Bassey Thelma E, Okekemba Ikechukwu, Egbara Walter O, Owai Promise, Okafor Love E, Elem David E, Edim Geraldine L, Onukak Asukwo, Ekeng Bassey E
Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria.
Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria.
Ther Adv Infect Dis. 2024 Oct 11;11:20499361241286973. doi: 10.1177/20499361241286973. eCollection 2024 Jan-Dec.
Deep mycoses are serious fungal diseases commonly associated with the immunocompromised but can also present in the immunocompetent following severe exposure to fungal pathogens. Included in this group are subcutaneous and systemic fungal infections.
Reviews highlighting skin involvement in patients with deep mycosis in the Nigerian setting are sparse in the literature. This systematic review summarized the clinical presentation, risk factors, and diagnosis of deep mycosis presenting with cutaneous manifestations in Nigerians.
This was a systematic review conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines.
PubMed, Google Scholar, and the African Journal Online database were searched from inception to February 2024 to identify published articles from Nigeria on deep mycoses with cutaneous manifestations. We included single case reports and case series on cutaneous involvement in deep fungal infections in Nigeria. Review articles, guidelines, meta-analyses, animal studies, and fungal studies not relating to the Nigerian setting were excluded.
We identified 16 well-documented articles on deep cutaneous mycoses published in Nigeria over the past six decades which amounted to 137 cases; 102 (74.5%) cases were reported before the year 2000, while the remainder were published within the past two decades. The 137 cases were majorly histoplasmosis ( = 87, 63.5%) and eumycetoma ( = 19, 13.9%) and predominant risk factors, farming ( = 13, 9.5%) and diabetes mellitus ( = 3, 2.2%), The diagnosis of cases was predominantly via histopathology ( =131, 95.6%) with a few cases diagnosed by fungal culture ( = 15, 10.9%), and antigen assay ( = 1, 0.7%) respectively. Twenty-one (15.3%) were clinically diagnosed as cancers including a case of carcinoma of the skin, and one each (0.7%) as skin tuberculosis or neurofibromatosis but all histologically confirmed as deep cutaneous mycoses.
The decline of reports on deep cutaneous mycoses in recent times suggests neglect or a low index of suspicion from attending clinicians. This is further buttressed in the misdiagnosis of cases as other clinical entities. Ensuring a histological diagnosis of skin lesions, especially in at-risk patients will mitigate these gaps.
深部真菌病是严重的真菌疾病，通常与免疫功能低下有关，但在严重接触真菌病原体后免疫功能正常的人群中也可能出现。这一组疾病包括皮下和全身性真菌感染。
在尼日利亚的背景下，强调深部真菌病患者皮肤受累情况的综述在文献中很少见。本系统综述总结了尼日利亚出现皮肤表现的深部真菌病的临床表现、危险因素和诊断方法。
这是一项按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行的系统综述。
检索了从数据库创建到2024年2月的PubMed、谷歌学术和非洲期刊在线数据库，以确定尼日利亚发表的有关有皮肤表现的深部真菌病的文章。我们纳入了关于尼日利亚深部真菌感染皮肤受累情况的单病例报告和病例系列。排除了与尼日利亚背景无关的综述文章、指南、荟萃分析、动物研究和真菌研究。
我们确定了过去六十年来在尼日利亚发表的16篇关于深部皮肤真菌病的详细记录文章，共计137例；2000年前报告了102例（74.5%），其余在过去二十年中发表。137例主要是组织胞浆菌病（87例，63.5%）和足菌肿（19例，13.9%），主要危险因素是务农（13例，9.5%）和糖尿病（3例，2.2%）。病例诊断主要通过组织病理学（131例，95.6%），少数病例分别通过真菌培养（15例，10.9%）和抗原检测（1例，0.7%）诊断。21例（15.3%）临床诊断为癌症，包括1例皮肤癌，各有1例（0.7%）诊断为皮肤结核或神经纤维瘤病，但所有病例经组织学证实为深部皮肤真菌病。
近年来深部皮肤真菌病报告数量的下降表明临床医生忽视或怀疑指数较低。病例被误诊为其他临床疾病进一步证明了这一点。确保对皮肤病变进行组织学诊断，尤其是对高危患者，将弥补这些差距。
