Estimated burden of fungal disease in Uganda

Ref ID: 19199

Author:

R. Parkes-Ratanshi*, B. Achan, A. Kambugu, D. Meya, D.W. Denning

Author address:

Kampala, UG

Full conference title:

23rd European Congress of Clinical Microbiology and
Infectious Diseases

Date: 27 April 2014

Abstract:

Background: In Uganda, as elsewhere in Sub Saharan Africa, the HIV epidemic has highlighted cryptococcal and Candida infections as important opportunistic fungal infections. However, the burden of other fungal diseases is not well described. Estimating the burden of these infections in Uganda is an important first step in highlight gaps in diagnosis, care and treatment for fungal illnesses.
Methods: All epidemiological papers of fungal diseases in Uganda were reviewed. For infections where there is no Ugandan data, global data or data from East Africa were used. Population statistics were obtained from World Bank, HIV statistics from the Uganda AIDS Indicator survey (UAIS), pregnancy rates from the UNFPA, and TB rates from WHO statistics (all 2011).
Results: Of 35 million Ugandans, 1.1million have HIV and an estimated 9.2% (101,000) have a CD4 count <200 cells/µL. The cryptococcal antigen positivity rate is well defined (Leitchy 2010, Meya 2010, Parkes-Ratanshi 2011), an estimated 2,834 cryptococcal cases per year. PCP rates in hospitalized HIV patients suggest around 748 cases per year (Worodria 2012). HIV related oral and vaginal Candida rates have been described pre-ART and post-ART, which gives an estimate of 41,329 cases/year (Parkes-Ratanshi, 2011). Recurrent vaginal candidiasis is estimated to be 5-8% worldwide in women (=312,950 Uganda women/ year). Prevalence of Candida in pregnant Ugandan women is 60% = 651,600 cases/year (Tann 2006). In 2011 Uganda had 38,444 cases of pulmonary TB (estimated 5,000 deaths). Using previously described calculations (Denning 2011) this gives an estimate of between 497 to 3816/year of chronic pulmonary aspergillosis post TB. Asthma affects 4.4% adults in East Africa (GINA, 2004), contributing 40,392 asthma-related fungal infections. There are no data on tinea capitis or fungal keratitis in Uganda, but in Kenya Tinea affects up to 10% of all school children per year (Uganda= approximately 1,300,000/year.) Summary: There are an estimated 1 million fungal infections per year in Uganda, excluding tinea capitis. . Cryptococcus and PCP alone may cause around 30,000 deaths per year. Despite cryptococcal research in Uganda, overall fungal disease burden in Africa is not well described. As chronic diseases such as asthma increase, and cancer treatments is more widely available, it will be important to improve diagnostics and research, as well as to educate medical staff on the prevention, care and treatment of a wider range of fungal diseases.

Abstract Number: P1043

Conference Year: 2013

Link to conference website: http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=167678&XNSPRACHE_ID=2&XNKONGRESS_ID=180&XNMASK

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