{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:32:43Z","timestamp":1777879963381,"version":"3.51.4"},"reference-count":56,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Infection"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Sierra Leone is a small, resource-limited country that has a low national prevalence of human immunodeficiency virus (HIV) and a very high burden of tuberculosis (TB). Fungal diseases are probably common, but poorly documented. In this article, we reviewed the existing literature on fungal epidemiology in Sierra Leone using national, regional, and international data, identified knowledge gaps, and propose solutions to address the challenges on the prevention and control of fungal diseases in Sierra Leone and similar countries. In advanced HIV disease, we estimate 300 cryptococcal meningitis, 640 Pneumocystis pneumonia, and over 4000 esophageal candidiasis cases annually. Chronic lung disease is common, with an estimated 6000 cases of chronic pulmonary aspergillosis, many mistaken for TB, 5000 adults with allergic bronchopulmonary aspergillosis complicating asthma, and probably over 6600 cases of severe asthma with fungal sensitization. Invasive aspergillosis is estimated at 478 cases. None of these diagnoses are made in Sierra Leone at present. Major burdens are recurrent vulvovaginal candidiasis (85,400) and tinea capitis in children (266,450). Improvement in fungal disease diagnosis in Sierra Leone will enable better estimates to be made and reduce morbidity and mortality.<\/jats:p>","DOI":"10.1177\/20499361211027996","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T07:45:34Z","timestamp":1625039134000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["The burden of serious fungal infections in Sierra Leone: a national estimate"],"prefix":"10.1177","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7639-0004","authenticated-orcid":false,"given":"Sulaiman","family":"Lakoh","sequence":"first","affiliation":[{"name":"College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone"},{"name":"University of Sierra Leone Teaching Complex, Ministry of Health and Sanitation, Freetown, Government of Sierra Leone, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Orefuwa","sequence":"additional","affiliation":[{"name":"Global Action Fund for Fungal Infections, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilda N.","family":"Kamara","sequence":"additional","affiliation":[{"name":"College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darlinda F.","family":"Jiba","sequence":"additional","affiliation":[{"name":"University of Sierra Leone Teaching Complex, Ministry of Health and Sanitation, Freetown, Government of Sierra Leone, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph B.","family":"Kamara","sequence":"additional","affiliation":[{"name":"University of Sierra Leone Teaching Complex, Ministry of Health and Sanitation, Freetown, Government of Sierra Leone, Freetown, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylaju","family":"Kpaka","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Njala University, Bo, Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Denning","sequence":"additional","affiliation":[{"name":"Global Action Fund for Fungal Infections, Geneva, Switzerland"},{"name":"Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"bibr1-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1590\/0074-02760200430"},{"key":"bibr2-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2015.10.004"},{"key":"bibr3-20499361211027996","doi-asserted-by":"publisher","DOI":"10.3390\/jof3040057"},{"key":"bibr4-20499361211027996","unstructured":"World Health Organization. Report on neglected tropical disease, https:\/\/www.who.int\/neglected_diseases\/diseases\/en\/ (2018, accessed 21 February 2021)."},{"key":"bibr5-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1186\/s40249-020-0630-9"},{"key":"bibr6-20499361211027996","unstructured":"World Health Organization. Accelerating elimination of NTDs \u2013 towards 2030, https:\/\/espen.afro.who.int\/ (accessed 13 March 2021)."},{"key":"bibr7-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002286"},{"key":"bibr8-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30374-2"},{"key":"bibr9-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.2706"},{"key":"bibr10-20499361211027996","unstructured":"Kaldor M, Vincent J. Evaluation of UNDP assistance to conflict-affected countries. Case study: Sierra Leone. New York: UNDP, 2006, pp.1\u201339."},{"key":"bibr11-20499361211027996","unstructured":"World Health Organization. Health worker Ebola infections in Guinea, Liberia and Sierra Leone. Geneva, Switzerland: World Health Organization, 2015, pp.1\u201316."},{"key":"bibr12-20499361211027996","doi-asserted-by":"publisher","DOI":"10.4102\/ajlm.v5i3.549"},{"key":"bibr13-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-020-4862-x"},{"key":"bibr14-20499361211027996","unstructured":"Statistics Sierra Leone (Stats SL) and ICF. Sierra Leone demographic and health survey 2019: key indicators, https:\/\/dhsprogram.com\/pubs\/pdf\/PR122\/PR122.pdf (2019, accessed 20 Febraury 2021)."},{"key":"bibr15-20499361211027996","unstructured":"Global AIDS Monitoring 2020. Country progress report \u2013 Sierra Leone, https:\/\/www.ecoi.net\/en\/file\/local\/2038366\/SLE_2020_countryreport.pdf (accessed 23 February 2021)."},{"key":"bibr16-20499361211027996","unstructured":"UNAIDS. Regional factsheets-West and Central Africa, https:\/\/www.unaids.org\/en\/regionscountries\/westandcentralafrica (2018) (accessed 23 February 2021)"},{"key":"bibr17-20499361211027996","unstructured":"The 2015 Sierra Leone Population Census, https:\/\/www.statistics.sl\/images\/StatisticsSL\/Documents\/Census\/2015\/sl_2015_phc_thematic_report_on_pop_structure_and_pop_distribution.pdf (accessed 23 February 2021)."