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The Global Burden of Fungal Diseases

The Global Burden of Fungal Diseases. David W. Denning National Aspergillosis Centre, University Hospital of South Manchester The University of Manchester Global Action Fund for Fungal Diseases. Cutaneous fungal infections.

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The Global Burden of Fungal Diseases

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  1. The Global Burden of Fungal Diseases David W. Denning National Aspergillosis Centre, University Hospital of South Manchester The University of Manchester Global Action Fund for Fungal Diseases

  2. Cutaneous fungal infections 4th most prevalent chronic disease problem after dental caries, tension headache and migraine. 985 million people affected, 14.3% of the global population Vos et al. Lancet 2012;380.:2163 * Including fungal complications www.GAFFI.org

  3. Years lived with disability - cutaneous fungal infections Hay et al. J Invest Dermatol 2014;134:1527: www.GAFFI.org

  4. Fungal infections in AIDS www.GAFFI.org

  5. Pneumocystis pneumonia Estimating the burden in AIDS People living with HIV 35,500,000 On ART 15,052,000 (42.4%) Unprotected 20,448,000 CD4<100 2,760,480 (13.5%) www.GAFFI.org

  6. Pneumocystis pneumonia Estimating the burden in AIDS Global burden calculated using a low/medium incidence PCP rate (Thailand) of 14.75% = 407,171 Ratanasuwan W et al, J Med Assc Thai 2005;88:335.: www.GAFFI.org

  7. Pneumocystis burden increases with increasing GDP PCP TB Lowe et al, PLoS One 2013;8:e69969.: www.GAFFI.org

  8. Pneumocystis cases in 1,000 HIV patients in the USA 1991-2001- happening despite being in care Morris et al, Emerg Infect Dis 2004;10:1713 . www.GAFFI.org

  9. PCP is reduced but not eliminated by ART Morris A et al, Emerg Infect Dis 2004;10:1713 : www.GAFFI.org

  10. Pneumocystis pneumonia in the UK – all underlying diseases Maini et al, Emerg Infect Dis 2013;10:386 . www.GAFFI.org

  11. Missed diagnoses in AIDS Antinori S et al, Am J Clin Pathol 2009;132:221 . www.GAFFI.org

  12. Fungal infections in AIDS www.GAFFI.org

  13. Histoplasma capsulatum geography Moshi, Tanzania, 0.9% disseminated histoplasmosis in 970 febrile inpatients - 67% DM patients HIV No map for Asia, Oceania or Australasia Lofgren et al. Trans Roy Soc Hyg Trop Med 2012;106:504. www.GAFFI.org

  14. Fungal infections in hospitalised and critically ill patients www.GAFFI.org

  15. Invasive fungal infections Candidaemia rate varies by country from 2 to 26/100,000 If 5/100,000 and global population 7 billion = 350,000+ Brown et al. Sci Transl Med 2012;4:165rv13. www.GAFFI.org

  16. Candidaemia reporting in the UK 1,719 cases in 2012 ~25% Candida glabrata 1.8% of bloodstream isolates 10th most common www.hpa.org.uk/hpr/infections/bacteraemia.htm Voluntary surveillance system in England that collects laboratory reports of all microorganisms isolated (including fungi) at approximately 400 NHS and other laboratories www.GAFFI.org

  17. Candidaemia in the UK 2.95/100,000 www.hpa.org.uk/hpr/infections/bacteraemia.htm www.GAFFI.org

  18. Invasive candidiasis (IC) and candidaemia in the UK The pooled blood culture positivity rate in patients with IC was 0.38 (95%CI: 0.29 to 0.46) And the proportion patients with IC who have candidaemia = 33% (most IC is intra-abdominal/peritonitis) Avni et al. J Clin Microbiol 2011;49:665; Nguyen et al. Clin Infect Dis 2012:54:1240 www.GAFFI.org

  19. Invasive candidiasis (IC) and candidaemia in the UK The pooled blood culture positivity rate in patients with IC was 0.38 (95%CI: 0.29 to 0.46) And the proportion patients with IC who have candidaemia = 33% (most IC is intra-abdominal/peritonitis) Therefore the rate of invasive candidiasis in the UK (excluding Scotland) = 1,719/3 = 573 (candidaemia + IC) + 573 x 2/0.38 = 3015 IC cases + 1,719-573 = 1146 candidaemia without IC = 4,734 IC and candidaemia cases in the UK Avni et al. J Clin Microbiol 2011;49:665; Nguyen et al. Clin Infect Dis 2012:54:1240 www.GAFFI.org

