. Fungi that Infect Humans. Microbiol Spectr. 2017;5(3):10. DOI: 10.1128/microbiolspec.FUNK-0014-2016. PMID: 28597822
14. Brown GD, Denning DW, Gow NA, Levitz SM, Netea MG, White TC. Hidden killers: human fungal infections. Sci Transl Med. 2012;4(165):165rv13. DOI: 10.1126/scitranslmed.3004404; PMID: 23253612
15. Bailly S, Maubon D, Fournier P, Pelloux H, Schwebel C, Chapuis C, et al. Impact of antifungal prescription on relative distribution and susceptibility of Candida spp. - Trends over 10 years. J Infect. 2016;72(1):103-11. DOI: 10.1016/j.jinf.2015.09.041; PMID: 26518058
16. Lakoh S, Orefuwa E, Kamara MN, Jiba DF, Kamara JB, Kpaka S, et al. The burden of serious fungal infections in Sierra Leone: a national estimate. Ther Adv Infect Dis. 2021;8:20499361211027996. DOI: 10.1177/20499361211027996; PMCID: PMC8252340; PMID: 34262759
17. Hoenigl M, Seidel D, Sprute R, Cunha C, Oliverio M, Goldman GH, Ibrahim AS, Carvalho A. COVID-19-associated fungal infections. Nat Microbiol. 2022;7(8):1127-1140. DOI: 10.1038/s41564-022-01172-2; PMCID: PMC9362108; PMID: 35918423
18. Tang KWK, Millar BC, Moore JE. Antimicrobial Resistance (AMR). Br J Biomed Sci. 2023;80:11387. DOI: 10.3389/bjbs.2023.11387; PMCID: PMC10336207; PMID: 37448857
19. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard—Eleventh Edition. CLSI document M02–A11. Wayne: Clinical and Laboratory Standards Institute; 2012.
20. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: 30th Informational Supplement. CLSI document M100-S22. Wayne, Clinical and Laboratory Standards Institute; 2020.
21. Njunda AL, Nsagha DS, Assob JC, Kamga HL, Teyim P. In vitro Antifungal Susceptibility Patterns of Candida Albicans from HIV and AIDS Patients Attending the Nylon Health District Hospital in Douala, Cameroon. J Public Health Afr. 2012;3(1):e2. DOI: 10.4081/jphia.2012.e2; PMCID: PMC5345446; PMID: 28299076
22. Njunda LA, Assob JCN, Nsagha SD. Oral and urinary colonization of Candida species in HIV/AIDS patients in Cameroon. Basic Sci Med. 2013;2(1):1–8. DOI: 10.5923/j.medicine.20130201.01
23. Abrantes PMDS, McArthur CP, Africa CWJ. Multi-drug resistant oral Candida species isolated from HIV-positive patients in South Africa and Cameroon. Diagn Microbiol Infect Dis. 2014;79(2):222-7. DOI: 10.1016/j.diagmicrobio.2013.09.016; PMID: 24726686
24. Nweze EI, Ogbonnaya UL. Oral Candida isolates among HIV-infected subjects in Nigeria. J Microbiol Immunol Infect. 2011;44(3):172-7. DOI: 10.1016/j.jmii.2011.01.028; PMID: 21524610
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Muhindo AB, Aliero AA, Syalhasha FM, Ntulume I, Eilu E, Odoki M, Mutebi J. A Review of Antifungal Resistance in West Africa. Borneo J Pharm [Internet]. 2024May30 [cited 2025Apr.6];7(2):187-9. Available from: https://journal.umpr.ac.id/index.php/bjop/article/view/6507
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