Abstract

Objective: To estimate the burden of fungal infections in Jordan for the first time. Material and Methods: Population data was from UN 2011 statistics and TB cases from WHO in 2012. Fewer than 100 patients with HIV were recorded in Jordan in 2013. Approximately 100 renal transplants and eight liver transplants are performed annually. There were 12,233 major surgical procedures in Jordan in 2013, of which 5.3% were major abdominal surgeries; candidemia was estimated in 5% of the population based on other countries, with 33% occurring in the ICU. Candida peritonitis/intra-abdominal candidiasis was estimated to affect 50% of the number of ICU candidemia cases. No adult asthma rates have been recorded for Jordan, so the rate from the Holy Land (8.54% clinical asthma) from To et al. has been used. There are an estimated 49,607 chronic obstructive pulmonary disease (COPD) patients in Jordan, with 64% symptomatic, 25% Gold stage 3% or 4%, and 7% (3472) are assumed to be admitted to hospital each year. No cystic fibrosis cases have been recorded. Literature searches on fungal infections revealed few data and no prevalence data on fungal keratitis or tinea capitis, even though tinea capitis comprised 34% of patients with dermatophytoses in Jordan. Results: Jordan has 6.3 million inhabitants (65% adults, 6% are >60 years old). The current burden of serious fungal infections in Jordan was estimated to affect ~119,000 patients (1.9%), not including any cutaneous fungal infections. Candidemia was estimated at 316 cases and invasive aspergillosis in leukemia, transplant, and COPD patients at 84 cases. Chronic pulmonary aspergillosis prevalence was estimated to affect 36 post-TB patients, and 175 in total. Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) prevalence in adults with asthma were estimated at 8900 and 11,748 patients. Recurrent vulvovaginal candidiasis was estimated to affect 97,804 patients, using a 6% rate among women 15–50 years of age. Conclusion: Based on local data and literature estimates of the frequency of mycoses in susceptible populations, at least 1.9% of Jordanians have some form of serious fungal disease.

Highlights

  • Jordan and the surrounding region have scanty information on the population prevalence of fungal infections

  • Candidemia burden was estimated at 316 cases, and invasive aspergillosis at 84 cases in patients with cancer and ICU [17], transplant, and chronic obstructive pulmonary disease (COPD) patients at 84 cases

  • In HIV patients only, the esophageal candidiasis rate was 0.10/100,000 [14,17], and oral candidiasis 0.14 [18], adding cancer patients as a risk group made estimates for oral candidiasis about 0.22/100,000 and esophageal candidiasis about 0.21/100,000

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Summary

Introduction

Jordan and the surrounding region have scanty information on the population prevalence of fungal infections. >60 years old) [1,2] It is in the Eastern Mediterranean region (Figure 1), east of Palestine and west of. Iraq and Saudi Arabia, in a relatively moderate climate where populations are mostly concentrated in the mountains, and less populated in the eastern part of the country where desert predominates [3]. This epidemiological modeling study is designed to assess the burden of serious fungal infections in Jordan based on some local data and data obtained from the UN 2011 and WHO 2013 for Jordan.

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