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Poster #19
The burden of serious fungal diseases in Japan
Koichi Izumikawa1, Masato Tashiro1, Takahiro Takazono1, Shintaro Kurihara1, Tomomi Saijo2, Kazuko
Yamamoto2, Yoshifumi Imamura2, Taiga Miyazaki1, Misuzu Tsukamoto1, Katsunori Yanagihara3, Hiroshi Mukae2,
Shigeru Kohno2 and David W. Denning4
1 Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences
2 Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences
3 Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences
4 The University of Manchester and The National Aspergillosis Centre in association with the LIFE program at
www.LIFE-Worldwide.org,.
Contacts:
Prof. Koichi IZUMIKAWA,
M.D.
[email protected]
Phone: +81 (95) 819-7730
FAX: +81 (95) 819-7766
1-7-1 Sakamoto
Nagasaki 852-8501, JAPAN
Abstract
Methods
Recent syudies revealed the fungal infections have acquired high relevance rate all over the
We searched for existing data and estimated the incidence and prevalence of fungal diseases
world. A fungal burden in Japan was preliminary estimated by deterministic scenario
based on the populations at risk and available epidemiological data. Data were derived from
modelling and published incidence and prevalence data.
the World Health Organization (WHO), The Joint United Nations Program on HIV/AIDS
Vaginal candidiasis was the most frequent fungal infection revealed in this study, followed
(UNAIDS) and national and regional published reports. When no data existed, risk
by esophageal candidiasis and severe asthma with fungal sensitization (SAFS) and allergic
populations were used to estimate frequencies of fungal infections, using previously
bronchopulmonary aspergillosis (ABPA).
described methodology by LIFE [1,2].
The incidence or prevalence of the above referred fungal infections and ~ 2,370,300 (1.9%)
people in Japan suffer from those fungal infections each year. Further epidemiological
Results and Discussion
studies are needed to validate and extend these estimations.

The population of Japan is ~127 million in 2015; 13% are children, and 30% are
women >65 years.

Introduction
An estimated 1,525/100,000 females suffer from recurrent vulvovaginal candidiasis
(>4 episodes/year) each year.
Fungal infections have been increasing over the past decades due to the increased number of
immunocompromised hosts with immunosuppressant, solid organ transplant, hematopoietic

Oesophageal candidiasis affects 280/100,000 per year.
stem cell transplant and others. The few data is currently available for their prevalence in the

Candidaemia affects 6,350 patients, 40% of the total of invasive candidiasis (15,875),
including an estimated 476 with intra-abdominal candidiasis.
world, and it is important to estimate the actual fungal burden all over the world to

understand the current scenario of these emergent infections.
million adult asthmatics
Cutaneous and fatal fungal infections have been studied extensively in Japan, and latterly
chronic pulmonary aspergillosis. However, no estimate of the nationwide incidence and

Invasive aspergillosis is estimated to affect 1,308, mostly in acute leukemia and after
allogeneic stem cell transplantation.
prevalence of fungal infections has been attempted. Here we estimate the burden of serious

fungal infections in Japan.
ABPA and SAFS were estimated in 20.8/100,000 and 27.5/100,000 respectively, in ~1
An estimated 3,957 have CPA after pulmonary tuberculosis (19,615 survivors in 2012)
50% of the total burden.
Objectives

Mucormycosis may affect 254 patients annually.
We attempt the first estimate of the burden of serious fungal disease in Japan using

There are no incidence data on tinea capitis or fungal keratitis, but probably both
uncommon or rare.
deterministic scenario modelling and published incidence and prevalence data.
Table 1. Total burden of fungal infections estimated in Japan
Infection
Oesophageal candidiasis
None
Number of infections per underlying disorder per year
HIV/AIDS
Respiratory
Cancer/Tx
ICU
Rate/100,000
Total burden
354,762
696
-
-
-
280
355,458
-
-
-
4,445
1,905
5
6,350
1,937,000
-
-
-
-
1,525*
1,937,000
Allergic bronchopulmonary aspergillosis (ABPA)
-
-
26,452
-
-
20.8
26,452
Severe asthma with fungal sensitization (SAFS)
-
-
34,914
27.5
34,914
Chronic pulmonary aspergillosis
-
-
7,914
-
-
6.2
7,914
Invasive aspergillosis
-
-
??
1,255
103
1
1,308
Mucormycosis
?
?
?
254
?
0.2
254
Cryptococcal meningitis
-
20
-
-
-
0.02
20
Pneumocystis pneumonia
-
9
-
-
-
0.01
9
Candidemia
Recurrent vaginal candidiasis (4x/year +)
Total burden estimated
2,370,314
* rate for females only
Conclusion
The present study indicates that around to 1.9% (2,370,300) of the population is affected by a serious fungal infection, predominantly recurrent VVC in women in Japan. This is a preliminary
study but constitutes the first report of the global burden of fungal infections in Japan. Further epidemiological studies are needed to validate and extend these estimates.
[1] Denning DW, et al. Bull World Health Organ 2011; 89:864-72.
[2] Denning DW, et al. Med Mycol 2013; 51:361-70