Abstract
The burden of severe fungal infections (FIs) is not well addressed in Ethiopia. We have estimated the burden of FIs from multiple demographic sources and by searching articles from PubMed. Opportunistic FIs were estimated using modelling and 2017 national HIV data. The burdens of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) were estimated by using the prevalence of asthma, chronic obstructive pulmonary disease, and annual the incidence of tuberculosis. Of the 105,000,000 estimated Ethiopian population, 610,000 are thought to have HIV infection. Our estimation of HIV-related FIs were: 9900 cryptococcal meningitis (CM), 12,700 Pneumocystis jirovecii pneumonia (PCP), 76,300 oral and 56,000 oesophageal candidiasis cases. A remarkable 7,051,700 4–14-year-olds probably have tinea capitis and 1,469,000 women probably have recurrent Candida vaginitis. There were 15,200 estimated CPA cases (prevalence) and 11,500 invasive aspergillosis (IA) cases (incidence). Data are scant, but we estimated 5300 candidaemia and 800 Candida peritonitis cases. In conclusion, approximately 8% of Ethiopians suffer from FIs annually, mostly schoolchildren with tinea capitis. IA, CM and PCP are the major causes of fungal deaths. The absence of CD4 count is challenging the identification of HIV patients at risk of opportunistic FIs. There is a pressing need to improve FI diagnosis, probably including national surveillance.
Highlights
Pathogenic, opportunistic and allergenic fungi cause a very wide range of diseases from simple superficial mycosis to complex disseminated endemic or opportunistic mycosis [1]
The number of immunosuppressed individuals who are at risk of developing opportunistic mycosis is increasing due to HIV/AIDS even though the rate is reduced because of antiretroviral therapy (ART), the expansion of intensive care units (ICUs), chronic diseases, malignancies and sophisticated procedures such as stem cell or organ transplantation [3]
We used different risk groups including people living with HIV/AIDS (PLWHA), patients with asthma, chronic obstructive pulmonary disease (COPD), cancer, pulmonary tuberculosis and postsurgical patients, and those admitted to ICUs to estimate specific infections
Summary
Pathogenic, opportunistic and allergenic fungi cause a very wide range of diseases from simple superficial mycosis to complex disseminated endemic or opportunistic mycosis [1]. Unlike superficial or cutaneous mycosis, disseminated fungal infections (FIs) are life threatening if not appropriately treated. In resource-limited settings (RLSs), invasive FIs remain understudied and underdiagnosed despite their high mortality rates when compared with other infectious diseases [1,2]. The number of immunosuppressed individuals who are at risk of developing opportunistic mycosis is increasing due to HIV/AIDS even though the rate is reduced because of antiretroviral therapy (ART), the expansion of intensive care units (ICUs), chronic diseases, malignancies and sophisticated procedures such as stem cell or organ transplantation [3]. Diagnosis and management of these opportunistic mycosis in RLSs is challenging as standard diagnostic methods and essential antifungal medicines are often absent [5]
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