The burden serious fungal disease from 6 European countries, Vietnam, Iraq and Qatar covering a total of 340 million people, has been presented at the ECCMID conference in Barcelona on May 10-13th 2014. The estimate from Vietnam is the first SE Asian country to be modelled. Notably different from other countries include high rates of Candida bloodstream infections in Denmark (8/100,000), increasing Pneumocystis pneumonia rates in the UK and Germany (0.94 and 1.2/100,000) and high rates of both chronic pulmonary aspergillosis (61/100,000) and tinea capitis (457/100,000) in Vietnam. Ukraine appears to have generally very high frequencies of several key infections.
|Country||Population (million)||Overall rate of serious fungal infection (million)||Especially common problems|
|Czech Republic||10.5||0.17 (1.56%)||Invasive aspergillosis|
|Denmark||5.6||0.093 (1.67%)||Candida bloodstream infection, ABPA and SAFS|
|Germany||82||4.01 (4.96%)||Recurrent VVC, ABPA, SAFS, candida peritonitis, pneumocystis pneumonia|
|Hungary||10||0.13 (1.3%)||Chronic pulmonary aspergillosis|
|Iraq||34||0.53 (1.6%)||Tinea capitis, invasive aspergillosis|
|UK||62.4||0.193 (0.3%)*||ABPA and invasive aspergillosis|
|Ukraine||45||1 (2.2%)||Pneumocystis pneumonia, oesophageal candidiasis|
|Vietnam||91||1.011 (1.1%)||Recurrent VVC, tinea capitis, chronic pulmonary aspergillosis|
VVC = vulvovaginal candidiasis, ABPA = allergic bronchopulmonary aspergillosis complicating asthma and cystic fibrosis, SAFS = severe asthma with fungal sensitisation, * excludes rVVC
The high rates of asthma in many european countries, notably Denmark, UK and Germany translate into large estimates of patients with ABPA and SAFS. Cystic frobosis contributes more affected patients. The German estimate of recurrent VVC at 9% is at the highest rate documented internationally, and could over-estimate cases as not all are medically documented. Ukraine has a high number of HIV-infected patients, which contribute many cases of Pneumocystis pneumonia and mucosal candidiasis, as well as substantial rates of cancer-related invasive aspergillosis and candidiasis.
Among skin infections, only tinea capitis is regarded as being a serious fungal infection in this analysis (because of its disproportionate impact on children and the 1-2% rate of kerion). The large number of affected children in Iraq (65,000) and Vietnam (415,000) is noteworthy and problematic.
The data from these 8 countries emphasises how much geographical diversity in serious fungal disease burden exists across Europe and the world. Local epidemiological data has never been more necessary to address the numerous diagnostic (and therefore treatment) gaps in serious fungal infections.
ECCMID is Europe’s premier infection meeting and attracted over 10,625 delegates from >117 countries, the world’s largest annual conference on human infectious diseases.