Invasive fungal diseases (IFDs) are increasingly recognized as a major public health challenge in sub-Saharan Africa, particularly among immunocompromised populations. Their diagnosis and management remain difficult because their clinical manifestations are often non-specific and overlap with those of more prevalent conditions such as HIV/AIDS, tuberculosis, opportunistic infections, and malignancies. This review examines the epidemiology, disease burden, and emerging antifungal resistance associated with invasive fungal diseases in sub-Saharan Africa, with the aim of improving understanding and identifying priorities for research and public health interventions. Evidence from published literature indicates that cryptococcosis remains the leading invasive fungal disease in the region and is responsible for a substantial proportion of HIV-related mortality. Invasive aspergillosis is increasingly reported but remains underdiagnosed and is frequently misdiagnosed as pulmonary tuberculosis, particularly among individuals living with HIV. Histoplasmosis is also an important opportunistic infection, especially in West Africa, where it commonly occurs among patients with advanced HIV infection and those initially presumed to have tuberculosis. Although the prevalence of Pneumocystis pneumonia has declined due to expanded access to antiretroviral therapy, other invasive fungal diseases, including mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidioidomycosis, continue to be reported across the region. Furthermore, the emergence of resistance to commonly used antifungal agents poses a growing threat to effective treatment and patient outcomes. Overall, invasive fungal diseases remain under-recognized but contribute significantly to morbidity and mortality in sub-Saharan Africa. Strengthening surveillance systems, expanding access to accurate diagnostic tools, improving antifungal stewardship, and increasing investment in research are essential to reducing the burden of these infections and addressing the growing challenge of antifungal resistance.
