Project: The Epidemiology of Invasive Fungal Diseases in Uganda

Acronym	FUNGAL-UG (Reference Number: TMA2018CDF-2371)
Duration	01/11/2019 - 31/10/2022
Project Topic	The epidemiology of invasive fungal diseases (IFD) has been evolving for the past two decades. In Uganda, HIV/AIDS has highlighted cryptococcal meningitis (CM) as a leading IFD which is caused by Cryptococcus neoformans. There is an associated high mortality where 10-week survival rates after cryptococcal meningitis are <50% in routine care. Furthermore, the incidence of the common opportunistic fungi causing invasive disease in other immunosuppressive conditions such as cancer is not known. Therefore, this study aims to determine the molecular epidemiology of Cryptococcus species causing CM and to describe the epidemiology of Candida, Cryptococcus and Aspergillus species that cause fungemia in immunosuppressed individuals in Uganda. Additionally, the epidemiology of Madurella mycetomatis which causes eumycetoma will be described. To characterise the epidemiology of IFDs in Uganda, blood culture retrieved fungal isolates will initially be identified to species level using the standard algorithm for identification. Briefly, identification methods will include India Ink stain, germ tube test (GTT), 10% Potassium hydroxide (KOH) mount, lactofuchsin stain, culture on Chrom-Candida, Niger bird seed, l-Canavanine glycine bromothymol blue (CGB) agar, and use of biochemical tests such as API 20C. Antifungal susceptibility testing will be performed using the EUCAST method for yeasts and moulds as described elsewhere. To describe the molecular ecology, polymerase chain reaction (PCR) will be used to identify Cryptococcus species isolates from the patient’s blood and environment. Environmental samples will include birds’s guano, tree barks, soil and inanimate objects in the vicinity of the patient. Mycetoma granules from patients who present with the triad features of mycetoma will be assessed by direct microscopy using 10 % KOH, culture on Sabouraud dextrose agar while the tissue biopsy will be examined using histological stains like Haematoxylin and Eosin, Periodic Acid Schiff and Grocott Methamine Silver stains to identify eumycetoma. Actinomycetoma will be identified by Gram, Ziehl Neelsen stains and culture on blood agar. Findings from this study will be important in providing baseline information on the epidemiological trend of IFDs in Uganda for patient management and research.
Network	EDCTP2
Call	Career Development Fellowships 2018

Project partner

Number	Name	Role	Country
1	Makerere University	Coordinator	Uganda