Human Fungal Infections in Kuwait—Burden and Diagnostic Gaps

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.

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Estimated burden of fungal infections in Kenya

The Journal of Infection in Developing Countries ◽

10.3855/jidc.7614 ◽

2016 ◽

Vol 10 (08) ◽

pp. 777-784 ◽

Cited By ~ 12

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.

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The Burden of Fungal Infections in Ethiopia

Journal of Fungi ◽

10.3390/jof5040109 ◽

2019 ◽

Vol 5 (4) ◽

pp. 109 ◽

Cited By ~ 4

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.

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Burden of Serious Fungal Diseases in Romania

10.20944/preprints201802.0137.v1 ◽

2018 ◽

Author(s):

Mihai Mareș ◽

Valentina Ruxandra Moroti-Constantinescu ◽

David W. Denning

Keyword(s):

Fungal Infections ◽

Allergic Bronchopulmonary Aspergillosis ◽

Pneumocystis Pneumonia ◽

Annual Incidence ◽

Fungal Diseases ◽

World Health ◽

Annual Reports ◽

Chronic Obstructive ◽

Number Of Patients ◽

Candida Peritonitis

Objective: To estimate for the first time the burden of serious fungal infections in Romania; Methods: Data derived from the World Health Organization (WHO), National Institute of Statistics, Romanian public health agencies and non-profit health organizations and published annual reports on local epidemiology were used in the present study. When no data was available, specific at-risk populations were used to calculate frequencies of serious fungal diseases, using previously published epidemiological parameters. All data refer to the year 2016; 3) Results: The estimated number of serious fungal infections in Romanian population was 435,930 in 2016. Recurrent vulvovaginal candidiasis accounts for up to 80% of total cases (more than 350,000 women annually). Concerning the HIV related infections, among 14349 infected persons, Pneumocystis pneumonia occurred in about 10% of late presenters (30 cases in 2016), while cryptococcal meningitis is rarely diagnosed (less than 20 cases). Annually, the total number of oesophageal candidiasis and oral thrush cases in HIV-positive patients may be as high as 1229 and 3066, respectively. In immunocompromised and cancer patient population, the annual incidence of candidaemia is 295, and at least 158 invasive aspergillosis cases and 4 mucormycosis cases occur yearly. With 4,966 critical care beds and approximately 200,000 abdominal surgeries performed, the estimated annual incidence of candidaemia and Candida peritonitis is 689 and 344, respectively. The annual incidence of pulmonary tuberculosis is still high in Romania (12,747 cases). Thus, the prevalence of post-TB chronic pulmonary aspergillosis is estimated to be 8.98/100,000 (1768 cases). The prevalence of chronic obstructive pulmonary disease (COPD) and asthma in adults is 6% and 6.5%, respectively. Therefore, allergic bronchopulmonary aspergillosis prevalence is estimated at 29,387 and severe asthma with fungal sensitisation at 38,731 cases annually. 4) Conclusions: Not being on the list of reportable diseases, the number of patients presenting with severe mycoses in Romania can only be roughly estimated. Based on local reports and prevalence estimation, we consider that at least 2.2% of Romanians suffer a serious form of fungal disease.

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Estimating the Burden of Serious Fungal Infections in Uruguay

10.20944/preprints201802.0053.v1 ◽

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.

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Allergic Diseases Caused by Aspergillus Species in Patients with Cystic Fibrosis

Antibiotics ◽

10.3390/antibiotics10040357 ◽

2021 ◽

Vol 10 (4) ◽

pp. 357

Author(s):

Aidan K. Curran ◽

David L. Hava

Keyword(s):

Cystic Fibrosis ◽

Fungal Infections ◽

Allergic Bronchopulmonary Aspergillosis ◽

Hyphal Growth ◽

Allergic Diseases ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Th2 Immune Response ◽

Difficulty Breathing ◽

Oral Corticosteroids

Aspergillus spp. are spore forming molds; a subset of which are clinically relevant to humans and can cause significant morbidity and mortality. A. fumigatus causes chronic infection in patients with chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). In patients with CF, A. fumigatus infection can lead to allergic disease, such as allergic bronchopulmonary aspergillosis (ABPA) which is associated with high rates of hospitalizations for acute exacerbations and lower lung function. ABPA results from TH2 immune response to Aspergillus antigens produced during hyphal growth, marked by high levels of IgE and eosinophil activation. Clinically, patients with ABPA experience difficulty breathing; exacerbations of disease and are at high risk for bronchiectasis and lung fibrosis. Oral corticosteroids are used to manage aspects of the inflammatory response and antifungal agents are used to reduce fungal burden and lower the exposure to fungal antigens. As the appreciation for the severity of fungal infections has grown, new therapies have emerged that aim to improve treatment and outcomes for patients with CF.

