scholarly journals Estimating the Burden of Serious Fungal Infections in Uruguay

2018 ◽  
Author(s):  
Marina Macedo-Viñas ◽  
David W. Denning
Keyword(s):  
Fungal Infections ◽  
Oral Candidiasis ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Laboratory Diagnosis ◽  
Population Characteristics ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Solid Organ ◽  
Hematopoietic Stem ◽  
Populations At Risk ◽  
Candida Peritonitis

We aimed to estimate for the first time the burden of fungal infections in Uruguay. Data on population characteristics and underlying conditions were extracted from the National Statistics Institute, the World Bank, national registries and published articles. When no data existed, risk populations were used to estimate frequencies extrapolating from the literature. Population structure: total 3,444,006; 73% adults; 35% women younger than 50 years. Size of populations at risk: HIV infected 12,000; acute myeloid leukemia 126; hematopoietic stem cell transplantation 30; solid organ transplants 134; COPD 272,006 (19.7% of older than 40); asthma in adults 223,431 (prevalence 9%); cystic fibrosis in adults 48; tuberculosis 613 (incidence 26.2%), lung cancer 1,400 (ASR incidence 27.4). Annual incidence estimations per 100,000: 22.4 invasive aspergillosis, 16.4 candidaemia, 3.7 Candida peritonitis, 1.62 Pneumocystis jirovecii pneumonia, 0.75 cryptococcosis, severe asthma with fungal sensitisation 217, allergic bronchopulmonary aspergillosis 165, recurrent Candida vaginitis 6,323, oral candidiasis 74.5 and oesophageal candidiasis 25.7. Although some under and overestimations could have been made, we expect that at least 127,525 people suffer from serious fungal infections each year. Sporothrichosis, histoplasmosis, paracoccidioidomycosis and dermatophytosis are known to be frequent but no data are available to make accurate estimations. Given the magnitude of the burden of fungal infections in Uruguay, efforts should be made to improve surveillance, strengthen laboratory diagnosis and warrant access to first line antifungals.

scholarly journals The Burden of Fungal Infections in Ethiopia

2019 ◽  
Vol 5 (4) ◽  
pp. 109 ◽  
Author(s):  
Tufa ◽  
Denning
Keyword(s):  
Tinea Capitis ◽  
Fungal Infections ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Chronic Obstructive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Obstructive Pulmonary Disease ◽  
Incidence Data ◽  
Patients At Risk ◽  
Chronic Pulmonary Aspergillosis ◽  
Candida Peritonitis

The burden of severe fungal infections (FIs) is not well addressed in Ethiopia. We have estimated the burden of FIs from multiple demographic sources and by searching articles from PubMed. Opportunistic FIs were estimated using modelling and 2017 national HIV data. The burdens of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) were estimated by using the prevalence of asthma, chronic obstructive pulmonary disease, and annual the incidence of tuberculosis. Of the 105,000,000 estimated Ethiopian population, 610,000 are thought to have HIV infection. Our estimation of HIV-related FIs were: 9900 cryptococcal meningitis (CM), 12,700 Pneumocystis jirovecii pneumonia (PCP), 76,300 oral and 56,000 oesophageal candidiasis cases. A remarkable 7,051,700 4–14-year-olds probably have tinea capitis and 1,469,000 women probably have recurrent Candida vaginitis. There were 15,200 estimated CPA cases (prevalence) and 11,500 invasive aspergillosis (IA) cases (incidence). Data are scant, but we estimated 5300 candidaemia and 800 Candida peritonitis cases. In conclusion, approximately 8% of Ethiopians suffer from FIs annually, mostly schoolchildren with tinea capitis. IA, CM and PCP are the major causes of fungal deaths. The absence of CD4 count is challenging the identification of HIV patients at risk of opportunistic FIs. There is a pressing need to improve FI diagnosis, probably including national surveillance.

scholarly journals Human Fungal Infections in Kuwait—Burden and Diagnostic Gaps

2020 ◽  
Vol 6 (4) ◽  
pp. 306
Author(s):  
Wadha Alfouzan ◽  
Faten Al-Wathiqi ◽  
Haya Altawalah ◽  
Mohammad Asadzadeh ◽  
Ziauddin Khan ◽  
...  
Keyword(s):  
At Risk ◽  
Fungal Infections ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Risk Groups ◽  
Epidemiological Studies ◽  
Public Health Issue ◽  
Chronic Obstructive ◽  
Disease Epidemiology ◽  
Populations At Risk ◽  
Candida Peritonitis

