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University of Manchester

1. Oladele, Rita Okeoghene. Current status of serious fungal infections in Nigeria.

Degree: 2018, University of Manchester

Fungal infections are ignored by social and political communities. However, they are estimated to affect more than a billion people, resulting in approximately 11·5 million life-threatening infections in the ‘at risk’ population and more than 1·5 million deaths annually. Though there have been huge advances in diagnostics and antifungal drug development over the past two decades, however, resource limited settings have not benefited from these advances. The aim of this research was to determine the burden of serious fungal infections in Nigerians with the appropriate underlying diseases. This epidemiological research was conducted across four study populations. Study 1; HIV-infected patients with CD4+ counts <250 cells/mm3, irrespective of their ART status, a CrAg lateral flow assay was used for detecting cryptococcal antigenaemia (n=214). Study 2; a cross-sectional multicentre survey of TB patients being managed for smear negative or treatment failure TB irrespective of their HIV status (n=208). Study 3; a multicentre histoplasmin skin sensitivity survey amongst healthy HIV-infected and non-HIV infected participants; intradermally; induration ≥5 mm was considered to be histoplasmin positive (n=750). Study 4; a prospective cohort study of critically ill patients in a Nigerian ICU (n=71). Two retrospective studies to analyse the clinical picture of serious fungal infections in two at risk populations (HIV/AIDS and neonatal intensive care babies) in Nigerians was also conducted (n-7034; n=2712 respectively). Results revealed an overall seroprevalence of cryptococcal antigenemia of 8.9% with 6 (9.8%) in those with CD4+ cell counts <100cells/mm3, 4 (5.0%) in the 100-200 group and 9 (12.3%) in 200-250 cells/mm3 group; a CPA prevalence of 8.7% (6.5% had HIV infection and 14.5% were HIV-negative) and a prior subclinical histoplasmosis of 4.4%. The ICU study revealed a 45% healthcare associated infection rate representing an incidence rate of 79/1000 patient-days in the ICU.The retrospective studies revealed a 2.3% rate of neonatal ICI with a case fatality rate of 18.5%. In the 12years retrospective study 18% had a fungal OI with 88% of patients having initiated ART. In conclusion, serious fungal infections do occur in the at risk population in Nigeria and they constitute a significant public health challenge. Our findings demonstrate that there has been an underestimation of the burden of the problem in Nigerians. There is a dire need to design guidelines for the management of fungal infections in at-risk population. Advisors/Committee Members: RICHARDSON, MALCOLM M, Denning, David, Richardson, Malcolm.

Subjects/Keywords: Nigeria; Pulmonary fungal infections; Histoplasmosis; Cryptococcal meningitis; Aspergillosis; Neonatal infections; Invasive candidiasis; Opportunistic infections; Histoplasmin

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Oladele, R. O. (2018). Current status of serious fungal infections in Nigeria. (Doctoral Dissertation). University of Manchester. Retrieved from http://www.manchester.ac.uk/escholar/uk-ac-man-scw:314179

Chicago Manual of Style (16th Edition):

Oladele, Rita Okeoghene. “Current status of serious fungal infections in Nigeria.” 2018. Doctoral Dissertation, University of Manchester. Accessed July 15, 2019. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:314179.

MLA Handbook (7th Edition):

Oladele, Rita Okeoghene. “Current status of serious fungal infections in Nigeria.” 2018. Web. 15 Jul 2019.

Vancouver:

Oladele RO. Current status of serious fungal infections in Nigeria. [Internet] [Doctoral dissertation]. University of Manchester; 2018. [cited 2019 Jul 15]. Available from: http://www.manchester.ac.uk/escholar/uk-ac-man-scw:314179.

Council of Science Editors:

Oladele RO. Current status of serious fungal infections in Nigeria. [Doctoral Dissertation]. University of Manchester; 2018. Available from: http://www.manchester.ac.uk/escholar/uk-ac-man-scw:314179

2. Denis, Blandine. Epidemiology of fungal infections in HIV infected individuals in France : P jirovecii pneumonia and invasive aspergillosis in FHDH ANRS CO4 : Infections fongiques chez les patients infectés par le VIH à l'ère des combinaisons antirétrovirales (cART) : étude des pneumocystoses et aspergilloses invasives sur la base FHDH.

Degree: Docteur es, Epidémiologie clinique, 2016, Université Pierre et Marie Curie – Paris VI

