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    Access to the World Health Organization-recommended essential diagnostics for invasive fungal infections in critical care and cancer patients in Africa: A diagnostic survey
    (Journal of Infection and Public Health, 2023-08-16) Tufa, Tafese Beyene; Bongomin, Felix; Fathallah, Akila; Luísa S.M., Ana; Hashad f, Rola; Soussi Abdallaoui g, Maha; Ahmed Nail h, Abdelsalam; Adetona Fayemiwo, Samuel; Penney, Richard O.S.; Orefuwa, Emma; Denning, David W.
    Background: Invasive fungal infections (IFIs) contribute to significant morbidity and mortality among patients with haemato-oncological conditions, seriously ill hospitalised patients and those in intensive care (ICU). We surveyed for the World Health Organization-recommended essential diagnostic tests for IFIs in these risk groups in Africa. Methods: The Global Action For Fungal Infections (GAFFI) evaluated the different levels of access to both diagnostics for IFIs for populations in Africa, with the aim of building a comparative dataset and a publicly available interactive map. Data was collected through a validated questionnaire administered to a country leader in relevant topics (i.e., HIV, laboratory coordination) and/or Ministry of Health representatives and followed up with 2 rounds of validation by video calls, and later confirmation by email of findings. Results: Initial data was collected from 48 African countries covering 99.65 % of the population.Conventional diagnostics such as blood cultures, direct microscopy and histopathology were often used for diagnosis of IFIs in more than half of the facilities. Bronchoscopy was rarely done or not done in 20 countries (population 649 million). In over 40 African countries (population > 850 million), Aspergillus antigen testing was never performed in either the public or private sectors. Computed tomography (CT) imaging is routinely used in 27 (56 %) of countries in the public sector and 21 44 %) in the private sector. However, magnetic resonance imaging remains relatively uncommon in most African countries. Conclusions: There are critical gaps in the availability of essential diagnostics for IFIs in Africa, particularly Aspergillus antigen testing and modern medical imaging modalities. Early diagnosis and commencement of targeted therapy of IFIs are critical for optimal outcomes from complex cancer therapies
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    Improving mycetoma case detection through the training of community health workers in Northern Uganda: protocol for a steppedwedge cluster-randomized trial
    (Therapeutic Advances in Infectious Disease, 2023-08-14) Kibone, Winnie; Semulimi, Andrew Weil; Kwizera, Richard; Bongomin, Felix
    Introduction: The World Health Organization acknowledges the need for countries to incorporate neglected tropical disease care into their routine health care system. However, low detection rates and late presentation of mycetoma to health facilities have been observed in endemic countries, including Uganda. Objective: To empower community health workers (CHWs) in Northern Uganda to recognize and refer suspects of mycetoma to health facilities. Design: This will be a stepped-wedge cluster-randomized trial based in Gulu and Pader districts over a period of 9months with sequential crossover from intervention phase to the control phase at different time points until both districts are exposed to the intervention. Methods and Analysis: The study will leverage on the ongoing partnership between Northern Uganda Medical Mission and the Uganda Ministry of Health that has trained over 300 CHWs in Gulu and Pader. The study evaluation will be done using the RE-AIM (Reach, Effectiveness,Adoption, Implementation, and Maintenance) framework. The expected outcome of the study is increased detection and referral of suspects of mycetoma. Data will be analyzed using STATA 17.0 and Friedman statistics or Analysis of Variance to determine increase in case identifications and referrals.
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    Breakthrough mother-to-child transmission of HIV in a low-health facility in Uganda
    (Elsevier Ltd, 2023-07-29) Okello, Benjamin; Nyana, Harriet; Luwukya, Richards; Odongkara, Moses; Kibone, Winnie; Bongomin, Felix
    Objectives: Mother-to-child transmission (MTCT) of HIV can be minimized using elimination of MTCT (eMTCT) services. This study aimed to determine the proportion of infants who tested positive for HIV despite receiving eMTCT services in a rural setting in Northern Uganda. Methods: We retrospectively reviewed the early infant diagnosis register for the year January 2019 through June 2021 to collect data on participants enrolled in eMTCT services at Lalogi Health Centre IV in Omoro district, Uganda. Breakthrough HIV infection was defined as a positive HIV RNA on a dried blood sample at 18 months in a patient who received eMTCT services as recommended by national guidelines. Results: A total of 118 infants were enrolled in the study, 64 (54.2%) of whom were female. Most of the participants (n = 111, 94.1%) were on nevirapine prophylaxis for at least 6 weeks, 115 (97.5%) were exclusively breastfed, two (1.7%) were on complementary feeding, and one (0.8%) was not breastfed. Only five (4.2%) infants were lost to follow-up, four (3.4%) had incomplete data, and three (2.5%) had breakthrough HIV infections (positive HIV RNA and HIV antibody tests). All three cases of breakthrough HIV infection (one male and two female infants) were born to mothers who were diagnosed with HIV at delivery and were on nevirapine prophylaxis for less than 6 weeks. Conclusion: Our findings indicate that while eMTCT services were largely successful in minimizing vertical transmission of HIV in the rural setting in Northern Uganda, there were still some cases of breakthrough HIV infection associated with non-adherence to nevirapine prophylaxis and delayed maternal HIV diagnosis. Therefore, adhering to the national guidelines on nevirapine prophylaxis for at least 6 weeks for children born to mothers with HIV is recommended to further reduce the risk of vertical transmission of HIV.
