Management and Outcome of Intracranial Fungal Infections in Africa: A Scoping Review

Abstract Aim To detail the management, and outcome of intracranial fungal infections (IcFIs) across Africa. Method This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review. Results Of the 5,779 records identified, 133 articles were included. The mean age of 35.7 years and the majority (52.3%) were males. The majority (n = 4,732/8,330, 84.4%) of IcFIs presented as meningitis, and the most common predisposing factor of IcFIs was HIV/AIDS (n = 8,176/9,054, 90.3%). Cryptococcus species was the most common (n = 8,789/9,054, 97.1%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 5,793/9,054, 64.0%). The most common treatment modality was medical management with antifungals only (n = 4,242/9,054, 46.9%). The mortality rate was (n = 3,810/9,054, 42.1%). Conclusions Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. The outcome of IcFIs in Africa was poor.