Burden of serious fungal infections in Jamaica

Ref ID: 19403

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 Jamaica is unknown. The first case of conidiobolus was
reported from Jamaica in 1965. Micrsporum gypseum has been found
frequently in the soil in Jamaica (50% samples), cases of histoplasmo-
sis are reported as are several cases of mycetoma. In addition the
mostly black ancestry predisposes to tinea capitis in children. We
estimated the burden of fungal infections in Jamaica from published
literature and modelling.
Methods All published epidemiology papers reporting fungal or HIV
infection rates from Jamaica were identified. We also extracted
reported data from the WHO STOP TB program and UNAIDS. Where
no data existed, we used specific populations at risk and fungal infec-
tion frequencies in those populations to estimate national incidence
or prevalence. CPA, ABPA, SAFS rates were based on asthma and
TB rates. Asthma rates (doctor diagnosed asthma) in 13-14 year olds
were taken from Kahwa et al, BMJ Open, 2012 and assumed to
relate to adulthood. 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 Jamaican population was estimated to be 2,719,000
million people (2009), of whom 29% are children (0-14 years) and
11% are >60 years old. The adult asthma population was estimated
at 522,000. Using a 2.5% rate of ABPA based on other studies (see
Denning et al, Med Mycol, 2013), Jamaica has 13,000 ABPA cases
and 17,225 SAFS cases (480 and 633/100,000 respectively). Only
98 cases of pulmonary TB were reported in 2011, so chronic pulmo-
nary aspergillosis is probably rare with an estimated prevalence of
14 cases after TB (1/100.000), perhaps 15% of the total CPA case-
load. An estimated 42,885 women have 4 or more attacks of vaginal candidiasis annually (6% women >15 yrs, based on a Nigerian rate)
(3,154/100,000 females). Using a common international figure for
candidaemia incidence of 5/100,000, 136 cases of candidaemia
occur each year, and 20 cases of Candida peritonitis in surgical
patients. The burden HIV/AIDS is estimated to be 27,000 + patients,
1.6% of adults of whom 14,000 are not receiving antiretroviral ther-
apy (CD4 counts <350/uL). Assuming 50% of these patients develop either oral or oesophageal candidiasis annually, 6,300 and 2,100 cases respectively would be expected annually. Assuming 20% of those not on ARVs progress to a life-threatening opportunistic infec- tions each year, and that the rate of PCP is 27%, 1,890 PCP cases would be expected in AIDS annually. It wasn’t possible to estimate the burden of histoplasmosis, invasive aspergillosis, mucormycosis, cryptococcal meningitis and fungal keratitis caseload through paucity of data. Conclusion Using local data and literature estimates of the inci- dence or prevalence of fungal infections, over 75,000 people in Jamaica probably suffer from serious fungal infections each year, most related to asthma, recurrent vaginal thrush and HIV infection. Local epidemiological studies are urgently required to validate or modify these estimates.

Abstract Number: p137

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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