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    Azole-Containing Agar Plates and Antifungal Susceptibility Testing for the Detection of Azole-Resistant Aspergillus Species in Hospital Environmental Samples
    (Mary Ann Liebert, 2023) Ghazanfari, Mona; Abastabar, Mahdi; Haghani, Iman; Moazeni, Maryam; Hedayati, Shakiba; Yaalimadad, Sanaz; Shirvan, Bahador Nikoueian; Bongomin, Felix; Hedayati, Mohammad T.
    The indoor environment of hospitals should be considered as an important reservoir of azole resistant Aspergillus species. In this study, we evaluated azole-containing agar plates (ACAPs) and antifungal susceptibility testing (AFST) for the detection of azole-resistant Aspergillus species in hospital environmental samples. Between September 2021 and January 2022, environmental samples (108 instruments and 12 air) were collected from different wards of 4 educational hospitals in Mazandaran province, Iran. All samples were cultured using ACAPs. Recovered Aspergillus isolates were molecularly identified at species level using partial DNA sequencing of beta-tubulin gene. AFST of Aspergillus species was performed using the Clinical and Laboratory Standards Institute M38-A3 guideline. Screening for cyp51A mutations was also done. Overall, 18 (15.0%) isolates of Aspergillus species were recovered from ACAPs, of which Aspergillus tubingensis (50%) and Aspergillus fumigatus (38.9%) were the commonest species. No isolate of Aspergillus species grew on posaconazole (PCZ)-containing agar plates. Among the 18 Aspergillus isolated species from ACAPs, 83.3% were related to samples from instruments. Of the nine isolates of A. tubingensis, 22.2% and 44.4% isolates showed minimum inhibitory concentration (MIC) = 2 mg/mL against voriconazole (VCZ) and itraconazole, respectively; and 44.4% isolates showed MIC= 1 mg/mL against PCZ. Of the seven isolates of A. fumigatus, one (14.3%) was resistant to VCZ. This isolate showed F46Y, G54E, G138C, M172V, M220I, D255E, T289F, G432C, and G448S mutation in cyp51A. Our finding showed the emergence of high MICs in cryptic and non-fumigatus species of Aspergillus such as A. tubingensis and VCZ resistance in A. fumigatus in indoor environment of hospitals
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    HIV and fungal priority pathogens
    (Europe PMC Funders Group, 2023-11-01) Alastruey-Izquierdo, Ana; FRCPath, Nelesh P. Govender; John, Perfect; Hatim, Sati; Harrison, Tom; Chiller, Tom; Sorrell, Tania; Bongomin, Felix; Oladele, Rita; Chakrabarti, Arunaloke; Wahyuningsih, Retno; Tudela, Juan Luis Rodriguez; Beyrer, Chris; Ford, Nathan; Colombo, Arnaldo Lopes
    The burden of invasive fungal infections associated with opportunistic fungal pathogens is a persistent challenge, particularly among people with advanced HIV disease. In October,2022, WHO published the Fungal Priority Pathogens List (FPPL)—the first global effort to systematically prioritise fungal pathogens. Of the 19 pathogens in the WHO FPPL, four opportunistic pathogens in particular cause invasive diseases in people living with HIV: Cryptococcus neoformans, Histoplasma spp, Pneumocystis jirovecii, and Talaromyces marneffei. These four fungal pathogens are major causes of illness and death in people with advanced HIV and overwhelmingly affect those in low-income and middle-income countries. Access to diagnostics, improved surveillance, targeted support for innovation, and an enhanced public health focus on these diseases are needed in the effort to reduce HIV-associated deaths.