Fungal infections are an increasingly important public health issue, yet accurate statistics on fungal burden worldwide and in Kuwait are scarce. Here we estimate the incidence and prevalence of fungal infections in Kuwait. Population statistics from 2018 collected by the Public Authority for Civil Information were used, as well as data from the Ministry of Health. A literature search for Kuwait data on mycotic diseases and population at risk (chronic obstructive pulmonary disease, HIV infection/AIDS, cancer, and transplant patients) was conducted. The population in 2018 was estimated at 4,226,920 million people: 1,303,246 million Kuwaitis and 2,923,674 million expatriates. We determined the annual burden of serious fungal infections number (per 100,000) from high to low based on earlier reported fungal rates for populations at risk: recurrent Candida vaginitis 54,842 (2595); severe asthma with fungal sensitisation 10,411 (246); allergic bronchopulmonary aspergillosis, 7887 (187); chronic pulmonary aspergillosis 995 (21.3); invasive aspergillosis 704 (16.7); fungal keratitis 654 (15.5); candidaemia 288 (6.8); Candida peritonitis 63 (3.5) and oesophageal candidiasis in HIV 33 (0.8). Besides identifying rising new risk groups and expanding reports on antifungal resistance, surveillance programs and further epidemiological studies are needed to achieve more precise assessments of fungal disease epidemiology and correlated morbidity and mortality.

scholarly journals Prevention of Infection Due to Pneumocystis spp. in Human Immunodeficiency Virus-Negative Immunocompromised Patients

2004 ◽  
Vol 17 (4) ◽  
pp. 770-782 ◽  
Author(s):  
Martin Rodriguez ◽  
Jay A. Fishman
Keyword(s):  
At Risk ◽  
Solid Organ ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Populations At Risk ◽  
Immunodeficiency Virus ◽  
Immune Deficiencies ◽  
Cellular Immune ◽  
Immune Defects ◽  
Ongoing Assessment

SUMMARY Pneumocystis infection in humans was originally described in 1942. The organism was initially thought to be a protozoan, but more recent data suggest that it is more closely related to the fungi. Patients with cellular immune deficiencies are at risk for the development of symptomatic Pneumocystis infection. Populations at risk also include patients with hematologic and nonhematologic malignancies, hematopoietic stem cell transplant recipients, solid-organ recipients, and patients receiving immunosuppressive therapies for connective tissue disorders and vasculitides. Trimethoprim-sulfamethoxazole is the agent of choice for prophylaxis against Pneumocystis unless a clear contraindication is identified. Other options include pentamidine, dapsone, dapsone-pyrimethamine, and atovaquone. The risk for PCP varies based on individual immune defects, regional differences, and immunosuppressive regimens. Prophylactic strategies must be linked to an ongoing assessment of the patient's risk for disease.

scholarly journals Estimated burden of fungal infections in Kenya

2016 ◽  
Vol 10 (08) ◽  
pp. 777-784 ◽  
Author(s):  
John Abuga Guto ◽  
Christine C Bii ◽  
David W Denning
Keyword(s):  
At Risk ◽  
Fungal Infection ◽  
Tinea Capitis ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Epidemiological Studies ◽  
High Rate ◽  
Asthma Prevalence ◽  
Populations At Risk

