Browsing by Author "Sande, Obondo James"

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    Distribution and antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with HIV in the era of universal test and treat policy in Uganda
    (Sage Publishing, 2024-04-30) Musinguzi, Benson; Turyamuhika, Laban; Mwesigwa, Alex; Nalumaga, Pauline Petra; Kabajulizi, Immaculate; Njovu, Israel Kiiza; Mwebesa, Edson; Luggya, Tonny; Ocheng, Francis; Kateete, David Patrick; Itabangi, Herbert; Mboowa, Gerald; Sande, Obondo James; Achan, Beatrice
    Despite the increased frequency of oropharyngeal candidiasis among people living with human immunodeficiency virus (HIV), its management is no longer effective due to empirical treatment and emergence of antifungal resistance (AFR). This study sought to investigate the prevalence of oropharyngeal candidiasis and assess the antifungal susceptibility profile of oropharyngeal Candida species isolated from people living with human immunodeficiency virus. Additionally, we evaluated the correlation between oropharyngeal candidiasis and CD4 T cell as well as viral load counts. A descriptive cross-sectional study was carried out from April to October 2023 in which 384 people living with HIV underwent clinical examination for oral lesions. Oropharyngeal swabs were collected and cultured on Sabouraud Dextrose agar to isolate Candida species which were identified using the matrix assisted laser desorption ionization time of flight mass spectrometry. Additionally, the antifungal susceptibility profile of Candida isolates to six antifungal drugs was determined using VITEK® (Marcy-l’Étoile, France) compact system. Data on viral load were retrieved from records, and CD4 T cell count test was performed using Becton Dickinson Biosciences fluorescent antibody cell sorter presto. The prevalence of oropharyngeal candidiasis was 7.6%. Oropharyngeal candidiasis was significantly associated with low CD4 T cell count and high viral load. A total of 35 isolates were obtained out of which Candida albicans comprised of 20 (57.1%) while C. tropicalis and C. glabrata comprised 4 (11.4%) each. C. parapsilosis, C. dubliniensis and C. krusei accounted for 2 (5.7%) each. Additionally, 7 (20%) isolates were resistant to fluconazole, 1 (2.9%) to flucytocine and 0.2 (5.7%) isolates were intermediate to caspofungin. However, specific specie isolates like C. albicans showed 20% (4/20), C. glabrata 50% (2/4) and C. krusei 50% (1/2) resistance to fluconazole. Additionally, C. krusei showed 50% resistance to flucytosine. The prevalence of oropharyngeal candidiasis (OPC) among people living with HIV was low, and there was a significant association between OPC and CD4 T cell count as well as viral load. C. albicans was the most frequently isolated oropharyngeal Candida species. C. glabrata and C. krusei exhibited the highest AFR among the non-albicans Candida species. The highest resistance was demonstrated to fluconazole.
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    Distribution of Candida species isolated from people living with human immunodeficiency virus with oropharyngeal and oral candidiasis in Africa in the era of universal test and treat policy: a systematic review and meta‑analysis
    (Springer Nature, 2024-11-27) Musinguzi, Benson; Obuku, Ekwaro A.; Mwesigwa, Alex; Migisha, Richard; Kinengyere, Alison Annet; Ndagire, Regina; Baguma, Andrew; Okek, Erick Jacob; Olum, Ronald; Itabangi, Herbert; Mboowa, Gerald; Sande, Obondo James; Achan, Beatrice
    Background: The introduction of antiretroviral therapy (ART) and the implementation of the human immunodeficiency virus (HIV) universal test and treat (UTT) policy have led to a decline in the incidence of opportunistic infections. However, oropharyngeal and oral candidiasis remain prevalent and continue to pose challenges among people living with human immunodeficiency virus (PLHIV) in Africa, indicating the need for a better understanding of the distribution of Candida species responsible for these infections. This systematic review and meta-analysis aimed to determine the distribution of Candida species isolated from PLHIV with oropharyngeal and oral candidiasis in Africa in the era of UTT policy. Methods: The review followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A comprehensive search was conducted to identify eligible studies to be included in the meta-analysis and analysed using a random effects model in STATA version 17. The risk of bias was assessed using the Joanna Briggs Institute quality assessment tool. Results: Fourteen studies with 4281 participants were included in the review. Overall, 2095 Candida isolates were reported, 78.7% (1650/2095) of which were C. albicans, 19.6% (410/2095), non-albicans Candida (NAC), and 1.7% (35/2095) could not be identified to the Candida specific species level. The most prevalent NAC species were C. glabrata (26.3%), followed by C. tropicalis (24.9%), C. krusei (15.6%), C. parapsilosis (11%), and C. dubliniensis (6.3%). The pooled prevalence of oropharyngeal and oral candidiasis was 48% (95% CI 34–62%). The prevalence of oropharyngeal candidiasis was higher in the pre-UTT era, at 56% (95% CI 40–72%, p < 0.001), than in the post-UTT era, at 34% (95% CI 10–67%, p < 0.001). The risk of bias assessment revealed that 71.4% (10/14) of the included studies had a low risk of bias and that 28.6% (4/14) had a moderate risk of bias. Conclusions: While C. albicans remain, the predominant species causing oropharyngeal and oral candidiasis among PLHIV in Africa, NAC species also contribute significantly to the infection burden. Despite ART and UTT policies, oropharyngeal candidiasis remains prevalent, emphasizing the need for targeted interventions.