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    Long COVID in Uganda: Electrographic findings among patients at risk
    (Wiley, 2023-03-13) Semulimi, Andrew Weil; Batte, Charles; Iraguha, Daniel; Okwir, Pamela Apio; Atuhaire, Hope; Lipoto, Chelsea; Muwonge, Tonny; Namirembe, Norah; Lubega, Grace Biyinzika; Ainembabazi, Provia; Mukisa, John; Bongomin, Felix; Ssinabulya, Isaac; Okello, Emmy
    Background: COVID-19 has a significant cardiovascular involvement. An electrocardiographic (ECG) abnormalities among people at a risk of Long COVID in Uganda was investigated. Methods: A cross-sectional study was conducted from February to June 2022 at the post COVID-19 clinic in Mulago National Specialized Hospital, Kampala. A standard resting ECG was performed on individuals at least 2 months following acute COVID-19, with a negative SARS-CoV-2 reverse-transcription polymerase chain reaction. Socio-demographic and clinical characteristics as well as vital signs were recorded for all study participants. Results: Of the 244 study participants, 117 (47.9%) were female. The median age of all the participants was 33.0 (interquartile range: 26.0–43.5) years. Twenty-five (10.2%) participants had a history of smoking, whereas 117 (48%) had a history of alcohol intake. In total, 46 (18.9%) had abnormal ECG findings (95% Confidence Interval [CI]: 14.39–24.29), and nonspecific T-wave inversion (n = 16, 34%) was the most frequent ECG abnormality. The proportion of participants with ECG abnormalities was 48% lower among females (adjusted prevalence ratio [aPR]: 0.52, 95% CI: 0.28–0.96, p value <0.05) and twofold greater for those with a history of smoking (aPR: 2.03, 95% CI: 1.096–3.776, p value <0.05). Conclusion: One in five Ugandans who were checked at the clinic at a risk of Long COVID showed ECG abnormalities. ECG screening is suggested to be integrated into the follow-up care of those at a risk of Long COVID
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    Predominance of Trichophyton tonsurans causing tinea capitis: A 12-year retrospective study in the north of Iran
    (Current Medical Mycology, 2023-07-13) Hedayati, Mohammad T.; Kermani, Firoozeh; Javidnia, Javad; Moosazadeh, Mahmood; Nosratabadi, Mohsen; Salimi, Maryam; Asadi, Sabrieh; Mosayebi, Elham; Hajheydari, Zohreh; Golpour, Masoud; Rokni, Ghasem Rahmatpour; Nejad, Armaghan Kazemi; Shokohi, Tahereh; Bongomin, Felix
    Background and Purpose: Among different clinical entities of dermatophytosis, tineacapitis (TC) is considered a major public health challenge in the world, especially in regions with poor health and low income. Therefore, this study aimed to provide a retrospective analysis of the patients suspected of TC who were referred to the medical mycology laboratory of Mazandaran, a northern province of Iran. Materials and Methods: A retrospective analysis was performed on the patients suspected of TC who were referred to the medical mycology laboratory from July 2009 to April 2022. Hair roots and skin scrapings were collected from the participants. The laboratory diagnosis was confirmed by direct microscopic examination and culture. Finally, 921 out of 11095 (8.3%) patients were suspected of TC. Results: Based on the findings, TC was confirmed in 209 out of 921 patients (22.7%). In terms of gender, 209 TC patients (75.1%) were male. Moreover, the male to female ratio of TC patients was 1:3.0. Trichophyton tonsurans (146/174, 83.91%) was the most etiological agent, followed by T. mentagrophytes (13/174, 7.47%), T. violaceum (9/174, 5.17%), Microsporum canis (3/174, 1.71%), T. verrucosum (2/174, 1.15%) and T. rubrum (1/174, 0.57%). Besides, endothrix (77.0%) was the most prevalent type of hair invasion. Conclusion: The results revealed the predominance of T. tonsurans, as a causative agent of TC. Despite the prevalence of TC, the absence of appropriate consideration highlights that it is a neglected complication among children.
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    Burden and associated phenotypic characteristics of tuberculosis infection in adult Africans with diabetes: a systematic review
    (Springer Nature, 2023) Kibirige, Davis; Biraro, IreneAndia; Kyazze, Andrew Peter; Olum, Ronald; Bongomin, Felix; Nakavuma, Rose Mwanje; Ssekamatte, Phillip; Emoru, Reagan; Nalubega, Goretti; Chamba, Nyasatu; Kilonzo, Kajiru; Laizer, Sweetness Naftal; Mrema, Lucy Elauteri; Olomi, Willyhelmina; Minja, LilianTina; Ntinginya, Nyanda Elias; Sabi, Issa; Hill, Philip C.; Brake, Lindsey te; Crevel, Reinout van; Sharples, Katrina; Critchley, Julia
    Diabetes mellitus (DM) increases the risk of developing tuberculosis infection (TBI). However, the evidence on the burden and phenotypic characteristics of TBI in African patients with DM is limited. This study aimed to determine the prevalence and characterisation of TBI in native African patients living with DM. We searched PubMed, EMBASE, and African Journals Online for original studies reporting information on the prevalence and characteristics of TBI in adult Africans with DM. A forest plot was used to describe the pooled prevalence estimate of TBI and the corresponding 95% confdence intervals (CI). Six studies conducted in four African countries involving 721 participants with DM were included in this systematic review. The pooled prevalence estimate of TBI was 40% (95% CI 20–60%, I 2 = 98.52%, p< 0.001). Age ≥ 40 years and glycated haemoglobin levels independently predicted TBI positivity in patients with DM in three studies. Africans with DM have a high prevalence of TBI, especially those who are older or with poorly controlled diabetes. This justifes the need for studies to explore how to screen and manage TBI to avert the progression to active TB disease
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    Partnering to Improve Mentorship Capacity for Ugandan Reproductive Health Researchers: Program Description and Evaluation
    (The American Journal of Tropical Medicine and Hygiene, 2023-11-20) Buser, Julie M.; August, Ella; Jacobson-Davies, Faelan E.; Bongomin, Felix; Kumakech, Edward; Gray, Rachel; Pebolo, Pebalo Francis; Auma, Anna Grace; Endale, Tamrat; Smith, Yolanda R.
