To a packed audience of researchers and science policy makers, GAFFI President Dr David Denning described the enormous and under-appreciated burden of fungal infections at the International Union of Microbiological Societies meeting in Montreal.

Very large numbers of people are affected, and many fungal disease estimates have yet to be made, so estimates are incomplete. Summary statistics include:

  • 985 million with skin, hair and nail fungal infection.
  • 10 million with oral candidiasis in AIDS
  • 2 million with oesophageal candidiasis in AIDS
  • 75% of all women having vulvovaginal candidiasis at some time in their life, and 137 million with recurrent vulvovaginal candidiasis
  • 1-12 million with fungal infection of the cornea of the eye (keratitis), usually after an injury or in contact lens wearers.
  • 20-35 million with fungal infection of the external ear (otitis externa).
  • 1.2 million with chronic pulmonary aspergillosis after tuberculosis
  • 4.8 million with allergic bronchopulmonary aspergillosis (ABPA) complicating asthma in adults (193 million adult of 334 million total asthmatics),
  • 3.5-15 million with severe asthma with fungal sensitisation (SAFS)
  • Around 25 million with allergic fungal rhinosinusitis, usually with nasal polyps
  • 1 million with cryptococcal meningitis complicating AIDS, with a 20-50% mortality
  • 400,000 cases of Candida bloodstream infection (candidaemia), with a 40% mortality
  • 100,000 cases of Candida peritonitis, with a 40%+ mortality,
  • Over 200,000 cases of invasive aspergillosis with a 30-85% mortality
  • Over 400,000 cases of Pneumocystis pneumonia, with a 15-50% mortality.

The number of people suffering and dying from fungal infections has been estimated in 33 countries covering ~55% of the world’s population (see link 1  & link 2). There is much variation between countries. Especially high incidence rates of Candida bloodstream infection in Brazil (15/100,000) and Spain (10.7/100,000), and extremely high rate of mucormycosis in India (170,000 cases annually, 13/100,000) related to the burgeoning epidemic of diabetes there, over 160,000 cases of invasive aspergillosis in China (11.9/100,000) partly related to COPD, over 38,000 cases of cryptococcal meningitis in AIDS in Uganda (110/100,000) and 75,000 and 18,000 cases of Pneumocystis pneumonia in Nigeria (48/100,000) and Brazil (39.6/100,000) respectively.

Montreal2

Even more prevalent were allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) complicating asthma. For example, an estimated 390,000 ABPA cases were estimated for Brazil (201/100,000), 491,000 cases for China (36.1/100,000) and at least 592,000 ABPA cases in India (47/100,000). Estimates of tinea capitis were very high in Africa, notably 15,580,000 cases in Nigeria (~50% of 155 million population are children) (1000/100,000) and 1,700,000 children affected in Kenya (4,300/100,000).

Dr Denning Global Burden presentation

Refs:

  • Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009 Feb 20;23(4):525-30.
  • Brown GD, Denning DW, Gow NAR, Levitz S, Netea M, White T. Human fungal infections: the hidden killers. Sci Transl Med 2012:4:165rv13.
  • Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to tuberculosis. Bull WHO 2011;89:864-72.
  • Denning DW, Pleuvry A, Cole DC. Global burden of ABPA in adults with asthma and its complication chronic pulmonary aspergillosis. Med Mycol 2013;51:361-70.
  • Armstead J, Morris J, Denning DW. Multi-country estimate of different manifestations of aspergillosis in cystic fibrosis. PLoS One 2014;9:e98502.

Link:  Fungal Diseases