Global prevalence of fungal infections

Some infections are common everywhere (e.g. Candida vaginitis), others are much more common in tropical underdeveloped countries (e.g. cryptococcal meningitis in AIDS), and others in temperate industrialised nations (e.g. SAFS).

Estimates of fungal infection burden are derived from multiple sources and are all crude estimates. Better local estimates are required in order to advocate for better access to modern diagnostics and treatments.

View detailed burden of disease reports by country at GAFFI.org

Geography

Mortality

  • Cryptococcal meningitis: 10% death rate in the USA, >70% in Africa. 180,000 deaths annually. Diagnosis is simple with CrAg (antigen) testing, but often late and appropriate medication not available.
  • Disseminated histoplasmosis in AIDS: >80% mortality rate in USA, ~50% in Central America, 100% if untreated.
  • Invasive aspergillosis: 50% mortality if treated, 100% if not. Diagnosis difficult; treatment often too late, and only partially effective.
  • Chronic pulmonary aspergillosis: diagnosis often confused with TB; requires radiology and Aspergillus antibody test; 30% mortality rate in 6 months, often by coughing up blood (haemoptysis). Treatment partially successful but long term.
  • Pneumocystis pneumonia: ~15% mortality in AIDS in UK, 30% in AIDS in Africa, ~50% non-AIDS, 100% if not diagnosed and treated. Diagnosis difficult without PCR or fluorescence microscopy. Treatment straightforward and available.
  • Invasive candidiasis: ~40% mortality, treated. Diagnosis by blood culture. Treatment straightforward, best drugs expensive. 350,000 deaths per year.
  • SAFS: increased risk of asthmatic death (estimated to be 450,000 annually worldwide).

Morbidity

  • Oral/oesophageal thrush: unpleasant, reduced food intake and weight loss.
  • ABPA/SAFS: breathlessness with severe asthma, reducing work capability especially for manual workers, co-morbidity issues with smoke from home cooking. Easy diagnosis (skin prick tests) if considered, antifungal treatment 60-80% effective.
  • Chronic pulmonary aspergillosis: progressive breathlessness and weight loss, with significant hospitalisation and medication costs (typically misdirected).
  • Fungal eye infection: (fungal keratitis and endophthalmitis) usually results in unilateral blindness as diagnosis late, good outcome if treated early. Diagnosis requires expert input; treatment intensive initially but unaffordable for most afflicted.
  • Candida vaginitis: misdiagnosis and anxiety major problems; impaired sex life and therefore relationship issues.
  • Fungal hair infection: (tinea capitis) most common in black children, who suffer patches of hair loss and psychological problems as a result. Diagnosis and treatment usually straightforward and highly effective.

Economic burden

The economic burden of invasive fungal infections is high because patients spend longer in hospital and many antifungal drugs are expensive.  An overview from the USA in 2002 (prior to licensing of echinocandins or voriconazole and posaconazole) indicates a country cost of at least $2.6 billion for systemic fungal infections (Wilson et al, 2002). Late diagnosis contributes substantially to the cost. 

  • Recurrent vulvovaginal candidiasis (yeast infection) leads to lost productivity of US$14·39 billion annually in high-income countries (Denning, 2018)
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