    Mentorship is essential to health researchers in achieving their full potential and advancing public health. In most low-resource settings, there is a paucity of training on how to be a successful mentor. The Center for International Reproductive Health Training at the University of Michigan conducted and evaluated a workshop at two universities in Uganda for mentors of new reproductive health research grant awardees. The program aimed to strengthen mentors’ mentorship skills and to identify ways to foster institutional support for mentoring. Mentors rated their post-training skills using a 5-point Likert scale (not skilled to extremely skilled) immediately and 3 months after the training. Ten of 19 mentors who participated in the training completed the evaluation. The majority were 41 to 50 years old, male, midcareer faculty. Immediately after the training, mentors rated themselves (mean 6 SD) highest in knowledge of research ethics (4.4 6 0.5), fostering independence in mentees (4.3 6 0.9), and understanding the benefits of mentoring (3.9 6 1.1). Mentors felt least confident in fostering institutional change to support mentorship (3.3 6 0.8), communication (3.5 6 0.5), and overcoming adversity (3.5 6 0.8). The two most important things the mentors learned were how to appreciate and manage diversity and how they can benefit from mentorship. Barriers to mentoring that persisted after the program ended included lack of time and institutional resources. Enhancing mentorship training opportunities will foster a generation of scientists who are more supported, skilled, and productive in research, leading to better reproductive and public health outcomes in their communities.
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    Self-Reported Hypertension and Associated Factors Among Adults in Butambala District, Central Uganda: A Community-Based Prevalence Study
    (Integrated Blood Pressure Control, 2023-11-08) Male Kato, Alex; Kibone, Winnie; Okot, Jerom; Bongomin, Felix; Baluku, Joseph Baruch
    Background: The prevalence of hypertension (HTN) differs among regions and income groups, showing a substantial increase in low- and middle-income countries. The development of hypertension is modulated by modifiable lifestyle factors, and uncontrolled hypertension poses a risk for the onset of cardiovascular diseases. Objective: To determine the community-level point-prevalence and factors associated with self-reported HTN among adults in Butambala district, central Uganda. Methods: A community-based cross-sectional study was conducted among adults aged ≥18 years in Budde subcounty, central Uganda. Data on sociodemographic characteristics and behavior were collected using a semistructured questionnaire. Self-reported HTN was assessed using a single question: “Do you have high blood pressure?” Bivariate and multivariate logistic regression analyses were performed to identify predictors of self-reported HTN. Results: A total of 565 participants (53.5% female) with a median age of 38 years (IQR: 26–52) were included in the study. The prevalence of self-reported hypertension was 18.9%. Factors independently associated with HTN were age 60 years or older (aOR: 2.9, 95% CI: 1.64–5.23, p<0.001), female sex (aOR: 3.3, 95% CI: 2.3–6.3, p<0.001), being widowed (aOR: 10.4, 95% CI: 1.25–87.14, p=0.03), secondary (aOR: 0.4, 95% CI: 0.20–0.85, p=0.016) and tertiary (aOR: 0.2, 95% CI: 0.09–0.64, p=0.005) education,unemployment (aOR: 3.0, 95% CI: 1.11–7.96, p=0.03), tobacco use (aOR: 2.9, 95% CI: 1.83–4.53, p<0.001), having had at least one blood pressure measurement during antenatal visit (aOR: 4.7, 95% CI: 1.97–11.33, p<0.001) or medical checkup (aOR: 10.7, 95% CI: 6.06–18. Conclusion: We observed a high prevalence of self-reported HTN affecting approximately one in five participants. More efforts are required to enhance routine screening, health education, and accessibility to HTN services in rural areas, with a particular emphasis on implementing HTN prevention and control strategies to effectively reduce the prevalence of HTN
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    The first Helicobacter pylori-induced Guillain–Barré syndrome in Sudan
    (Wiley, 2023-10-31) Ahmed, Ayman; EL-Sadig, Sarah Misbah; Eltigani, Hala Fathi; Bongomin, Felix; Siddig, Emmanuel Edwar
    We report the first known case of Guillain–Barré syndrome (GBS) associated with Helicobacter pylori infection in Sudan. This case highlights the role of H.pylori infection in the development of GBS. It also emphasizes the importance of wide screening of different endemic infections for patients with neurological syndromes for early detection and improves the case management in resource limited settings like Sudan. Further research is needed to better understand the underlying mechanisms of H.pylori-inducing neurological disorders.
