Bacterial and Fungal Coinfections among Patients with Tuberculosis in Africa: A Systematic Review

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Résumé

Tuberculosis (TB) remains a major public health challenge in Africa, where HIV prevalence varies considerably
across countries but remains, overall, higher than the global average. Limited diagnostic capacity and the
growing emergence of antimicrobial resistance further contribute to unfavorable treatment outcomes. Bacterial
and fungal coinfections may complicate TB diagnosis and treatment, yet evidence from Africa remains
fragmented. This systematic review aimed to synthesize available data on the prevalence, microbiological
profiles, antimicrobial resistance patterns, and clinical implications of bacterial and fungal coinfections among
TB patients in Africa. A systematic review was conducted according to PRISMA 2020 guidelines.
PubMed/MEDLINE, ProQuest Central, and African Journals Online were searched for studies reporting
bacterial and/or fungal coinfections among TB patients in Africa. Data extraction and quality assessment were
performed independently by two reviewers using validated tools (NOS, AXIS, and JBI). Due to substantial
methodological heterogeneity, a narrative synthesis was performed. Thirteen studies from nine African
countries were included. Bacterial coinfections included non-tuberculous mycobacteria (13.9% to 36.6%),
Staphylococcus spp., Streptococcus spp., Haemophilus influenzae, Klebsiella pneumoniae, and Nocardia spp.
Fungal coinfections included chronic pulmonary aspergillosis (3.5%), Candida albicans (35.0%), dimorphic
fungi (9.2%), and cryptococcosis. High levels of antimicrobial resistance were reported, including extended
beta-lactam resistance among K. pneumoniae isolates and fluconazole resistance in 92.5% of fungal isolates.
HIV coinfection frequently exacerbated disease severity and opportunistic infections. Bacterial and fungal
coinfections among TB patients in Africa appear common and likely underdiagnosed. Strengthening
microbiological and mycological diagnostic capacity, integrating antimicrobial resistance surveillance into TB
programs, and conducting standardized multicenter studies are urgently needed to improve patient outcomes.

Mots-clés

Tuberculosis; coinfection; bacteria; fungi; antimicrobial resistance; Africa