  20. Invasive candidiasis (IC) and candidaemia in the UK The pooled blood culture positivity rate in patients with IC was 0.38 (95%CI: 0.29 to 0.46) And the proportion patients with IC who have candidaemia = 33% (most IC is intra-abdominal/peritonitis) Therefore the rate of invasive candidiasis in the UK (excluding Scotland) = 1,719/3 = 573 (candidaemia + IC) + 573 x 2/0.38 = 3015 IC cases + 1,719-573 = 1146 candidaemia without IC = 4,734 IC and candidaemia cases in the UK Population of 58.3M Overall rate of 8.1 /100,000 Avni et al. J Clin Microbiol 2011;49:665; Nguyen et al. Clin Infect Dis 2012:54:1240 www.GAFFI.org

  21. Invasive candidiasis (IC) and candidaemia in the world 1,719 candidaemia cases = 4,734 IC and candidaemia cases So if 350,000 candidaemia cases in the world, then 963,875 IC and candidaemia cases Probably an underestimate partly because of India – an estimated 675,000 cases, based on a recent multicentre study in ICU www.GAFFI.org

  22. Fungal infections in hospitalised and critically ill patients www.GAFFI.org

  23. Aspergillus, IPA and COPD ~ 1.3% of COPD admissions have invasive aspergillosisby culture ~ 22% of Aspergillus in COPD = invasive aspergillosis Guinea et al. Clin Microbiol Infect 2010;16:870. www.GAFFI.org

  24. IA in COPD 58 of the 298 COPD admissions with a lower respiratory tract sample processed grew Aspergillus spp. 39 (3.9%) had probable IA. Xu H et al. Clin Microbiol Infect 2012;18:403. www.GAFFI.org

  25. Aspergillus, IPA and COPD Xu H et al. Clin Microbiol Infect 2012;18:403. www.GAFFI.org

  26. COPD admissions (rate per 40+ years old) OECD Health Statistics 2013, ttp://dx.doi.org/10.1787/health-data-en. www.GAFFI.org

  27. Fungal Infections in China ECCMID 2013. www.GAFFI.org

  28. COPD in China 32,800,000 patients with COPD 11,858,100 admissions to hospital 154,155 IA cases in COPD at a 1.3% rate 462,466 IA cases in COPD at a 3.9% rate Zhu et al. ECCMID 2013; Abstr 3393. www.GAFFI.org

  29. Fungal infections in hospitalised and critically ill patients www.GAFFI.org

  30. Fungal disease of the lungs in outside the hospital www.GAFFI.org

  31. Fungal keratitis • 1–12 million affected worldwide, • Usually farmers and labourers • 4% children Deorukhkar S. Singapore Med J 2012;53:264. www.GAFFI.org

  32. Chromoblastomycosis www.GAFFI.org

  33. Aspergillus otitis externa • Acute otitis affects 1 in 250 people annually • Chronic otitis affects 3-5% of the population (200-350 million) • ~10% are fungal in origin, usually A. niger www.GAFFI.org

  34. Allergic fungal sinusitis Chronic rhinitis ~900 million adults 6.8% have fungal rhinosinusitis ~25 million with fungal rhinosinusitis Responsive to polyp removal, nasal steroids, saline douches and antibiotics Antifungals have a minor role www.GAFFI.org

  35. Argentina, Austria, Australia, Belgium, Brazil, Canada, Chile, China, Czech Republic, Dominican Republic, Ecuador, Egypt, France, Germany, Guatemala, Hungary, India (3 topics), Indonesia, Iran, Iraq, Ireland, Israel, Jamaica, Jordan, Kenya, Mexico, Mongolia, Nepal, Netherlands, New Zealand, Nigeria, Qatar, Romania, Russia, Senegal, Singapore, South Korea, Spain, Sri Lanka, Saudi Arabia, South Korea, Tanzania, Thailand, Trinidad and Tobago, Uganda, UK, Ukraine, Uruguay, Vietnam, Zambia. National burden estimates – countries covered

  36. Conclusions • Burden of fungal disease is much much greater than generally appreciated • Their impact on quality of life is not well studied • Estimations based on local epidemiological data and modelling a good start, but high quality epidemiological data are required • Country-specific estimates important for setting local priorities and garnering Global Fund and other support • Improved diagnosis is the key to better data and clinical outcomes • Chronic fungal infections (NCDs) need more attention generally www.GAFFI.org

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