Published in PLOS One on 2026-04-24, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. HealthSignal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Zackary Salem-Bango, Mary Basiru Njai, Zainab Tambajang, Tessa Rose Cornell, Jayne Sutherland, Karen Forrest, Omai Garner, Behzad Nadjm, Saffiatou Darboe, Basil Sambou, Sheikh Jarju
Source: PLOS One • DOI 10.1371/journal.pone.0347766
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Invasive fungal infections are an increasing global health concern, particularly in low-resource settings where diagnostic capacity is limited. In The Gambia, where tuberculosis is highly prevalent, fungal infections may be misdiagnosed as mycobacterial disease due to overlapping clinical symptoms and limited access to fungal testing. This study aimed to determine the presence of three priority fungal pathogens by the World Health Organization (WHO) classification system—Aspergillus species (spp.), Histoplasma spp., and Pneumocystis jirovecii—in patients with symptoms suggestive of tuberculosis, and to develop a molecular tool to support future surveillance. A multiplex quantitative polymerase chain reaction assay was developed and validated for simultaneous detection of Aspergillus spp., Histoplasma spp., and Pneumocystis jirovecii DNA in human sputum. The assay was applied to 273 stored sputum samples collected from adult patients presenting with respiratory symptoms concerning for tuberculosis in The Gambia. The multiplex assay demonstrated high sensitivity and specificity, detecting as few as ten DNA copies per reaction for each target. Among the 273 sputum samples analyzed, Aspergillus DNA was identified in five samples (1.8%), Pneumocystis jirovecii DNA in three samples (1.1%), and no samples were positive for Histoplasma. Cough and weight loss were the most frequently reported symptoms among participants with positive results. This study represents the first molecular detection of Aspergillus spp. and Pneumocystis jirovecii in adults in The Gambia. These findings suggest that fungal colonization or infection may occur in a small proportion of patients presenting with tuberculosis-like symptoms. The multiplex molecular platform developed here provides an accessible approach for fungal surveillance and may improve diagnosis and management of fungal infections in resource-limited settings.
Introduction
The 2022 “WHO fungal priority pathogens list to guide research, development and public health action” highlighted the underrecognized and increasing global health threat of invasive fungal disease [1]. This comprehensive guide classified nineteen fungal pathogens as critical, high and medium priority. Prioritization criteria included trends in incidence and prevalence, rate or level of antifungal resistance, and access to diagnostics and evidence-based treatment options. An estimated 6.5 million cases of invasive fungal infections occur worldwide annually: leading to 3.8 million deaths, of which 2.5 million are directly attributable to fungal infections [2]. This underscores the critical need for improved surveillance and diagnostic and treatment modalities to address the global burden of invasive fungal disease.
In underrepresented and under resourced settings worldwide, including The Gambia, the limited availability of fungal diagnostics and surveillance tools in reference or institutional laboratories creates data gaps which prevent accurate estimation of the global fungal disease burden [3]. Conventional gold-standard approaches for mycology diagnostics include direct microscopy, histopathology, culture, and antigen detection [4]. However, despite the availability and feasibility of culture and microscopy techniques, they present significant limitations including long growth time and low sensitivity. Although standard fungal media culture can be accessible and cost-effective for some low-resource settings, many target species/clades require special media [5] and skilled personnel for accurate pathogen identification, and contamination is common. Other techniques, such as antigen-based detection, is prohibitively costly when needing to screen a single patient for multiple fungal targets in low-resource settings or when a large cohort/population needs to be screened.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Zackary Salem-Bango, Mary Basiru Njai, Zainab Tambajang, Tessa Rose Cornell, Jayne Sutherland, Karen Forrest, Omai Garner, Behzad Nadjm, Saffiatou Darboe, Basil Sambou, Sheikh Jarju. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by HealthSignal. The researchers are the authors of the source study, not members of HealthSignal’s staff.
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