Introduction: Kenya is a developing country with a high rate of tuberculosis (TB) and a moderate HIV infection burden. No estimate of the burden of fungal diseases in Kenya is published. Methodology: We used specific populations at risk and fungal infection frequencies from the literature to estimate national incidence or prevalence of serious fungal infections. Used sources were: 2010 WHO TB statistics, Kenya Acquired Immunodeficiency Syndrome (AIDS) Epidemic Update 2012, Kenya Facts and figures 2012, Kenya Demographic and Health Survey 2008-2009. Results: Of Kenya’s population of ~40 million, 43% are under 15 years old and approximately 594,660 Kenyan women get >4 episodes Candida vulvovaginitis annually (2,988/100,000). The HIV/AIDS population at risk of opportunistic infections (OI) is 480,000 and the OI estimates include 306,000 patients with oral thrush (768/100,000), 114,000 with oesophageal candidiasis (286/100,000), 11,900 with cryptococcal meningitis (29/100,000) and 17,000 patients with Pneumocystis pneumonia (42/100,000). Chronic pulmonary aspergillosis following TB has a prevalence of 10,848 cases (32/100,000). The adult asthma prevalence is 3.1% and assuming 2.5% have allergic bronchopulmonary aspergillosis then 17,696 (44/100,000) are affected.  Invasive aspergillosis, candidaemia and Candida peritonitis are probably uncommon. Tinea capitis infects 9.6% of children in Kenya, while fungal keratitis and otomycoses are difficult to estimate. Conclusion: At any one time, about 7% of the Kenyan population suffers from a significant fungal infection, with recurrent vaginitis and tinea capitis accounting for 82% of the infections. These estimates require further epidemiological studies for validation.

scholarly journals 90. Incidence and Risk Factors for Inappropriate Use of Non-culture Based Fungal Assays: Implication for Diagnostic Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S176-S176
Author(s):  
Hiroshi Ito ◽  
Koh Okamoto ◽  
Marie Yamashita ◽  
Shinya Yamamoto ◽  
Yoshiaki Kanno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Multivariate Logistic Regression Analysis ◽  
Solid Organ ◽  
Hematopoietic Stem ◽  
Factors Associated ◽  
Inappropriate Use ◽  
Transplant Patients ◽  
Galactomannan Antigen ◽  
Low Sensitivity

Abstract Background Culture-based diagnostic tests are the gold standard for diagnosing invasive fungal diseases (IFDs). Because these tests have low sensitivity, non-culture-based fungal assays (NCBFAs) have been used increasingly to help diagnose IFDs. However, little is known about inappropriate use of NCBFAs. We aimed to investigate inappropriate use of NCBFAs in a tertiary academic hospital in Tokyo, Japan. Methods This retrospective cohort study included all patients who underwent testing with beta-D glucan (BDG) between January and March 2018, or galactomannan antigen (GMA) or cryptococcal antigen (CRAG) between January and June 2018. Patients who had received hematopoietic stem cell or solid organ transplantations were excluded. Appropriateness was assessed according to the previously published study. We compared patients with appropriate and inappropriate use of NCBFAs. Risk factors for inappropriate use were evaluated using multivariate logistic regression analysis. Results Of 1,140 patients (BDG, 1,009; GMA 273; CRAG, 310) who underwent tests, 470 patients (BDG, 394; GMA, 138; CRAG, 164) were included in this study. Four hundred thirty-eight patients (93.2%) were aged 18 or older. About 80% of NCBFAs (BDG, 334 patients [74.8%]; GMA, 117 patients [74.8%]; CRAG, 146 patients [89.0%]) were deemed inappropriate. The factors associated with inappropriate NCBFAs use included specialties of ordering physicians, risk factors for fungal infections, and recommendation from infectious disease physicians (Table). Sixty-four patients (13.6%) underwent three inappropriate NCBFAs simultaneously. Furthermore, during the study period, 408 patients (35.8%) with inappropriate NCBFAs underwent the same assays repeatedly during the study period; 643 times for BDG, 163 times for GMA, and 192 times for CRAG. The Factors Associated with Inappropriate Use of Non-Culture Based Fungal Assays Conclusion We found a large proportion of NCBFAs were deemed inappropriate and it was mostly driven by ordering physicians who generally care for transplant patients. Because inappropriate use of NCBFAs could lead to additional inappropriate tests and treatment with substantial costs to patients and health systems, diagnostic stewardship targeting NCBFAs is urgently needed. Disclosures All Authors: No reported disclosures

scholarly journals Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium

2019 ◽  
Vol 71 (6) ◽  
pp. 1367-1376 ◽  
Author(s):  
J Peter Donnelly ◽  
Sharon C Chen ◽  
Carol A Kauffman ◽  
William J Steinbach ◽  
John W Baddley ◽  
...  
Keyword(s):  
Invasive Fungal Disease ◽  
Laboratory Diagnosis ◽  
Diagnostic Techniques ◽  
Epidemiologic Studies ◽  
Study Group ◽  
Solid Organ ◽  
European Organization ◽  
Final Version ◽  
Populations At Risk ◽  
Research Consortium