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    "I thought I was going to die": Experiences of COVID-19 patients managed at home in Uganda
    (PLOS ONE, 2023-12-12) Nakireka, Susan; Mukunya, David; Tumuhaise, Crescent; Olum, Ronald; Namulema, Edith; Napyo, Agnes; Serwanja, Quraish; Ingabire, Prossie Merab; Muyinda, Asad; Bongomin, Felix; Musaba, Milton; Mutaki, Vivian; Nantale, Ritah; Akunguru, Phillip; Ainembabazi, Rozen; Nomujuni, Derrick; Olwit, William; Nakawunde, Aisha; Nyiramugisha, Specioza; Mwa Aol, Pamela; Rujumba, Joseph; Munabi, Ian; Kiguli, Sarah
    Background In Uganda, approximately 170,000 confirmed COVID-19 cases and 3,630 deaths have been reported as of January 2023. At the start of the second COVID-19 wave, the Ugandan health system was overwhelmed with a sudden increase in the number of COVID-19 patients who needed care, and the Ministry of Health resorted to home-based isolation and care for patients with mild to moderate disease. Before its rollout, the COVID-19 homebased care strategy had neither been piloted nor tested in Uganda. Objective To explore the experiences of COVID-19 patients managed at home in Uganda. Methods This was a qualitative study that was conducted to explore the lived experiences of COVID19 patients managed at home. The study was carried out among patients who presented to three hospitals that were designated for treating COVID-19 patients in Uganda. COVID-19 patients diagnosed at these hospitals and managed at home were followed up and contacted for in-depth telephone interviews. The data were analysed using thematic content analysis with the aid of NVIVO 12.0.0 (QRS International, Cambridge, MA). Results Participants experienced feelings of fear and anxiety: fear of death, fear of losing jobs, fear of infecting loved ones and fear of adverse events such as loss of libido. Participants also reported feelings of loneliness, hopelessness and depression on top of the debilitating and sometimes worsening symptoms. In addition to conventional medicines, participants took various kinds of home remedies and herbal concoctions to alleviate their symptoms. Furthermore, COVID-19 care resulted in a high economic burden, which persisted after the COVID-19 illness. Stigma was a major theme reported by participants. Participants recommended that COVID-19 care should include counselling before testing and during and after the illness to combat the fear and stigma associated with the diagnosis. Another recommendation was that health workers should carry out home visits to patients undergoing homebased care and that COVID-19 treatment should be free of charge. Conclusion COVID-19 home-based care was associated with fear, anxiety, loneliness, depression, economic loss and stigma. Policymakers should consider various home-based follow-up strategies and strengthen counselling of COVID-19 patients at all stages of care.
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    Isolated renal and urinary tract aspergillosis: a systematic review
    (Sage Publications, 2023-11-16) Bongomin, Felix; Ekeng, Bassey E.; Mushi, Martha F.; Kibone, Winnie; Olum, Ronald; Meya, David B.; Hamer, Davidson H.; Denning, David W.; Morgan, Bethan
    Abstract Background: Aspergillosis localized to the kidneys and the urinary tract is uncommon. We conducted a comprehensive systematic review to evaluate risk factors and clinical outcomes of patients with isolated renal and genito-urinary tract aspergillosis. Methods: We systematically searched Medline, CINAHL, Embase, African Journal Online, Google Scholar, and the Cochrane Library, covering the period from inception to August2023 using the key terms ‘renal’ OR ‘kidney*’ OR ‘prostate’ OR ‘urinary bladder’ OR ‘urinary tract*AND ‘aspergillosis’ OR ‘aspergillus’ OR ‘aspergilloma’ OR ‘mycetoma’. We included single case reports or case series. Review articles, guidelines, meta-analyses, animal studies,protocols, and cases of genitourinary and /or renal aspergillosis occurring as a part of disseminated disease were excluded. Results: We identified 91 renal and urinary aspergillosis cases extracted from 76 publications spanning 1925–2023. Among the participants, 79 (86.8%) were male, with a median age of 46years. Predominantly, presentations consisted of isolated renal infections (74 instances,81.3%), followed by prostate (5 cases, 5.5%), and bladder (7 cases, 7.7%) involvement. Aspergillus fumigatus (42.9%), Aspergillus flavus (9.9%), and Aspergillus niger/glaucus (1.1% each) were isolated. Underlying risk factors included diabetes mellitus (29.7%), HIV (12.1%), haematological malignancies (11%), and liver cirrhosis (8.8%), while common symptoms encompassed flank pain (36.3%), fever (33%), and lower urinary tract symptoms (20.9%). An autopsy was conducted in 8.8% of cases. Diagnostic work-up involved histopathology (70.5%), renal CT scans and urine microscopy and culture (52.6% each), and abdominal ultrasound (17.9%). Treatments included amphotericin B (34 cases, 37.4%) and azole-based regimens (29 cases, 31.9%). Nephrectomy was performed in 16 of 78 renal cases (20.5%). All-cause mortality was 24.4% (19 cases). No significant mortality rate difference was observed among antifungal regimens (p=0.739) or nephrectomy status (p=0.8). Conclusion: Renal and urinary aspergillosis is an important cause of morbidity and mortality, particularly in immunocompromised and people with diabetes mellitus. While varied treatment strategies were observed, mortality rates showed no significant differences based on treatments or nephrectomy status. Further research is needed to refine diagnostics, optimize treatments, and enhance awareness among clinicians for early detection and management.
