Estimated burden of fungal infections in Kenya

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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Human Fungal Infections in Kuwait—Burden and Diagnostic Gaps

Journal of Fungi ◽

10.3390/jof6040306 ◽

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.

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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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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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First Detection and Genotyping of Human-Associated Microsporidia in Pigeons from Urban Parks

Applied and Environmental Microbiology ◽

10.1128/aem.71.6.3153-3157.2005 ◽

2005 ◽

Vol 71 (6) ◽

pp. 3153-3157 ◽

Cited By ~ 74

Author(s):

M. Haro ◽

F. Izquierdo ◽

N. Henriques-Gil ◽

I. Andrés ◽

F. Alonso ◽

...

Keyword(s):

At Risk ◽

Opportunistic Infections ◽

Enterocytozoon Bieneusi ◽

Fecal Samples ◽

Encephalitozoon Intestinalis ◽

Prophylactic Measures ◽

Populations At Risk ◽

Animal Phyla ◽

Staining Methods ◽

Internally Transcribed Spacer

ABSTRACT Microsporidia are ubiquitous opportunistic parasites in nature infecting all animal phyla, and the zoonotic potential of this parasitosis is under discussion. Fecal samples from 124 pigeons from seven parks of Murcia (Spain) were analyzed. Thirty-six of them (29.0%) showed structures compatible with microsporidia spores by staining methods. The DNA isolated from 26 fecal samples (20.9%) of microsporidia-positive pigeons was amplified with specific primers for the four most frequent human microsporidia. Twelve pigeons were positive for only Enterocytozoon bieneusi (9.7%), 5 for Encephalitozoon intestinalis (4%), and one for Encephalitozoon hellem (0.8%). Coinfections were detected in eight additional pigeons: E. bieneusi and E. hellem were detected in six animals (4.8%); E. bieneusi was associated with E. intestinalis in one case (0.8%); and E. hellem and E. intestinalis coexisted in one pigeon. No positive samples for Encephalitozoon cuniculi were detected. The internally transcribed spacer genotype could be completed for one E. hellem-positive pigeon; the result was identical to the genotype A1 previously characterized in an E. hellem Spanish strain of human origin. To our knowledge, this is the first time that human-related microsporidia have been identified in urban park pigeons. Moreover, we can conclude that there is no barrier to microsporidia transmission between park pigeons and humans for E. intestinalis and E. hellem. This study is of environmental and sanitary interest, because children and elderly people constitute the main visitors of parks and they are populations at risk for microsporidiosis. It should also contribute to the better design of appropriate prophylactic measures for populations at risk for opportunistic infections.

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Impact of antifungal resistance in Australia

Microbiology Australia ◽

10.1071/ma07171 ◽

2007 ◽

Vol 28 (4) ◽

pp. 174 ◽

Cited By ~ 5

Author(s):

David Ellis ◽

Tania Sorrell ◽

Sharon Chen

Keyword(s):

Antifungal Activity ◽

Selection Pressure ◽

Opportunistic Infections ◽

Fungal Infections ◽

Fungal Species ◽

Antifungal Drugs ◽

Drug Resistant ◽

Populations At Risk ◽

Complete Resistance ◽

Major Increase

The last two to three decades have seen a major increase in invasive fungal infections (IFIs), a small, but increasing proportion of which are caused by pathogens with partial or complete resistance to antifungal drugs. The increase in IFIs has largely been associated with the increase in immunocompromised and critically ill patients. Opportunistic infections with relatively drug-resistant environmental fungi account for much of the resistance. In addition, amongst the only fungal species to colonise humans, Candida, two species that are resistant (C. krusei) or relatively resistant (C. glabrata) to fluconazole have emerged. In part this is explained by the selection pressure exerted by widespread use of fluconazole. Together with the introduction of new antifungal drugs with selective and/or variable antifungal activity, these changes have stimulated interest in understanding mechanisms and origins of resistance, the identification of resistance in the laboratory and its relationship to clinical outcomes, and in surveillance of clinical isolates and populations at risk of IFIs.

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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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Key Immune Cell Subsets Are Dysregulated in Patients with Myelofibrosis

Blood ◽

10.1182/blood.v124.21.5580.5580 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5580-5580

Author(s):

Marco Romano ◽

Lucia Catani ◽

Daria Sollazzo ◽

Martina Barone ◽

Margherita Perricone ◽

...

