Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
BMC Infect Dis. 2024 Aug 6;24(1):789. doi: 10.1186/s12879-024-09694-2.
Intracranial fungal infections' (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this review, we aim to detail the management, and outcome of IcFIs across Africa.
This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review.
Of the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%).
Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients.
颅内真菌感染（IcFIs）临床表现多样，导致诊断和治疗困难。非洲人口受疾病负担的影响不成比例。对于整个非洲大陆使用的诊断和治疗方法，尚不清楚。在这篇综述中，我们旨在详细描述非洲各地 IcFIs 的治疗和结局。
本范围综述使用 Arksey 和 O'Malley 框架进行。从数据库成立到 2021 年 8 月 10 日，在 MEDLINE、EMBASE、Cochrane 图书馆、非洲医学索引和非洲期刊在线上搜索相关文章。使用系统评价和荟萃分析扩展的首选报告项目来报告综述结果。
在确定的 5779 条记录中，有 131 篇文章被纳入。平均年龄为 35.6 岁，大多数（56.4%）为男性。大多数（n=8433/8693，97.0%）IcFIs 表现为脑膜炎，最常见的传染性 IcFI 致病因素是 HIV/AIDS（n=7815/8693，89.9%），最常见的非传染性危险因素是糖尿病（n=32/8693，0.4%）。隐球菌属是最常见的（n=8428/8693，97.0%）致病病原体。最常用的诊断方法是脑脊液（CSF）培养（n=4390/6830，64.3%）用于弥漫性 IcFIs，和 MRI 成像（n=12/30，40%）用于局灶性 IcFIs。最常用的治疗方法是仅用抗真菌药物进行医学治疗（n=4481/8693，51.6%）。在儿科和成年患者中最常用的抗真菌药物是两性霉素 B 和氟康唑联合治疗（51.5%vs44.9%）。总死亡率很高（n=3475/7493，46.3%），成年和儿科患者相似（47.8%vs42.1%）。
大多数 IcFIs 发生在免疫抑制个体中，尽管有新的诊断技术，但 CSF 培养在非洲仍大多使用。儿童和成人使用的抗真菌药物方案相似。非洲的 IcFI 结果对儿科和成年患者均不佳。
