Diagnostic options for pulmonary fungal diseases in Africa

What is it about?

Evidence before this study Both acute and chronic respiratory infection and airways disease are common in Africa, in all age groups. Fungal lung disease includes life-threatening infection in immunocompromised and critically ill patients, chronic pulmonary aspergillosis complicating and mistaken for TB, and allergy, including fungal asthma, which is responsive to inexpensive antifungal therapy. Diagnostic capacity for COPD and asthma, lung cancer and fungal disease has not been mapped previously in the African continent. Added value This survey of capacity to diagnose lung disease, including fungal lung infections finds major deficiencies. CT scanning is unavailable in 8 countries and rarely done in 5. Spirometry is unavailable or rarely done in 21 and 11 countries respectively. Bronchoscopy is never or rarely done in 11 and 11 countries, respectively. Diagnosing Pneumocystis pneumonia and chronic pulmonary aspergillosis require Pneumocystis PCR and Aspergillus IgG antibody, unavailable in 78% of countries. Implication of the findings Many gaps in diagnostic capacity exist in Africa. Implementation of the WHO Essential tests would be a good start. Training in spirometry, CT scanning and bronchoscopy is required in many countries. Clinician awareness about fungal lung disease, supported by technical training of healthcare workers would improve respiratory health in Africa.

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