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    Prevalence of chronic pulmonary aspergillosis along the continuum of pulmonary tuberculosis care: A protocol for a living systematic review and meta-analysis
    (PLOS ONE, 2023-12-15) Bongomin, Felix; Olum, Ronald; Kibone, Winnie; Namusobya, Martha; Rhijn, Norman van; Denning, David W.
    Introduction Chronic pulmonary aspergillosis (CPA) is a debilitating disease estimated to affect over 3million people worldwide. Pulmonary tuberculosis (PTB) is the most significant risk factor for CPA. However, the true burden of CPA at the time of PTB diagnosis, during, and after PTB treatment remains unknown. In this paper, we present a protocol for a living systematic review aimed at estimating the current burden of CPA along the continuum of PTB care. Materials and methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines to formulate this protocol, which is registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023453900). We will identify primary literature through various electronic databases, including CINAHL, Ovid MEDLINE, MEDLINE (PubMed), EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and African Journal Online. The search will encompass articles from inception to December 31st, 2023, using medical subject heading search terms "pulmonary tuberculosis" AND "chronic pulmonary aspergillosis". Two reviewers will independently assess titles, abstracts, and full texts for eligibility using the Covidence web-based software.The eligible studies will comprise original observational research that reports on the prevalence of CPA diagnosed in individuals with PTB, based on established criteria, without language or geographic restriction. We intend to exclude single case reports and case series with fewer than 10 participants, as well as review articles, guidelines, and letters to the editors. Cochrane Risk of Bias Tools (ROB2 and ROBINS-I) will used to assess study quality and risk of bias and the quality of the evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. Our data syntheses will encompass meta-analysis and meta-regression, conducted using STATA version 18 and R- Studio version 4.0.2. This systematic review will be updated every 3–5years as more data emerges. Conclusions The findings of this proposed systematic review will summarize the available evidence on the occurrence of CPA, at the time of PTB diagnosis, during and after PTB treatment. The study results have the potential to guide healthcare policies regarding screening for CPA,enhance clinical decision-making, and catalyse further research into understanding the interplay between PTB and CPA. By shedding light on the current burden of CPA along the continuum of PTB care, we aspire to contribute to the betterment of patient care, disease management, and global health outcomes.
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    Diagnostic Accuracy of Clinical Diagnostic Scoring Systems for Childhood Tuberculosis: A Systematic Review and Meta-analysis
    (Oxford University Press, 2023-12-11) Kakinda, Michael; Olum, Ronald; Baluku, Joseph Baruch; Bongomin, Felix
    Background. Diagnosis of childhood tuberculosis (TB) poses several challenges. Therefore, point-based scoring systems and diagnostic algorithms have been developed to improve the diagnostic yields in this population. However, there are no updated systematic reviews of the existing childhood TB scoring systems and algorithms. Hence, we systematically reviewed the diagnostic accuracy of the childhood TB diagnostic scoring systems and algorithms. Methods. We systematically searched PubMed, CINAHL, Embase, Scopus, and Google Scholar databases for relevant articles published until 30 March 2023. QUADAS-2 was used to assess their study quality. Diagnostic accuracy measures (ie, sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) were pooled using a random-effects model. Results. We included 15 eligible studies, with a total of 7327 study participants aged <15 years, with 10 evaluations of childhood TB diagnostic scoring systems and algorithms. Among these algorithms and scoring systems, only 3 were evaluated more than once. These were the Keith Edwards scoring system with 5 studies (sensitivity, 81.9%; specificity, 81.2%), Kenneth Jones criteria with 3 studies (sensitivity, 80.1%; specificity, 45.7%), and the Ministry of Health–Brazil algorithm with 3 studies (sensitivity, 79.9%; specificity, 73.2%). Conclusions. We recommend using the Keith Edwards scoring system because of its high sensitivity and specificity. Further research is necessary to assess the effectiveness of scoring systems and algorithms in identifying TB in children with HIV and malnutrition.
