Burden of serious fungal infections in China

IntroductionThe number of fungal infections occurring each year in Austria is not known. We have estimated these based on populations at risk, supplemented with existing dataMethodsAll published epidemiology papers reporting fungal infection rates from Austria were identifiedResultsOf the 8.22M population, 14.5% are children (0-14 years) and 18% of population are >65 years old. We therefore estimate that 110,000 Austrian women get recurrent vaginal thrush (4+times annually). 106 cases have been recordedin Tirol in 2011, a total of 1221 nationally. Of the 688 cases of pulmonary TB in 2011, 84% in HIV negative people, and that 25% of chronic pulmonary aspergillosis (CPA) cases are TB relatedwe estimate a 5-year period prevalence of 382 CPA cases (assuming 15% annual mortality). Asthma prevalence in adults is 7% and assuming 2.5% of asthmatics have ABPA 7,537 patientswith ABPA are likely and 9,949 with severe asthma with fungal sensitisation (SAFS). Of the 15,000 estimated HIV positive patients, only 45 presented with AIDS in 2010 and 100% are takingARVs. Only 5 cases of cryptococcal meningitis were identified and it is not possible to estimate the annual incidence of Pneumocystis pneumonia, or oesophageal candidiasis which isprincipally in non-AIDS patients. The rate of candidemia in Austria is low at 2.63/100,000 population consistent with 209 cases, although only 165 were actually documented. Candidaperitonitis is estimated at 40% of the ICU candidaemia rate, based on French data. Most cases or oral and oesophageal candidiasis were probably in non-HIV infected people. Invasiveaspergillosis in haematological and transplant patients is estimated at 96 cases [which contrasts with 158 from registry data (2007/8)] and 283 in COPD patients admitted to hospital. 28mucormycosis and 2 histoplasmosis cases were recordedConclusionSubstantial uncertainty surrounds these estimates except for invasive aspergillosis figures in immunocompromised patients and candidaemia, where hospital-based surveillance studies havebeen done. Therefore, epidemiological studies are urgently required to validate or modify these estimates Introduction and BackgroundInvasive fungal diseases (IFDs) are an increasingly encountered threat among critically ill patients and are a significant cause of morbidity and mortality [1]. Worldwide, most infections arecaused by the genera Candida, Aspergillus and Cryptococcus. The incidence and severity of IFD are dependent on a variety of factors including increased use of immunosuppressive agentsantineoplastic agents, broad-spectrum antibiotics, prosthetic devices and grafts and hyperalimentation. Improvements in medical care have resulted in critically ill patients surviving longerrendering them vulnerable to IFD. Populations at risk for IFD include haematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients; patients with haematologicamalignancy; patients with HIV/ AIDS; and intensive care unit (ICU), surgical and burn patients [1, 2, 3]Candida species have historically been the most common causative organisms. However, the epidemiology of IFD has shifted in recent years as Aspergillus species and other moulds havebecome increasingly important pathogens [4, 5]. Most data available are mainly derived from single-institution reports or multiple sites within countries rather than from multi-nationalreports.Fungi infect billions of people every year, yet their contribution to the global burden of disease is largely unrecognized. True rates are unknown because of a lack of good epidemiologicadata and despite the high mortality rates of invasive fungal infections, they remain understudied and underdiagnosed as compared with other infectious diseases. Most serious fungalinfections occur as a consequence of other health problems such as asthma, AIDS, cancer, transplantation and corticosteroid therapiesEndemic mycoses, such as histoplasmosis, coccidioidomycosis, and penicilliosiss have a restricted geographic distribution and largely confined to areas of the world where the etiologicagents are found in nature. In recent years, however, increased domestic and international travel has led to an increase in the number of reported outbreaks and sporadic cases of mycoticdiseases. In Austria, for most fungal infections we lack any surveillance data, active or passiveHerein, we have estimated fungal infections based on populations at risk, supplemented with existing data from several sourcesMaterial and MethodsAll published epidemiology papers reporting fungal infection rates from Austria were identified. We also extracted reported data from the International Classification of Diseases (ICD) fromMinistry of Health as comparators. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence orprevalence, depending on the condition. Asthma and COPD rates were from Statistik Austria, Gesundheitsbefragung 2006/2007 and OECD. 2011 HIV data was from Ministry of Health. 2011transplantation numbers were from Gesundheit Osterreich. Infections are grouped in invasive fungal infections (cryptococcal meningitis, invasive aspergillosis, candida bloodstreaminfection, Pneumocystis pneumonia), chronic lung or deep tissue infection (chronic pulmonary aspergillosis), allergc fungal disease (allergic bronchopulmonary aspergillosis (ABPA), severeasthma with fungal sensitisation (SAFS)), mucosal infection (oral and oesophageal candidiasis, Candida vaginitis (thrush)) and skin, hair and nail infection (tinea capitis) Underlying diseasesOesophageal candidiasis