Double country estimates of fungal disease published for Indonesia and Democratic Republic of Congo

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Histoplasmosis (intracellular)
Histoplasmosis (intracellular)

With populations of 267 and 95 million, Indonesia and DRC are the 4th and 16th most populous countries in the world. In the esteemed journal Mycoses, estimates of the incidence and prevalence of all serious fungal diseases have been conducted for the first time.

In Indonesia, GAFFI Ambassador Prof Retno Wahyuningsih from Universitas Indonesia and Universitas Kristen Indonesia, Jakarta, found 7.7 million people (2.9% of the population). As with other countries, recurrent vulvovaginal candidiasis (rVVC) is common, but chronic pulmonary and allergic aspergillosis comprised over a million people.

Nearly 300,000 people are thought to have chronic fungal rhinosinusitis in Indonesia. Histoplasmosis and talaromycosis are endemic in Indonesia and estimates are uncertain as diagnostics (other than microscopy and culture) are not in place.

Doctors Guyguy Kamwiziku and Jean-Claude Makangara sourced all available data in DRC to find that 5.2 million (5.4% of the population) people are affected with a serious fungal infection. Tinea capitis in school-age children (3.6 million) and rVVC (1.2 million) dominated the large burden.

However, the number of life-threatening HIV-related infections cryptococcal meningitis is also large at 6,200 annually and 2,800 adult and 600 paediatric Pneumocystis pneumonia and an uncertain number of cases of histoplasmosis.

Neither estimate included the fungal complications of Covid-19 – notably invasive aspergillosis (“green fungus”) or mucormycosis (“black fungus”), which will have contributed to some deaths in recent months.

Prof Wahyuningsih said on the release of this ground-breaking work:

“Indonesia has a large population and a huge number of patients with TB and other lung diseases. Fungal disease has a low awareness among the 75 medical schools and tens of thousands of physicians in our country. Rapid diagnostics are lacking for most fungal conditions, which combined with a lack of awareness must be leading to a large number of unnecessary deaths.”

From Kinshasa, Dr Kamwiziku declared:

‘This publication is truly transformational for our country in developing a national action plan to address fungal diseases. The DRC has a huge burden of infectious diseases, many dramatic such as Ebola, and so fungal infections have tended to be sidelined. Our review of the literature on fungal diseases in DRC should be considered as a pipeline for carrying out several studies in various fields to improve the diagnosis and the management of fungal diseases..”

Not many data were available on fungal Neglected Tropical Diseases such as mycetoma or chromoblastomycosis. Conservative estimates of fungal keratitis were 12,700 (DRC) and 40,000 (Indonesia), probably blinding almost all these eyes, each year.

These papers bring the published country-specific burden estimates to 76 countries [1] to date.

Links to papers on GAFFI website:

Indonesia. Wahyningsih, Mycoses 2021;

Congo DRC, Kamwiziku. Mycoses 2021;