Aspergillus fumigatus carrying TR34/L98H resistance allele causing complicated suppurative otitis media in Tanzania: Call for improved diagnosis of fungi in sub-Saharan Africa

Abstract

Background: Suppurative otitis media (SOM) is a major public health concern worldwide and is associated with increased morbidity. Cases of fungal suppurative otitis media were studied to establish the effect of fungi in otitis media. Methods: Ear swabs from 410 patients were collected aseptically using sterile cotton swabs from discharging ear through perforated tympanic membrane. Swabs were subjected to microscopic and culture investigations. The species of fungal growing on Sabouraud's agar were identified using MALDI-TOF MS. For moulds broth micro dilution method following EUCAST guidelines was employed to determine susceptibility patterns against itraconazole, voriconazole and posaconazole. Results: A total of 44 (10.74 %) cases with positive fungal culture growth were studied. The median age of patients with fungal infection was 29.5 (IQR 16-43) years. Of 44 patients; 35 (79.6 %) had pure growth of one type of fungal. Candida albicans was the most common fungus isolated (n = 13; 29.6 %) followed by Aspergillus versicolor (n = 8; 18.2 %). A total of 7 (15.9 %) patients had disease complication at time of enrollment; of them 6 (13.6 %) had hearing loss. On follow up 7 (15.9 %) had poor treatment outcome. All five Aspergillus fumigatus strains resistant itraconazole with reduced susceptibility to voriconazole and posaconazole carried carrying TR34/L98H resistance allele. In addition, all Penicillium citrinum isolates were resistant to voriconazole while all Penicillium sumatrense were resistant to both itraconazole and voriconazole. There were non-significant association of poor treatment outcome and female gender, being HIV positive and being infected with moulds. Conclusion: Fungal infections play a significant role in SOM pathology in our setting. Diagnosis of fungal infections in developing countries should be improved so that appropriate management can be initiated on time to prevent associated complications.

Evidence of unique genetic diversity in Aspergillus fumigatus isolates from Cameroon

“…These resistant isolates had the same resistance mechanism as the dominant resistance mechanism previously found in Dutch and Indian isolates . In September 2016, the same mechanism of resistance was reported in isolates obtained from otitis media patients in Bugando Medical Center, Tanzania . These findings underline the need for continuous surveillance as resistant A. fumigatus can be disseminated through long‐distance dispersal events.…”

“…16 In September 2016, the same mechanism of resistance was reported in isolates obtained from otitis media patients in Bugando Medical Center, Tanzania. 17 These findings underline the need for continuous surveillance as resistant A. fumigatus can be disseminated through long-distance dispersal events.…”

Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

“…Countries reporting the presence of azole-resistant Aspergillus fumigatus and mechanisms of resistance in surveyed isolates [47,48,49,52,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97]. …”

First Investigative Study of Azole-Resistant Aspergillus fumigatus in the Environment in Burkina Faso

“…Resistance rates vary between countries and underlying conditions [ 2 , 3 ]. In Africa, only Tanzania and Kenya have performed susceptibility-related studies and reported the presence of Azole-resistant Aspergillus fumigatus (ARAF) isolates [ 4 , 5 , 6 ]. However, there are several arguments supporting the presence of ARAF isolates in other African countries.…”