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Estimated Burden of Fungal Infections in Oman

Journal of Fungi ◽

10.3390/jof7010005 ◽

2020 ◽

Vol 7 (1) ◽

pp. 5

Author(s):

Abdullah M. S. Al-Hatmi ◽

Mohammed A. Al-Shuhoumi ◽

David W. Denning

Keyword(s):

Fungal Infection ◽

Fungal Infections ◽

Epidemiological Studies ◽

Vaginal Candidiasis ◽

Skin Infections ◽

Opportunistic Pathogens ◽

Fungal Rhinosinusitis ◽

Populations At Risk ◽

Different Populations ◽

Underlying Pathology

For many years, fungi have emerged as significant and frequent opportunistic pathogens and nosocomial infections in many different populations at risk. Fungal infections include disease that varies from superficial to disseminated infections which are often fatal. No fungal disease is reportable in Oman. Many cases are admitted with underlying pathology, and fungal infection is often not documented. The burden of fungal infections in Oman is still unknown. Using disease frequencies from heterogeneous and robust data sources, we provide an estimation of the incidence and prevalence of Oman’s fungal diseases. An estimated 79,520 people in Oman are affected by a serious fungal infection each year, 1.7% of the population, not including fungal skin infections, chronic fungal rhinosinusitis or otitis externa. These figures are dominated by vaginal candidiasis, followed by allergic respiratory disease (fungal asthma). An estimated 244 patients develop invasive aspergillosis and at least 230 candidemia annually (5.4 and 5.0 per 100,000). Only culture and microscopy are currently available for diagnosis, so case detection is suboptimal. Uncertainty surrounds these figures that trigger the need for urgent local epidemiological studies with more sensitive diagnostics.

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Estimated Burden of Serious Fungal Infections in Ghana

Journal of Fungi ◽

10.3390/jof5020038 ◽

2019 ◽

Vol 5 (2) ◽

pp. 38 ◽

Cited By ~ 1

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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VIRAL HEPATITIS

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.03.384 ◽

2018 ◽

Vol 25 (03) ◽

pp. 400-408

Author(s):

Sohail Iqbal ◽

Rao Salman Aziz ◽

Rehana Mukhtar ◽

Farwa Naqvi ◽

Maheen Rana

Keyword(s):

At Risk ◽

Risk Groups ◽

Target Population ◽

Diabetic Patients ◽

Retrospective Case ◽

Study Materials ◽

Populations At Risk ◽

Starting Date ◽

Study Setting ◽

Control Study

Objectives: Diabetes mellitus has been shown to be an independent risk factorfor hepatocellular carcinoma in populations at risk. Different anti-diabetic drugs have beenshown to have different effects on incidence of cancers in diabetic patients. Data Source:Outpatient and inpatient hospital records as well as fresh cases. Design of Study: Hospitalbased retrospective case control study. Setting: DHQ, Sargodha. Period: Fifteen years (10years retrospective, 5 years prospective, from the starting date of study). Materials & Methods:In a hospital based study we recorded the incidence of HCC in patients otherwise consideredto be at risk. We also observed whether anti-diabetic monotherapy has any effects on HCCoccurrence in our target population. Results: We found out that incidence of HCC in diabeticpatients with a concomitant HBV or HCV infection was at least 1.5 times higher than non-diabetichepatitis patients. The incidence of HCC reduced in patients using metformin as compared tosulfonylureas. Conclusion: Diabetes is an independent risk factor for hepatocellular carcinomaand metformin use is correlated with reduced HCC occurrence in risk groups.

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Burden of fungal infections in Iran

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10476 ◽

2018 ◽

Vol 12 (10) ◽

pp. 910-918 ◽

Cited By ~ 6

Author(s):

Mohammad T Hedayati ◽

Mojtaba Tagizadeh Armaki ◽

Jamshid Yazdani Charati ◽

Newsha Hedayati ◽

Seyedmojtaba Seyedmousavi ◽

...

Keyword(s):

Tinea Capitis ◽

Fungal Infections ◽

Hematologic Malignancy ◽

Allergic Bronchopulmonary Aspergillosis ◽

Epidemiological Data ◽

Fungal Diseases ◽

Relative Impact ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Populations At Risk