},{"key":"bibr18-20499361211027996","unstructured":"IMF Staff Country Reports. Sierra Leone: economic development documents-national development plan, 2019-23, https:\/\/www.imf.org\/en\/Publications\/CR\/Issues\/2019\/07\/09\/Sierra-Leone-Economic-Development-Documents-National-Development-Plan-2019-23-47099#:~:text=Staff%20Country%20Reports-Sierra%20Leone%20%3A%20Economic%20Development%20Documents,National%20Development%20Plan%2C%202019%2D23&text=The%20Government%20of%20Sierra%20Leone's,welfare%20of%20Sierra%20Leone's%20citizens (accessed 23 February 2021)."},{"key":"bibr19-20499361211027996","unstructured":"Sierra Leone demographic and health survey 2008, https:\/\/dhsprogram.com\/pubs\/pdf\/FR225\/FR225.pdf (accessed 20 February 2021)."},{"key":"bibr20-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7614-3"},{"key":"bibr21-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofy208"},{"key":"bibr22-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.04.038"},{"key":"bibr23-20499361211027996","unstructured":"World Health Organization. Global TB report, https:\/\/www.who.int\/tb\/publications\/global_report\/en\/ (2020) (accessed 10 January 2021)."},{"key":"bibr24-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-204"},{"key":"bibr25-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2013.08.022"},{"key":"bibr26-20499361211027996","unstructured":"The World Health Organization. The global TB report 2019, https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/336069\/9789240013131-eng.pdf?ua=1 (accessed 10 January 2021)."},{"key":"bibr27-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03548.x"},{"key":"bibr28-20499361211027996","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.089441"},{"key":"bibr29-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2010.08.010"},{"key":"bibr30-20499361211027996","doi-asserted-by":"publisher","DOI":"10.3109\/13693786.2012.738312"},{"key":"bibr31-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e32833e84d2"},{"key":"bibr32-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2010.03360.x"},{"key":"bibr33-20499361211027996","doi-asserted-by":"publisher","DOI":"10.3109\/00365549009027119"},{"key":"bibr34-20499361211027996","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5154.31921"},{"key":"bibr35-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2018.0010"},{"key":"bibr36-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmr.2015.06.007"},{"key":"bibr37-20499361211027996","unstructured":"Resilient & Responsive Health Organizations. Consolidated guidelines on HIV prevention, diagnosis, treatment and care in Sierra Leone, https:\/\/www.resilientinstitutionsafrica.org\/resources\/consolidated-guidelines-hiv-prevention-diagnosis-treatment-and-care-sierra-leone (accessed 13 March 2021)."},{"key":"bibr38-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12141"},{"key":"bibr39-20499361211027996","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.10476"},{"key":"bibr40-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2222.1980.tb02109.x"},{"key":"bibr41-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0215530"},{"key":"bibr42-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1186\/s13601-020-00353-8"},{"key":"bibr43-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30448-5"},{"key":"bibr44-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13221"},{"key":"bibr45-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-0825.2000.tb00110.x"},{"key":"bibr46-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.1998.7.1167"},{"key":"bibr47-20499361211027996","author":"Denning DW","journal-title":"Lancet Infect Dis"},{"key":"bibr48-20499361211027996","first-page":"107","volume":"33","author":"Oladele RO","year":"2014","journal-title":"West Afr J Med"},{"key":"bibr49-20499361211027996","doi-asserted-by":"publisher","DOI":"10.3390\/jof5020038"},{"key":"bibr50-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-13-2526-7_8"},{"key":"bibr51-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1717295115"},{"key":"bibr52-20499361211027996","unstructured":"World Health Organization. Guidelines on the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection March 2018, https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/260399\/9789241550277-eng.pdf;jsessionid=F81E45975EB6B4A621564A40556FA193?sequence=1 (2018, accessed 24 February 2021)."},{"key":"bibr53-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12390"},{"key":"bibr54-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaa119"},{"key":"bibr55-20499361211027996","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2017.11.020"},{"key":"bibr56-20499361211027996","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.10327.1"}],"container-title":["Therapeutic Advances in Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361211027996","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20499361211027996","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361211027996","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:58:05Z","timestamp":1777593485000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20499361211027996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":56,"alternative-id":["10.1177\/20499361211027996"],"URL":"https:\/\/doi.org\/10.1177\/20499361211027996","relation":{},"ISSN":["2049-9361","2049-937X"],"issn-type":[{"value":"2049-9361","type":"print"},{"value":"2049-937X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]},"article-number":"20499361211027996"}}