A recently published review by British scientists has found that global incidence and mortality from invasive fungal disease is substantially higher than thought, and that greater awareness and improved testing could decrease the alarming numbers.
Using data from literature published between 2010 and 2023, along with 85 papers on individual country and global disease burden, the systematic review estimates that more than 6.55m people annually are affected by invasive fungal infection, including more than 2.1m with invasive aspergillosis, 1.8m with chronic pulmonary aspergillosis, and 1.5m with a Candida bloodstream infection or invasive candidiasis, 500 000 with Pneumocystis pneumonia, and 194 000 with Cryptococcal meningitis.
These infections lead to more than 3.75m deaths annually, of which 2.55m are directly attributable to the fungal disease, reports CIDRAP.
The review – published in The Lancet Infectious Diseases – also estimates that fungal asthma affects 11.5m people annually, with 92 000 asthma deaths linked to fungal allergy and 46 000 directly attributable.
Higher than previous estimates
The mortality figures are higher than the prior estimates of 1.5m to 2m annual deaths, in part because many fungal infections exacerbate diseases such as leukaemia, lung cancer, and Aids, and deaths have often been attributed to those diseases.
In addition, many fungal diseases go undiagnosed and untreated because of limited access to diagnostics.
But the new estimates, based on a combination of untreated mortality, the proportion of patients who are treated, and percentage survival in treated patients, suggest that invasive aspergillosis could be responsible for up to one-third of the 3.23m annual deaths from chronic obstructive pulmonary disease, while 340 000 (28%) of the more than 1.2m deaths from TB may have been attributable to chronic pulmonary aspergillosis.
Professor David Denning, PhD, author of the study, and from the University of Manchester, said that while the estimates are “necessarily crude” and limited by the scarcity of adequate epidemiologic data from many countries and uncertainty in the mortality rate of undiagnosed and untreated patients, they’re “critical to health system capacity building”.
“Improved clinical awareness, appropriate sampling, and timely laboratory diagnostic testing, combined with imaging, could definitively reduce the substantial number of mostly avoidable premature deaths from life-threatening fungal disease,” he wrote.
Study details
Global incidence and mortality of severe fungal disease
Prof David W Denning
Published in The Lancet Infectious Diseases on 12 January 2024
Summary
Current estimates of fungal disease incidence and mortality are imprecise. Population at risk denominators were used to estimate annual incidence for 2019–21. Extensive literature searches from 2010 to 2023 were combined with over 85 papers on individual country and global disease burden. Crude and attributable mortality were estimated using a combination of untreated mortality, the proportion of patients who are treated, and percentage survival in treated patients. Awareness, guidelines, and accessibility of diagnostics and therapies informed the ratio of treated to untreated cases. Estimates do not include influenza or Covid-19 outbreaks. Data from more than 120 countries were included. Annually, more than 2 113 000 people develop invasive aspergillosis in the context of chronic obstructive pulmonary disease, intensive care, lung cancer, or haematological malignancy, with a crude annual mortality of 1 801 000 (85·2%). The annual incidence of chronic pulmonary aspergillosis is 1 837 272, with 340 000 (18·5%) deaths. About 1 565 000 people have a Candida bloodstream infection or invasive candidiasis each year, with 995 000 deaths (63·6%). Pneumocystis pneumonia affects 505 000 people, with 214 000 deaths (42·4%). Cryptococcal meningitis affects 194 000 people, with 147 000 deaths (75·8%). Other major life-threatening fungal infections affect about 300 000 people, causing 161 000 deaths (53·7%). Fungal asthma affects approximately 11·5 million people and might contribute to 46 000 asthma deaths annually. These updated estimates suggest an annual incidence of 6·5 million invasive fungal infections and 3·8 million deaths, of which about 2·5 million (68%; range 35–90) were directly attributable.
The Lancet article – Global incidence and mortality of severe fungal disease (Open access)
CIDRAP article – Global mortality from fungal diseases has nearly doubled (Open access)
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