Abstract Background Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. Methods To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups’ findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. Results There is no change in the classifications of “proven,” “probable,” and “possible” IFD, although the definition of “probable” has been expanded and the scope of the category “possible” has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. Conclusions These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

scholarly journals Diagnosis of Pneumocystis jirovecii Pneumonia in Pediatric Patients in Serbia, Greece, and Romania. Current Status and Challenges for Collaboration

2020 ◽  
Vol 6 (2) ◽  
pp. 49
Author(s):  
Valentina Arsić Arsenijevic ◽  
Timoleon-Achilleas Vyzantiadis ◽  
Mihai Mares ◽  
Suzana Otasevic ◽  
Athanasios Tragiannidis ◽  
...  
Keyword(s):  
Molecular Diagnosis ◽  
Pediatric Patients ◽  
Fungal Infections ◽  
Laboratory Diagnosis ◽  
Pneumocystis Jirovecii ◽  
Current Status ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Clinical Practices ◽  
Online Questionnaire ◽  
Regional Collaboration

Pneumocystis jirovecii can cause fatal Pneumocystis pneumonia (PcP). Many children have been exposed to the fungus and are colonized in early age, while some individuals at high risk for fungal infections may develop PcP, a disease that is difficult to diagnose. Insufficient laboratory availability, lack of knowledge, and local epidemiology gaps make the problem more serious. Traditionally, the diagnosis is based on microscopic visualization of Pneumocystis in respiratory specimens. The molecular diagnosis is important but not widely used. The aim of this study was to collect initial indicative data from Serbia, Greece, and Romania concerning pediatric patients with suspected PcP in order to: find the key underlying diseases, determine current clinical and laboratory practices, and try to propose an integrative future molecular perspective based on regional collaboration. Data were collected by the search of literature and the use of an online questionnaire, filled by relevant scientists specialized in the field. All three countries presented similar clinical practices in terms of PcP prophylaxis and clinical suspicion. In Serbia and Greece the hematology/oncology diseases are the main risks, while in Romania HIV infection is an additional risk. Molecular diagnosis is available only in Greece. PcP seems to be under-diagnosed and regional collaboration in the field of laboratory diagnosis with an emphasis on molecular approaches may help to cover the gaps and improve the practices.

Efficacy and Safety of Posaconazole (POS) in the Treatment of Refractory Invasive Fungal Infections (rIFIs) in Patients with Underlying Renal Impairment.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5380-5380
Author(s):  
Amelia A. Langston ◽  
Donald R. Graham ◽  
J. Richard Graybill ◽  
Lisa D. Pedicone ◽  
Issam I. Raad
Keyword(s):  
Renal Impairment ◽  
Antifungal Therapy ◽  
Fungal Infections ◽  
Severe Renal Impairment ◽  
Solid Organ Transplantation ◽  
Similar Response ◽  
Solid Organ ◽  
Total Study Population ◽  
Hematopoietic Stem ◽  
Study Population

