Burden of serious fungal infections in Dominican Republic

Ref ID: 19406

Author:

D. W. Denning1 and H. Gugnani2

Author address:

1The University of Manchester, United Kingdom and
2Microbiology and Epidemiology, Saint James School of
Medicine, Bonaire, the Netherlands Antilles

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Background and rationale The incidence and prevalence of fungal
infections in Dominican Republic (DR) is unknown. Extraordinarily
little is known about fungal infections in DR, other than Microsporum
audouinii and Trichophyton tonsurans are the leading cause of tinea
capitis in children and that histoplasmosis is endemic. We estimated
the burden of fungal infections in Jamaica from published literature
and modelling.
Methods There were no epidemiology papers reporting fungal infec-
tion rates from DR, so every estimate is based on modelling. We
extracted data from the WHO STOP TB program and UNAIDS
annual reports. We used specific populations at risk and fungal infec-
tion frequencies in those populations to estimate national incidence
or prevalence. ABPA and SAFS estimates were based on a 9.97%
adult clinical asthma rate (To et al, BMC Pub Health 2012) and CPA
on TB rates. Other assumptions were based on incidence rates reported in the local and international literature. The denominator
included the overall Jamaican population, number of patients with
HIV/AIDS and respiratory diseases.
Results The DR population was estimated to be 10,090,000 million
people (2009), of whom 31% are children (0-14 years) and 9% are
>60 years old. The adult asthma population was estimated at 1 mil-
lion. Using a 2.5% rate of ABPA based on other studies (see Denning
et al, Med Mycol, 2013), DR is estimated to have 25,150 cases of
ABPA and 34,000 SAFS cases (250 and 529/100,000 respectively).
3,300 cases of pulmonary TB were reported in 2011, which is esti-
mated to lead to 145 new cases of chronic pulmonary aspergillosis
annually and a 5 year prevalence of 458, assuming a 15% death
anual death rate. If TB accounts for 33% of the cases then the total
CPA prevalence is 1,374 cases in DR. Invasive aspergilosis in haema-
toliogical malignancy is estimated to affect 61 patients, assuming a
10% attack rate. If the incidence of candidaemia is 5/100,000, 505
cases of candidaemia occur each year, and 76 cases of Candida peri-
tonitis post-surgery. An estimated 158,134 women have >4 attacks
of vaginal candidiasis annually (6% women >15 yrs). The burden of
HIV/AIDS is estimated to be 62,000 + patients, 1.1% of adults of
whom 24,000 have CD4 counts <350/uL and are not being treated Assuming 50% of these patients develop either oral or oesophageal candidiasis annually, 5,400 and 3,800 cases respectively are esti- mated annually. Assuming 20% of those not on ARVs progress to a life-threatening opportunistic infections each year, and that the rate of PCP is 27%, 1,296 PCP cases are anticipated annually. It wasn’t possible to estimate the burden of histoplasmosis, cryptococcal men- ingitis or fungal keratitis, and some estimates are incomplete, notably invasive aspergillosis, as relevant data are not available. Conclusion We estimate that over 220,000 people in DR probably suffer from serious fungal infections each year, most related to asthma, prior TB, recurrent vaginal thrush and HIV infection.

Abstract Number: p140

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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