Molecular Characterisation of Fungi Populations in the Chronic Wounds of Filarial Lymphedema Patients in Southern Ghana: A Cross-Sectional Study.

BACKGROUND AND AIMS: Lymphatic filariasis (LF) and associated chronic wounds are of public health concern worldwide. Despite the significant burden of lymphatic filariasis (LF) and its associated chronic wounds, the fungal component of the wound microbiome remains poorly understood. Previous research has primarily focused on bacterial pathogens, neglecting the potential role of fungi in wound pathogenesis and progression. A comprehensive understanding of the microbial landscape, especially the overlooked fungal component, is crucial for developing effective prevention and treatment strategies. The study aimed to molecularly characterize the fungal populations present in these wounds via Internal Transcribed Spacer (ITS) sequencing.

METHODS

This was a cross-sectional study, with a total of 63 individuals sampled from eight (8) LF-hyperendemic communities within the Ahanta West District in Ghana. Skin and wound swabs were collected from each participant between December 2021 and February 2022 and subjected to standard culture-based techniques. Fungal isolates were identified, and their DNA was extracted for subsequent PCR amplification of the ITS region. The sequencing was performed using the Oxford Nanopore platform.

RESULTS

Of the 63 patients sampled, fungal colonies were observed in 16 individuals (25.4% prevalence) through culture-based methods. Molecular characterisation identified 24 Twenty-four (24) distinct fungal species at different frequencies from nine different genera: Cladosporium, Aspergillus, Periconia, Penicillium, Candida, Lasiodiplodia, Acrophialophora, Zygosporium, and Trichoderma. Cladosporium spp. was the most prevalent, accounting for 30% of isolates, followed by Aspergillus spp. (28.6%), Periconia spp. (14.3%), Penicillium spp. (12.9%), and Candida spp. (8.6%). A smaller proportion of isolates represented Lasiodiplodia spp., Acrophialophora spp., Zygosporium spp., and Trichoderma spp., each comprising 1.4% of the total isolates. Notably, only 2 out of the 16 patients did not present with mixed fungal populations in their wounds.

CONCLUSIONS

The presence of fungal pathogens and the potential for polymicrobial infections within the LF-wound environment highlight the need for comprehensive and tailored treatment protocols. Effective wound management is essential to address these complex wounds and mitigate the development of antibiotic resistance, a growing concern in chronic wound care.