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    Extracellular hydrolytic enzyme activities and biofilm formation in Candida species isolated from people living with human immunodeficiency virus with oropharyngeal candidiasis at HIV/AIDS clinics in Uganda
    (Elsevier, 2024-12-14) Musinguzi, Benson; Akampurira, Andrew; Derick, Hope; Turyamuhika, Laban; Mwesigwa, Alex; Mwebesa, Edson; Mwesigye, Vicent; Kabajulizi, Immaculate; Sekulima, Tahalu; Ocheng, Francis; Itabangi, Herbert; Mboowa, Gerald; Sande, Obondo James; Achan, Beatrice
    Background: Commensal oral Candida species can become opportunistic and transition to pathogenic causes of oropharyngeal candidiasis (OPC) in individuals with impaired immunity through ecological cues and the expression of extracellular hydrolytic enzyme activities and biofilm formation. Objective: We evaluated phospholipase, proteinase, hemolysin, esterase, and coagulase enzymatic activities and biofilm formation in Candida species isolated from people living with human immunodeficiency virus (PLHIV) with OPC. Methods: Thirty-five Candida isolates from PLHIV with OPC were retrieved from a sample repository and evaluated for phospholipase activity using the egg yolk agar method, proteinase activity using the bovine serum albumin agar method, hemolysin activity using the blood agar plate method, esterase activity using the Tween 80 opacity test medium method, coagulase activity using the classical tube method, and biofilm formation using the microtiter plate assay method in vitro. Results: A total of 35 Candida isolates obtained from PLHIV with OPC were included in this study, and phospholipase and proteinase activities were detected in 33/35 (94.3 %) and 31/35 (88.6 %) Candida isolates, respectively. Up to 25/35 (71.4 %) of the Candida isolates exhibited biofilm formation, whereas esterase activity was demonstrated in 23/35 (65.7 %) of the Candida isolates. Fewer isolates (21/35, 60 %) produced hemolysin, and coagulase production was the least common virulence activity detected in 18/35 (51.4 %) of the Candida isolates. Conclusion: Phospholipase and proteinase activities were the strongest in oropharyngeal Candida species.
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    Increasing postgraduate medical mycology research dissertations at Uganda's higher institution of learning
    (Elsevier, 2025-01) Achan, Beatrice; Musinguzi, Benson; Itabangi, Herbert; Sande, Obondo James; Meya, David B.
    Objectives Postgraduate medical mycology research may also be affected by funding. This study reports the positive impact of funding on postgraduate medical mycology research at Makerere University, Uganda. Methods This retrospective study was conducted on postgraduate medical microbiology dissertation topics from 2023 to 2024 using data collected between September and November 2024. Results A total of N = 60 postgraduate medical microbiology dissertations were analyzed for medical mycology topics, of which a total of 18 (30%) focused on medical mycology. The percentage of dissertations centered on medical mycology increased from 16% (four of 25) in 2023 to 40% (14 of 35) in 2024. Cryptococcal meningitis is the most studied fungal disease (35.7%) (five) in 2024. Notably, molecular-based polymerase chain reaction (50%, two) and semi-automated culture (35.7%, five) were the most commonly used laboratory methods in 2023 and 2024. There were 75% (four) and 71.4% (14) timely completions of the postgraduate students, and the Makerere University Fungal Group was formed to promote the “buddy system of learning” among the postgraduate medical mycology students. Conclusion There has been an increase in medical mycology research among postgraduate medical microbiology students at Makerere University, Uganda, which is attributable to increased funding.