Keyword(s):

T Cells ◽

Immune Cells ◽

Th17 Cells ◽

Immune Cell ◽

Opportunistic Infections ◽

Fungal Infections ◽

High Rate ◽

Healthy Controls ◽

Immune Cell Subsets

Abstract Introduction: Myelofibrosis (MF) is a clonal disorder associated mainly with JAK2V617F and MPL mutations. Recently, a new mutation in the gene encoding calreticulin (CALR) was discovered in the majority of JAK2/MPL negative patients. MF is burdened by a high rate of potentially life-threatening infections. The issue of recurrent and opportunistic infections is increased after the introduction in clinical practice of JAK inhibitors with immunosuppressive activity. However, the role of crucial immune cell subsets is still poorly characterized. Here, we investigated the phenotype/function of selected immune cells in MF. Specifically, we focused on circulating regulatory (Tregs) and IL-17-producing T cells (Th17 cells), monocytes and dendritic cells (DCs). Monocyte-derived DCs were also characterized. Methods: We characterized circulating Th17 cells, Tregs, monocytes and DCs of 17 untreated MF patients and 8 healthy controls (HC) by flow cytometry. Th17 cells were identified as CD4+ CD161+ CD196+ cells while Tregs were enumerated as CD4+ CD25high CD127low T cells. We also tested the in vitro suppressive activity of circulating CD4+ CD25+ Tregs with a mixed leukocyte reaction assay. Two subpopulations of circulating DCs, myeloid CD11c+ and plasmacytoid CD123+cells, were enumerated as well. In addition, after immunomagnetic selection, we tested both phenotype of circulating monocytes and their capacity to differentiate into CD14-derived immature and mature DCs, using a specific cytokines cocktail. JAK2V617F and MPL mutations were detected with RT-PCR while the presence of CALR mutations were tested with Exon 9 Next Generation Sequencing assay. Results: JAK2V617F (11 cases), MPL (3 cases), and CARL (3 cases) mutations were detected. We found that circulating CD4+CD25highCD127low Tregs were reduced in MF patients as compared with healthy controls (p=0.043), although their suppressive ability was maintained. We also found a lower number of circulating Th17 cells (p=0.0026) in MF patients. This finding was particularly evident in JAK2V617F+(p=0.008) and CARL+(p=0.03) patients. Despite their number was in the normal range, circulating monocytes from MF patients showed reduced expression of the CD86 co-stimulatory molecule. Moreover, as compared with the normal counterparts, immature monocytes-derived DCs from patients maintained low CD14 expression without upregulating the CD80 co-stimulatory molecule expression (p=0.0063). Interestingly, at variance with plasmacytoid DCs, a reduced number of circulating myeloid DCs was observed in MF patients as compared with that of HC (p=0.01). Conclusions: Here we demonstrated that specific crucial subsets of immune cells show quantitative and/or qualitative abnormalities in MF patients. These findings may be useful to better understand the increased susceptibility of these patients to infections, since Th17 cells play a role in bacterial and fungal infections while myeloid DCs regulate Th1 activity. Of note, DCs inhibition might result in increased propensity to infections and compromised immune response to cancer.In addition, since monocytes are DC precursors, alterations in their differentiation pathway may contribute to develop defective immune responses. Disclosures Martinelli: NOVARTIS: Consultancy, Speakers Bureau; BMS: Consultancy, Speakers Bureau; PFIZER: Consultancy; ARIAD: Consultancy.

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COVID - 19 Presenting with Fungal Infections - The Hidden Pandemic within Pandemic?

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/770 ◽

2021 ◽

Vol 10 (44) ◽

pp. 3810-3814

Author(s):

Vidyashree S. Hulkoti ◽

Samarth Shukla ◽

Sourya Acharya ◽

Dhruv Talwar ◽

Aditi Goyal

Keyword(s):

Fungal Infection ◽

Fungal Infections ◽

Organ Damage ◽

High Rate ◽

Treatment Modalities ◽

Medical Attention ◽

Current State ◽

Increasing Trend ◽

Cellular Immunodeficiency ◽

Immunocompetent Patients

As the pandemic continues to spread vigorously, it is being noted that the COVID 19 virus is associated with various complications during the disease and also a great deal of post disease sequel.1 These gruelling complications are integrated with the overwhelming infection caused by the cytokine storm produced by the virus. While the treatment modalities are still under trial, glucocorticoids seem to have played a pivotal role in putting a check to the inflammation caused by the virus and have forbidden the organ damage caused thereafter. However, the aftermath of glucocorticoids usage has its own benefits and risks. Glucocorticoids cause cellular immunodeficiency and thus have immunosuppressive effects, additionally the use of immunomodulators such as tocilizumab alters the immune system and it subsequently predisposes the host to various secondary opportunistic infective agents. In the current state, as the pandemic abstains from fading away, an increasing trend of secondary fungal infections has been seen with COVID-19, resulting in an outbreak of fungal infections such as mucormycosis and candidiasis. Mucormycosis refers to any infection caused by the fungi of the Order Mucorales. Mucormycosis has been documented in the literature to be associated with a high rate of mortality due to its potential to spread drastically.2 Altered immunity is an important risk factor for mucormycosis. Additionally, diabetes has been noted to be critical for the development of mucormycosis in immunocompetent patients. Candidiasis is an infection caused by the candida species due to the immunosuppressed state developed by the use of glucocorticoids, which results in secondary fungal infection requiring urgent medical attention. The objective of this case report is to highlight the impending secondary fungal infection outbreak in COVID-19 and the need to contain this emerging spread of fungal infections under the blanket of this deadly pandemic.