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    Cor pulmonale complicating chronic pulmonary aspergillosis with fatal consequences: Experience from Uganda
    (Medical mycology case reports, 2019-07-04) Bongomin, Felix; Kwizera, Richard; Atukunda, Angella; Kirengaa, Bruce J.
    Cor pulmonale is a rare complication of pulmonary aspergillosis (CPA). A 45-year-old Ugandan male with a history of recurrent community-acquired pneumonias was admitted with symptoms of progressive difficulty in breathing, chronic productive cough, non-exertional left sided chest pain and progressive weight loss occurring over a 12-month period. Chest CT scan and echocardiography confirmed the diagnosis of CPA with an asper gilloma complicating bronchiectasis, complicated with cor pulmonale. However, this was previously clinically misdiagnosed as PTB.
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    Innate and Adaptive Immune Defects in Chronic Pulmonary Aspergillosis
    (Journal of Fungi, 2017-05-29) Bongomin, Felix; Harris, Chris; Foden, Philip; Kosmidis, Chris; Denning, David W.
    We evaluated the expression of biomarkers of innate and adaptive immune response in correlation with underlying conditions in 144 patients with chronic pulmonary aspergillosis (CPA). Patients with complete medical and radiological records, white cell counts, and a complete panel of CD3, CD4, CD8, CD19, and CD56 lymphocyte subsets were included. Eighty-four (58%) patients had lymphopenia. Six (4%) patients had lymphopenia in all five CD variables. There were 62 (43%) patients with low CD56 and 62 (43%) patients with low CD19. Ten (7%) patients had isolated CD19 lymphopenia, 18 (13%) had isolated CD56 lymphopenia, and 15 (10%) had combined CD19 and CD56 lymphopenia only. Forty-eight (33%) patients had low CD3 and 46 (32%) had low CD8 counts. Twenty-five (17%) patients had low CD4, 15 (10%) of whom had absolute CD4 counts <200/μL. Multivariable logistic regression showed associations between: low CD19 and pulmonary sarcoidosis (Odds Ratio (OR), 5.53; 95% Confidence Interval (CI), 1.43–21.33; p = 0.013), and emphysema (OR, 4.58; 95% CI; 1.36–15.38; p = 0.014), low CD56 and no bronchiectasis (OR, 0.27; 95% CI, 0.10–0.77; p = 0.014), low CD3 and both multicavitary CPA disease (OR, 2.95; 95% CI, 1.30–6.72; p = 0.010) and pulmonary sarcoidosis (OR, 4.94; 95% CI, 1.39–17.57; p = 0.014). Several subtle immune defects are found in CPA.
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    Isavuconazole and voriconazole for the treatment of chronic pulmonary aspergillosis: A retrospective comparison of rates of adverse events
    (Mycoses, 2018-12-13) Bongomin, Felix; Maguire, Niamh; Moore, Caroline B.; Felton, Timothy; Rautemaa-Richardson, Riina
    Background: Long-term oral triazole antifungal therapy is the cornerstone of man agement for patients with chronic pulmonary aspergillosis (CPA). Itraconazole is the first-line choice of treatment. Voriconazole, posaconazole or isavuconazole can be used as alternative treatments in case of resistance or intolerance. All of these can cause significant adverse drug reactions. Objectives: To evaluate how CPA patients tolerate voriconazole and isavuconazole after prior triazole therapy. Methods: We performed a retrospective observational study at the UK National Aspergillosis Centre. Medical records for all consecutive CPA patients started on isa vuconazole and voriconazole during an observation period of 12 and 6 months re spectively were analysed. Results: During this study period, 20 patients were started on isavuconazole and 21 patients on voriconazole. Adverse events were seen in 18 of 21 (86%) the patients in the voriconazole group and 12 of 20 (60%) in the isavuconazole group (P = 0.02). For those who developed adverse events to these agents, the rates of discontinuation of therapy were comparable (ie 10/18 [56%], voriconazole vs 8/12 [67%], isavucona zole; P = 0.54). Five (25%) patients in the isavuconazole group who were intolerant to other triazoles tolerated the standard dose of isavuconazole. Conclusions: Compared with isavuconazole, adverse events were significantly higher in CPA patients commenced on voriconazole. Isavuconazole may be an option for those patients who are intolerant to other triazoles.