Depuis la disponibilité des combinaisons antirétrovirales (cART) en 1996, l’incidence des infections opportunistes classantes SIDA (IO), dont la pneumocystose (PCP) a très fortement diminué. Malgré tout, chez les patients infectés par le VIH, la PCP était la 2ème IO la + fréquente en France en 2001-2003 et les infections fongiques, avec 1 million de nouveaux cas/an de cryptococcose, restent un problème de santé publique majeur au niveau mondial. Cependant, depuis l’ère des cART, très peu de recherches épidémiologiques sur les infections fongiques dans les pays industrialisés ont été entreprises. C’est dans ce contexte que nous avons mené une étude épidémiologique de 2 infections fongiques chez les patients infectés par le VIH en France sur la French Hospital Database on HIV ANRS CO4 (FHDH) : la pneumocystose et l’aspergillose invasive. Concernant la pneumocystose, sur la période 2004-2011, dans la base FHDH, la moitié des 1259 cas de PCP étaient survenus chez des patients qui avaient interrompus leur suivi, et, pour ceux qui avaient déjà eu une IO avant la PCP, leur mortalité était de 25% à 3 ans. Pour l’aspergillose invasive (AI), après un retour national aux dossiers des cas déclarés sur 20 ans sur la base FHDH, un comité d’experts a validé 242 cas d’AI. Les données montrent que, chez les patients infectés par le VIH, seulement la moitié des AI validées répondaient aux critères EORTC. La mortalité à 3 mois après une AI s’est améliorée après l’ère des cART et un rôle protecteur du voriconazole sur la survie à 3 mois a également été démontré pour la 1ère fois chez les patients infectés par le VIH.

The advent of combined antiretroviral therapy (cART) in 1996 resulted in a dramatic fall in the incidence of AIDS-defining illness (ADI), including Pneumocystis jirovecii pneumonia (PCP). Nevertheless, PCP was the second most frequent ADI in France in 2001-2003 and fungal infections remain a major threat for HIV-infected individuals worldwide. Epidemiological data on fungal infections in the late cART period in resource-rich settings are scarce. The purpose of our work was to study changes in the epidemiology of fungal infections among HIV-infected individuals in France in the late cART period, focusing on PCP and invasive aspergillosis (IA) in the French Hospital Database on HIV ANRS CO4 (FHDH). In the FHDH, during the 2004-2011 period, half of the 1259 PCP cases occurred among HIV-infected individuals who had waning adherence to care, and for those who had a prior ADI before PCP the 3-year mortality rate was 25%. For the second study on IA, a review committee validated IA cases among all the cases that included a diagnostic code for aspergillosis (ICD-9 or ICD-10) in the FHDH over a 20-year period. Our study demonstrated that only half of validated IA cases among HIV-infected individuals met EORTC criteria. The 3-months survival rate after IA diagnosis improved after the advent of cART and a protective role of voriconazole was observed in the period after 2001.

Advisors/Committee Members: Costagliola, Dominique (thesis director), Lortholary, Olivier (thesis director).

Subjects/Keywords: VIH; SIDA; Pneumocystose; Aspergillose invasive; Épidémiologie; Évolution; HIV; Invasive aspergillosis (IA); Pneumocystis jirovecii pneumonia; Fungal infections; 614.4

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Denis, B. (2016). Epidemiology of fungal infections in HIV infected individuals in France : P jirovecii pneumonia and invasive aspergillosis in FHDH ANRS CO4 : Infections fongiques chez les patients infectés par le VIH à l'ère des combinaisons antirétrovirales (cART) : étude des pneumocystoses et aspergilloses invasives sur la base FHDH. (Doctoral Dissertation). Université Pierre et Marie Curie – Paris VI. Retrieved from http://www.theses.fr/2016PA066109

Chicago Manual of Style (16th Edition):

Denis, Blandine. “Epidemiology of fungal infections in HIV infected individuals in France : P jirovecii pneumonia and invasive aspergillosis in FHDH ANRS CO4 : Infections fongiques chez les patients infectés par le VIH à l'ère des combinaisons antirétrovirales (cART) : étude des pneumocystoses et aspergilloses invasives sur la base FHDH.” 2016. Doctoral Dissertation, Université Pierre et Marie Curie – Paris VI. Accessed July 15, 2019. http://www.theses.fr/2016PA066109.

MLA Handbook (7th Edition):

Denis, Blandine. “Epidemiology of fungal infections in HIV infected individuals in France : P jirovecii pneumonia and invasive aspergillosis in FHDH ANRS CO4 : Infections fongiques chez les patients infectés par le VIH à l'ère des combinaisons antirétrovirales (cART) : étude des pneumocystoses et aspergilloses invasives sur la base FHDH.” 2016. Web. 15 Jul 2019.

Vancouver:

Denis B. Epidemiology of fungal infections in HIV infected individuals in France : P jirovecii pneumonia and invasive aspergillosis in FHDH ANRS CO4 : Infections fongiques chez les patients infectés par le VIH à l'ère des combinaisons antirétrovirales (cART) : étude des pneumocystoses et aspergilloses invasives sur la base FHDH. [Internet] [Doctoral dissertation]. Université Pierre et Marie Curie – Paris VI; 2016. [cited 2019 Jul 15]. Available from: http://www.theses.fr/2016PA066109.

Council of Science Editors:

Denis B. Epidemiology of fungal infections in HIV infected individuals in France : P jirovecii pneumonia and invasive aspergillosis in FHDH ANRS CO4 : Infections fongiques chez les patients infectés par le VIH à l'ère des combinaisons antirétrovirales (cART) : étude des pneumocystoses et aspergilloses invasives sur la base FHDH. [Doctoral Dissertation]. Université Pierre et Marie Curie – Paris VI; 2016. Available from: http://www.theses.fr/2016PA066109

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