Epidemiology of Visceral Mycoses in Autopsy Cases in 2011

Abstract

To identify recent trends in the frequency of mycoses in autopsy cases, we performed an epidemiological analysis using the data reported in the "Annual Report of Autopsy Cases in Japan" from 2011. 12,339 cases were autopsied, of which 608 (4.9 %) were found to have fungal infections. Of these, 411 cases (67.6 %) were male, the median age was 67, and 353 cases were severe (58.1 %). Aspergillus spp. was the most predominant causative agent among those infected with one pathogen. These data corroborate our previous data from reports in 2007 and 2009. For the first time since 1989, we observed a case of mycoses caused by Exophiala spp. with adult T cell leukemia and lymphoma. The types of underlying disease were also typical of that in our previous analysis in 2009. These included solid cancers in 124 cases (20.4 %), leukemia in 83 cases (13.7 %), bacterial infections such as pneumonia 69 cases (11.3 %) and malignant lymphoma in 66 cases (10.9 %). In 2011, the number of mycoses following solid organ transplantation totaled 12 cases and was the most numerous since 2005. A limitation of this study may be that the epidemiology of autopsied cases includes the more severe end of the fungal infection spectrum, and selection bias could not be ruled out. Nonetheless, this epidemiological analysis of autopsied cases with fungal infection provides a strong incentive to intensify and improve efforts in diagnosing and treating visceral mycosis.