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Fungal infection risks associated with the use of cytokine antagonists and immune checkpoint inhibitors

Experimental Biology and Medicine ◽

10.1177/1535370220939862 ◽

2020 ◽

Vol 245 (13) ◽

pp. 1104-1114

Author(s):

Xin Li ◽

Susanna KP Lau ◽

Patrick CY Woo

Keyword(s):

Fungal Infection ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Opportunistic Infections ◽

Fungal Infections ◽

Checkpoint Inhibitors ◽

Biologic Agents ◽

Soluble Form ◽

Cytokine Antagonists ◽

Tnf Α

The revolutionary success of biologic agents in treating various malignant and autoimmune conditions has been met with increased risk of opportunistic infections due to perturbations in immunity. In patients receiving biologic-containing regimens, the risk of fungal infection is less well-understood, and there is a lack of established guideline on the standard of care in terms of screening and prophylaxis. In this article, we reviewed the risk of fungal infections associated with cytokine antagonists, including anti-tumor necrosis factor (TNF) agents and interleukin (IL) antagonists, and immune checkpoint inhibitors. The risk of fungal infection in this group of patients is drug-, pathogen-, host-, and context-dependent. Among the biologic agents reviewed, anti-TNF agents are associated with highest number of reported cases of fungal infection, especially histoplasmosis. In fact, infection due to all dimorphic fungi except Talaromyces marneffei have been reported in patients receiving TNF-α inhibitors, despite their widespread use in T. marneffei-endemic regions. The risk is higher with TNF-α inhibitors that block both the membrane-bound and soluble forms of TNF-α, i.e., infliximab and adalimumab, compared with etanercept which inhibits the soluble form only. In addition to the preferential suppression of Th1 pathway and granuloma formation leading to genuinely higher risk of infection, the longer history and extensive use of infliximab coupled with the endemicity of histoplasmosis in the United States lead to an apparent increase in reported cases. IL-17 antagonists lead to a moderate increase in mucocutaneous candidiasis, but not the risk of life-threatening mycosis, consistent with the essential role of Th17 cells in mucosal defense. Immune checkpoint inhibitors, on the other hand, do not significantly increase the risk of invasive fungal infections when used alone and may even be of therapeutic value in the treatment of severe and refractory mycosis. Impact statement The risk of opportunistic infections due to fungi is relatively less well addressed in patients receiving biologic agents, compared with other opportunistic bacterial and viral infections. There is a lack of consensus guideline on the screening, prophylaxis, and management of fungal infection in patients anticipated to receive or actively receiving biologic therapy. In addition, invasive mycosis in immunocompromised patients is associated with high mortality and morbidity. This review highlighted the risk of fungal infection in patients receiving cytokine antagonists and immune checkpoint inhibitors, two big categories of biologic agents that are widely used in the treatment of various autoimmune and malignant conditions, often in combination with other immunomodulatory or immunosuppressive agents but also as standalone therapy. The adverse outcomes of opportunistic fungal infection in these patients can be reduced by heightened awareness, active case finding, and prompt treatment.

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Cutaneous Fungus Infections in Children

Pediatrics in Review ◽

10.1542/pir.13.4.152 ◽

1992 ◽

Vol 13 (4) ◽

pp. 152-156

Author(s):

James E. Rasmussen

Keyword(s):

Fungal Infection ◽

Tinea Capitis ◽

Fungal Infections ◽

Diagnostic Methods ◽

Tinea Corporis ◽

Clinical Impression ◽

Fungus Infection ◽

Common Term ◽

Tinea Versicolor ◽

Deep Fungal Infection

Cutaneous fungus infection in children may be either superficial or deep. The most common superficial infections include tinea versicolor, tinea capitis, tinea corporis, tinea cruris, tinea pedis, and candidiasis. "Ringworm" is a common term used to describe these infections, stemming from the fact that "tinea" is Latin for "worm" or "moth." The only deep fungal infection discussed in this review is sporotrichosis. Diagnostic Methods All forms of superficial fungal infection can be diagnosed easily with a variety of quick, simple, and inexpensive diagnostic methods. Once mastered, the tests need not be used on patients with obvious diagnoses; nevertheless, confirmation of one's clinical impression is personally satisfying and often important. POTASSIUM HYDROXIDE Superficial fungal infections of the skin involve the outer portion of the epidermis, including the hair and nails. Hyphae and spores are visible easily with low-to-moderate microscopic magnification. With the exception of mucous membranes or eroded surfaces (as often found in the case of candidiasis), skin and hair for sampling should be moistened with a drop of water or an alcohol swab. The skin should be abraded gently with the round belly of a 15 blade at the active margin of tinea corporis or, in the case of tinea capitis, any place where alopecia is visible.

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