Abstract Background: Patients with IFIs often have underlying renal impairment. POS, an extended-spectrum triazole antifungal, is in development for the treatment of rIFIs. We studied the activity and safety of POS in rIFI subjects with underlying renal impairment, some of whom had undergone hematopoietic stem cell transplantation (HSCT). Methods: This was a 12-month, multicenter, open-label study of POS (800 mg/day in divided doses) in subjects with IFIs who were refractory to or intolerant of prior antifungal therapy. Success was defined as complete or partial response; nonsuccess was defined as stable disease, failure, or undetermined outcome. For this analysis, patients were stratified by baseline estimated creatinine clearance (CrCl) or serum creatinine (SCr). Results: Of the 330 subjects enrolled who were refractory to or intolerant of prior antifungal therapy and received ≥1 dose of POS, 39 subjects with CrCl <40 mL/min and 20 subjects with CrCl of 40-<50 mL/min were included in this analysis. An additional 6 subjects with baseline SCr >2 mg/dL for whom CrCl could not be determined were also included. In the <40 mL/min group, 31% (12/39) had undergone HSCT, 38% (15/39) had underlying hematologic malignancy (HM), and 33% (13/39) had undergone solid organ transplantation (SOT). In the 40-<50 mL/min group, 60% had undergone HSCT (12/20), 80% (16/20) had HM, and 20% (4/20) were SOT recipients. In patients with SCr >2 mg/dL, 67% (4/6) had undergone HSCT and 83% (5/6) had HM. As shown in the table, POS therapy resulted in similar response rates for most IFIs regardless of degree of renal impairment. These results are comparable to the total study population (Raad et al. 44th ICAAC 2004 abs M-669). POS was generally well tolerated. The safety profile in subjects with baseline renal dysfunction was similar to that reported for the total study population (Raad et al. 44th ICAAC 2004 abs M-669). The most common treatment-related treatment-emergent adverse events were nausea (6/39 in <40 mL/min group; 3/20 in 40-<50 mL/min group), vomiting (4/39 in <40 mL/min group), increased SCr (4/39 in <40 mL/min group), dizziness (3/39 in <40 mL/min group), increased phosphatase alkaline levels (3/39 in <40 mL/min group), and altered drug level (3/39 in <40 mL/min group). Conclusion: As in the overall study population, POS demonstrated good activity against refractory IFIs and was well tolerated in these subjects with underlying renal impairment, regardless of the level of renal impairment. POS may offer a clinically important alternative for treatment of refractory IFI in subjects with underlying renal impairment. CrCl (mL/min) Successful Response by Organism Moderate to Severe Renal Impairment (<40) Mild Renal Impairment (40-<50) SCr >2 mg/dL *Subjects could have >1 pathogen; †Histoplasma and other; ‡Histoplasma, Phaeohyphomycetes, Pseudallescheria, and other. All* 19/39 (49%) 9/20 (45%) 4/6 (67%) Aspergillus 11/24 (46%) 4/13 (31%) 1/2 (50%) Candida 1/3 (33%) 0/2 (0%) – Fusarium 1/1 (100%) 2/2 (100%) – Cryptococcus 3/5 (60%) 1/1 (100%) – Coccidioides 0/1 (0%) 0/1 (0%) – Zygomycetes 1/3 (33%) – – Miscellaneous 2/3 (66%)† 2/4 (50%)‡ 3/4 (75%)†

scholarly journals Estimated Burden of Serious Fungal Infections in Ghana

2019 ◽  
Vol 5 (2) ◽  
pp. 38 ◽  
Author(s):  
Bright K. Ocansey ◽  
George A. Pesewu ◽  
Francis S. Codjoe ◽  
Samuel Osei-Djarbeng ◽  
Patrick K. Feglo ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Fungal Infections ◽  
Risk Groups ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Disseminated Histoplasmosis ◽  
Deterministic Modelling ◽  
Life Threatening ◽  
Chronic Pulmonary Aspergillosis ◽  
Candida Peritonitis ◽  
Global Data

Fungal infections are increasingly becoming common and yet often neglected in developing countries. Information on the burden of these infections is important for improved patient outcomes. The burden of serious fungal infections in Ghana is unknown. We aimed to estimate this burden. Using local, regional, or global data and estimates of population and at-risk groups, deterministic modelling was employed to estimate national incidence or prevalence. Our study revealed that about 4% of Ghanaians suffer from serious fungal infections yearly, with over 35,000 affected by life-threatening invasive fungal infections. Incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia, and disseminated histoplasmosis cases in AIDS was estimated at 6275, 12,610 and 724, respectively. Oral and esophageal candidiasis collectively affect 27,100 Ghanaians and 42,653 adult asthmatics are estimated to have fungal asthma. We estimate a prevalence of 12,620 cases of chronic pulmonary aspergillosis (CPA and an incidence of 1254 cases of invasive aspergillosis (IA). Estimated cases of candidemia and candida peritonitis cases were 1446 and 217, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) and tinea capitis was 442,621 and 598,840, respectively. Mucormycosis and fungal keratitis each may affect 58 and 810 Ghanaians. These data highlight the urgent need for intensified awareness to improve diagnosis and management.

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