Introduction: The number of fungal infections occurring each year in Iran is not known. As the burden of fungal disease is a measure used to assess and compare the relative impact of different type of fungal diseases on populations, we have estimated the burden of fungal diseases in Iran. Methodology: We estimated the burden of human fungal diseases based on the specific populations at risk, existing epidemiological data in both local and international databases, and modelling previously described by the LIFE program (http://www.LIFE-worldwide.org). Results: Among the population of Iran (79,926,270 in 2016), 6,670,813 (8.3%) individuals are estimated to suffer from a fungal infection each year. A total of 2,791,568 women aged between 15 and 50 years are estimated to suffer from recurrent vulvovaginal candidiasis, annually. In addition, considering the 13.3% prevalence rate of tinea capitis in children, a total of 2,552,624 cases per year are estimated. The estimated burden of invasive aspergillosis in the 3 groups of patients with hematologic malignancy, lung cancer and chronic pulmonary obstructive disease was 6394 (8.0 per 100,000). The estimate for the burden of allergic disease related to fungi including allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization and allergic fungal rhinosinusitis was 272,095 (340 per 100,000). Based on the 28,663 cases of HIV infection reported, an estimated 900 and 113 cases with pneumocystosis and cryptococcal meningitis are annually anticipated, respectively. Conclusion: Our estimates indicate that the importance of fungal infections is high but overlooked in Iran, which warrants further actions by health care authorities.

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Holotranscobalamin, a New Early Marker Improves the Diagnostic Utility of the Macrocytic Anemia Panel Assays Performed on the Abbott AxSYM® Analyser.

Blood ◽

10.1182/blood.v108.11.3773.3773 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3773-3773

Author(s):

Fabrizia Bamonti ◽

Nicola Fracchiolla

Keyword(s):

At Risk ◽

Macrocytic Anemia ◽

Risk Groups ◽

Cobalamin Deficiency ◽

Total Serum ◽

Diagnostic Strategy ◽

Blood Disorder ◽

Populations At Risk ◽

B12 Deficiency ◽

Low Levels

Abstract A diagnosis of macrocytic anemia, a common blood disorder presenting in many forms, requires additional tests to determine the underlying cause. In particular, the prevalence of a sub-clinical functional Vitamin B12 (B12) deficiency in the general population is higher than expected. Treatment of B12 deficiency is important to prevent neurological and/or hematological complications but requires a reliable diagnosis. Total serum cobalamin concentrations may not reliably indicate B12 status. Several recent studies have reported that holotranscobalamin (HoloTC), the bio-available cobalamin fraction, would be an early indicator of B12 status with improved accuracy compared to total serum B12. We evaluated the diagnostic value of measurements of a macrocytic anemia panel (total B12, HoloTC, Folate and Homocysteine) in order to characterize populations at risk of metabolic cobalamin deficiency. Our observational study included 66 myelofibrosis patients (MF), 56 neurological patients (26 probable Alzheimer’s disease, AD; 17 Mild Cognitive Impairment, MCI; 13 Vascular Disease,VaD), 20 vegans (V) and 16 apparently healthy volunteers (C) matched for age and sex. Serum concentrations of B12, Folate, and HoloTC were determined by microparticle enzyme immunoassay (MEIA); plasma Hcy levels were measured by fluorescence polarization immunoassay (FPIA) all on the Abbott AxSYM analyser. Hyperhomocysteinemia (>12 micromol/L) was present in 33.3% of MF (median 10.4, range 3.9–30.9); 38.5% of AD (median 11.4, range 7.1–46.5); 41.2% of MCI (median 12.0, range 8.3–16.4); 69.2% of VaD (median 15.0, range 6.6–23.6); 76.5% of V (median 14.2, range 5.9–31.5) and 33.3% of C (median 10.0, range 5.7–15.8). Low levels of B12 (< 180 pmol/L) were found in 10.6% of MF (median 471, range 137–959); 11.5% of AD (median 275, range 78–695); 11.8% of MCI (median 259, range 127–648); 15.4% of VaD (median 283, range 114–591); 10.6% of V (median 231, range 172–883) and 11.1 % of C (median 237, range 177–795). Low levels of HoloTC (< 35 pmol/L) were found in 43.9% of MF (median 46, range 14.9–123); 46.1% of AD (median 43, range 6.0–185); 52.9% of MCI (median 37, range 12–114); 23.1% of VaD (median 56, range 31–105); 82.3% of V (median 15.3, range 4.1–197) and 33.3 % of C (median 45, range 29–75). Vegans showed HoloTC levels significantly lower than all the other groups (p<0.02, Mann Whitney U test). Folate levels were considered not to add information in this context. Our preliminary findings clearly showed that HoloTC together with Hcy can help detect subjects likely to develop neurological and/or hematologic complications, and thereby likely to benefit from early tailored pharmacological treatment. In conclusion, HoloTC determination may be included as a complementary or alternative diagnostic strategy. Anemia Panel Results In At-Risk Groups Group Hcy>12μmol/L(%) B12<180pmol/L (%) HoloTC<35pmol/L (%) MF 33.3 10.6 43.9 AD 38.5 11.5 46.1 MCI 41.2 11.8 52.9 VaD 69.2 15.4 23.1 V 76.5 10.6 82.3 C 33.3 11.1 33.3

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