Burden of fungal infections in Iran

Abstract

Introduction: The number of fungal infections occurring each year in Iran is not known. As the burden of fungal disease is a measure used to assess and compare the relative impact of different type of fungal diseases on populations, we have estimated the burden of fungal diseases in Iran.
 Methodology: We estimated the burden of human fungal diseases based on the specific populations at risk, existing epidemiological data in both local and international databases, and modelling previously described by the LIFE program (http://www.LIFE-worldwide.org).
 Results: Among the population of Iran (79,926,270 in 2016), 6,670,813 (8.3%) individuals are estimated to suffer from a fungal infection each year. A total of 2,791,568 women aged between 15 and 50 years are estimated to suffer from recurrent vulvovaginal candidiasis, annually. In addition, considering the 13.3% prevalence rate of tinea capitis in children, a total of 2,552,624 cases per year are estimated. The estimated burden of invasive aspergillosis in the 3 groups of patients with hematologic malignancy, lung cancer and chronic pulmonary obstructive disease was 6394 (8.0 per 100,000). The estimate for the burden of allergic disease related to fungi including allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization and allergic fungal rhinosinusitis was 272,095 (340 per 100,000). Based on the 28,663 cases of HIV infection reported, an estimated 900 and 113 cases with pneumocystosis and cryptococcal meningitis are annually anticipated, respectively.
 Conclusion: Our estimates indicate that the importance of fungal infections is high but overlooked in Iran, which warrants further actions by health care authorities.

Update on invasive fungal infections in the Middle Eastern and North African region

“…In Turkey, the estimated rate was 0.13 per 100,000 population with the prediction of 106 annual cases occurring among HIV patients [21]. Similarly, the incidence rate in Iran was estimated at 0.14 per 100,000 population [17]. In Algeria, a nearly negligible rate of 0.09 per 100,000 population was estimated [20].…”

“…Several studies have estimated the incidence rates of candidemia in MENA countries. Candidemia incidence rate was estimated to be the highest in Qatar, with an estimated rate of (15.4/100,000) [16] and the lowest in Iran (0.34/100,000) [17] (Fig. 1).…”

“…In fact, C. auris is closely related to the species of the C. haemulonii complex, leading to a misidentification with other Candida species such Fig. 1 Available estimates of the incidence rate (per 100,000 population) of invasive fungal infections in MENA countries [16][17][18][19][20][21][22] as C. haemulonii or C. famata [69,70]. Even though most of the region belong to the middle-income countries, the total mass of the publication of research is lower than its global proportion of population or income [60].…”

“…IA burden estimates have been done for several MENA countries, and the highest estimated incidence rate in Egypt is 10.7/100,000 [18], followed by Iran with 7.9/100,000 among COPD cases, 0.1/100,000 among lung cancer cases, and 0.03/100,000 among acute myeloid leukemia cases [17]. In Saudi Arabia, incidence rate was 7.6/100,000 [19], followed by Algeria (7.1/100,000) [20], Turkey (4.48/100,000) [21], Iraq (2.62/100,000) [77], Jordan (1.34/100,000) [22], and reached its lowest value (0.6/100,000) in Qatar [16].…”

“…Estimated incidence rates were scarce. The highest estimated rate was in Iran at 9.2 per 100,000 population [17], then in Iraq and Algeria at 0.2 per 100,000 [20,77]. In Lebanon, an average incidence of 0.83 cases/10,000 admissions (range 0-2.22) was seen over a 10-year period in hospitalized patients, in addition to 20% mucormycosis-related deaths [115].…”