Transcript Portugal - Global Action Fund for Fungal Infections

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.