Burden of serious fungal infections in Trinidad and Tobago

Ref ID: 19404

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 the Carribean is not known, but is likely to be high
because of substantial rates of asthma and HIV infection. As most
people are black, tinea capitis in children likely to be common. Histoplasma
capsulatum is endemic on the islands with a 69% skin posi-
tivity rate in those <60 years old (1981). We estimated the burden of fungal infections in Trinidad and Tobago (T&T) from published lit- erature and modelling. Methods All published epidemiology papers reporting fungal or HIV infection rates from T&T 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 infection fre- quencies in those populations to estimate national incidence or prev- alence. Data for invasive mycoses, CPA, IA, ABPA, Asthma and COPD rates were made on assumptions based on incidence rates reported in the local and international literature. The denominator included the overall T&T population, number of patients with HIV/ AIDS and respiratory diseases. Results The T&T population was estimated to be 1,339,000 million people (2009), of whom 21% are children (0-14 years) and 10% are >60 years old. Asthma prevalence (wheezing in the last 12 months) is
13.2% in adolescents (11-19 years old) and assumed to be the same
throughout adulthood; an estimated adult asthma population of
139,631. Using a 2.5% rate of ABPA based on other studies including
one from South Africa, T&T has 3,491 ABPA cases and 4,608 SAFS
cases. In contrast, chronic pulmonary aspergillosis is uncommon with
an estimated prevalence of 27 cases after TB (2/100.000), as few cases
of TB are found on T&T, perhaps 25% of the total CPA caseload. An
estimated 23,763 women have >4 attacks of vaginal candidiasis annu-
ally (6% women >15 yrs, based on a Nigerian rate). Using a common
international figure for candidaemia incidence of 5/100,000, 87 cases
of candidaemia occur each year, and 10 cases of Candida peritonitis in
surgical patients. An estimated 14,00 people are infected with HIV in
T&T, an adult prevalence rate of 1.1%., of whom at least 5,000 are
not on antiretroviral therapy (<350 CD4/uL). We estimate that 2,250 and 750 patients develop either oral or oesophageal candidiasis annu- ally, assuming 50% of those not on ARVs are affected. Assuming 20% of those not on ARVs progress to a life-threatening opportunistic infection each year, and that the rate of PCP is 27%, 486 PCP cases would be expected in AIDS annually. It wasn’t possible to estimate the burden of histoplasmosis because of paucity of data, but it certain exists as several small series have been reported. Likewise invasive aspergillosis, mucormycosis, cryptococcal meningitis and fungal kera- titis caseload could not be estimated. Conclusion Using local data and literature estimates of the inci- dence or prevalence of fungal infections, over 33,000 people in T&T are estimated to suffer from serious fungal infections each year. Sub- stantial uncertainty surrounds these estimates and local epidemiolog- ical studies are urgently required to validate or modify these estimates.

Abstract Number: p138

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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