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The burden of serious fungal infections in Portugal Raquel Sabino1, Cristina Verissímo C1, Célia Pais2, David W. Denning3 1 Nacional Institute of Health Dr. Ricardo Jorge – URSZ- Infectious Diseases Department, Lisbon, Portugal 2 Centre of Molecular and Environmental Biology (CBMA), Department of Biology, University of Minho, Braga, Portugal 3 The University of Manchester and National Aspergillosis Centre, University Hospital of South Manchester, UK in association with the LIFE program at www.LIFE-worldwide.org Contacts: [email protected] [email protected] Phone number: (00351)217519247 Mycology laboratory – Infectious Diseases Department National Health Institute Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal Abstract Methods Fungal infections have acquired high relevance all over the world. A preliminary estimate Published epidemiology papers reporting fungal infection rates from Portugal were of the fungal burden in Portugal was done using deterministic scenario modelling and identified. Where no data existed, we used specific populations at risk and fungal published incidence and prevalence data. infection frequencies in those populations to estimate national incidence or prevalence, Vaginal candidiasis was the most frequent fungal infection detected in this study, depending on the condition. Population statistics were derived from the Statistics followed by severe asthma with fungal sensitization and allergic bronchopulmonary Portugal and the population census (2011). The incidence and prevalence of fungal aspergillosis. Dermatomycosis and fungal keratitis were not included. infections affecting HIV patients were obtained from the report on HIV/AIDS 2013 The incidence or prevalence of the above referred fungal infections and ~ 194,293 (1.8%) published by the National Health Institute Doutor Ricardo Jorge, I.P. The total number of people in Portugal suffer from those fungal infections each year. Nevertheless, this value transplants was obtained from the Authority for Blood Services and Transplantation is probably an underestimate and much more data are required to obtain more precise (data from 2011). Data on respiratory infections were recovered and inferred from the estimates, not only based on published data and population statistics. WHO data on TB. Results and Discussion Introduction The population of Portugal in 2011 was 10.56M, with 75% >15 years of age. Fungal infections have been neglected all over the world. In fact, fungal infections have An estimated 150,000 women (15-50) suffer from recurrent vulvovaginal candidiasis each year. We have not estimated oral or oesohphageal candidiasis rates (Table 1). been increasing over the past decades, posing major problems for physicians. One issue is their prevalence: more fungal disease than ever before is being encountered in a wider Candidaemia affects 0.88/1,000 hospital admissions or approximately 8.1/100,000 patients, a total of 856 cases nationally (Table 1). range of human hosts and caused by a large array of fungal species. Therefore, it is mandatory to estimate the actual fungal burden in each country, in order to fully grasp the An estimated 150 patients develop intra-abdominal candidiasis, post-operatively. current scenario of these emergent infections. Invasive aspergillosis is less common than other countries as COPD is uncommon in Portugal, a total of 180 cases annually (Table 1). In Portugal, till few decades ago, the prevalence of fungal infections was low or unknown. Infections with the highest prevalence were (and still are) those with very low mortality An estimated 69 patients develop chronic pulmonary aspergillosis after TB each year. and morbidity (eg. dermatomycosis or vaginal candidiasis) and national statistics on So, assuming a 15% annual mortality and surgical resection rate, the prevalence is invasive infections was not performed. As such, the national scientific community has 218 cases following TB, whereas the prevalence of chronic pulmonary aspergillosis for underestimated the importance of mycology until recently. all underlying pulmonary conditions was estimated to be 654 patients (Table 1). Objectives cases/100,000), 17,586 ABPA episodes (167/100,000) (Table 1). We here attempt the first estimate of the burden of serious fungal disease in Portugal using deterministic scenario modelling and published incidence and prevalence data. Infection 81 patients developed pneumocystis pneumonia in AIDS and 16 cryptococcosis (Table 1). Table 1. Total burden of fungal infections estimated in Portugal Data on dermatophytosis and fungal keratitis were not included in this study. Number of infections per underlying disorder per year None Oesophageal candidiasis Candidaemia Candida peritonitis Recurrent vaginal candidiasis (4x/year +) 149,751 ABPA SAFS Chronic pulmonary aspergillosis Invasive aspergillosis Mucormycosis Cryptococcosis Pneumocystis pneumonia Total burden estimated 149,751 * rate for females only. In contrast, asthma rates are high and so an estimated 23,198 SAFS episodes (220 HIV/AIDS Respiratory Cancer/Tx ICU 16 81 97 17,586 23,198 654 41,438 556 - 300 150 - 97 21 674 83 533 Rate/100K Total burden 8.1 1.4 2,836* 167 220 6.2 1.7 0.2 0.2 0.8 856 150 149,751 17,586 23,198 654 180 21 16 81 194,293 ABPA: allergic bronchopulmonary aspergillosis; SAFS: severe asthma with fungal sensitization Conclusion Using published data, we were able to estimate the incidence or prevalence of the above referred fungal infections and ~ 194,293 (1.8%) people in Portugal suffer from those fungal infections each year. Vaginal candidiasis was the most frequent fungal infection detected in this study. Further inclusion of dermatomycosis data will largely increase the incidence and prevalence of fungal infections. This is a preliminary study but constitutes the first report of the global burden of fungal infections in Portugal. Further studies based on local surveys are required to obtain more precise and complete data.