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    Internal Medicine Clerkship Amidst COVID-19 Pandemic: A Cross-Sectional Study of the Clinical Learning Experience of Undergraduate Medical Students at Makerere University, Uganda
    (Dove Press, 2021) Bongomin, Felix; Olum, Ronald; Nakiyingi, Lydia; Lalitha, Rejani; Ssinabulya, Isaac; Sekaggya Wiltshire, Christine; Ocama, Ponsiano; Byakika-Kibwika, Pauline
    Background: The coronavirus-2019 (COVID-19) pandemic continues to impose a significant impact on medical education. We aimed to describe the clinical learning experience of undergraduate medical students undertaking internal medicine clerkship during the COVID-19 pandemic at Makerere University, Uganda. Methods: A descriptive, cross-sectional study among medical students in clinical years of study pursuing the Bachelor of Medicine and Bachelor of Surgery undergraduate degree program was conducted in November 2020. Only 3rd (junior clerks) and 5th (senior clerks) year medical students whose internal medicine clerkships were interrupted by the COVID-19 pandemic were studied. Results: Data of 188 (95%) eligible clinical year students; junior (101, 54.0%) and senior (86, 46.0%) were analysed. Median age was 24 (range: 22–42) years. Majority (70.1%) were male and Ugandan nationals (94.1%). Sixty-four (30.3%) students reported inadequate personal protective equipment, 152 (81.7%) felt at risk of contracting COVID-19, and 127 (67.9%) said it was difficult to observe COVID-19 standard operating procedures. Twenty two students (11.9%) were discouraged from pursuing a career in internal medicine. Overall, most students reported good or excellent clinical experience pre-COVID-19 era compared to during the COVID-19 era (4.0 vs 3.5, p<0.0001). Senior clerks significantly believed that the time allocated for the rotation was adequate (p<0.0001) and they were able to complete their study objectives (p<0.001), compared to the junior clerks. Senior clerks believed that learning was difficult when combined with junior clerks (p=0.013). About half of the students (51.4%, n=95) reported clinical teaching should remain as it was in the pre COVID-19 era. Conclusion: The COVID-19 pandemic has had a significantly negative effect on the clinical learning experience of the students. There is need to review the current teaching and learning methods to suit teaching and learning during pandemics of highly infectious diseases to ensure safe and effective learning experience.
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    COVID-19 vaccine acceptance among high-risk populations in Uganda
    (Therapeutic Advances in Infectious Disease, 2021) Bongomin, Felix; Olum, Ronald; Andia-Biraro, Irene; Nakwagala, Frederick Nelson; Hudow Hassan, Khalid; Nassozi, Dianah Rhoda; Kaddumukasa, Mark; Byakika-Kibwika, Pauline; Kiguli, Sarah; Kirenga, Bruce J.
    Background: Immunization is an important strategy for controlling the COVID-19 pandemic. COVID-19 vaccination was recently launched in Uganda, with prioritization to healthcare workers and high-risk individuals. In this study, we aimed to determine the acceptability of COVID-19 vaccine among persons at high risk of COVID-19 morbidity and mortality in Uganda. Methods: Between 29 March and 14 April 2021, we conducted a cross-sectional survey consecutively recruiting persons at high risk of severe COVID-19 (diabetes mellitus, HIV and cardiovascular disease) attending Kiruddu National Referral Hospital outpatient clinics. A trained research nurse administered a semi-structured questionnaire assessing demographics, COVID-19 vaccine related attitudes and acceptability. Descriptive statistics, bivariate and multivariable analyses were performed using STATA 16. Results: A total of 317 participants with a mean age 51.5±14.1years were recruited. Of this, 184 (60.5%) were female. Overall, 216 (70.1%) participants were willing to accept the COVID-19 vaccine. The odds of willingness to accept COVID-19 vaccination were four times greater if a participant was male compared with if a participant was female [adjusted odds ratio (AOR): 4.1, 95% confidence interval (CI): 1.8–9.4, p=0.00]. Participants who agreed (AOR: 0.04, 95% CI: 0.01–0.38, p=0.003) or strongly agreed (AOR: 0.04, 95% CI: 0.01–0.59, p=0.005) that they have some immunity against COVID-19 were also significantly less likely to accept the vaccine. Participants who had a history of vaccination hesitancy for their children were also significantly less likely to accept the COVID-19 vaccine (AOR: 0.1, 95% CI: 0.01–0.58, p=0.016). Conclusion: The willingness to receive a COVID-19 vaccine in this group of high-risk individuals was comparable to the global COVID-19 vaccine acceptance rate. Increased sensitization, myth busting and utilization of opinion leaders to encourage vaccine acceptability is recommended.