Burden of Serious Fungal Infections in Argentina

Abstract

The number of fungal infections at any given time in Argentina is not known. Here we estimate the burden of serious fungal infections in Argentina for the first time. Specific population statistics were searched from multiple sources, local literature was identified, and estimates made. Some additional data were sourced from the Ministry of Health, the Global Initiative for Asthma (GINA) program, and national haematology and transplant societies. Argentina has a population of 43.8 million, with 25% of this total being children under 15 years. The predicted candidemia annual incidence is 2193 cases, with 50% occurring in the ICU. At a 6% prevalence rate, an estimated 593,695 women suffer from recurrent vulvovaginal candidiasis. Invasive aspergillosis is relatively common because of high smoking and chronic obstructive pulmonary disease (COPD) rates, with 268 cases in immunocompromised patients and another 1938 in the 168,000 COPD patients admitted to hospital. Asthma is also common, affecting 14% of adults, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) are major problems. An estimated 432 cases of cryptococcal meningitis (CM)—90% of them in AIDS patients—and 1177 cases of Pneumocystis pneumonia (PCP) occur each year. The estimated annual case number of disseminated histoplasmosis is 404 in AIDS patients, almost as frequent as CM. Paracoccidioidomycosis annual incidence is estimated at 219, and coccidioidomycosis at 16 cases. At least 881,023 people (>2.01%) in Argentina are affected by a serious fungal disease annually, with considerable morbidity and mortality.

Re-drawing the Maps for Endemic Mycoses

“…While coccidioidomycosis is a reportable disease within 26 states plus the District of Columbia as of February 2019 (Table 2 ), it is not a notifiable disease in the other 24 US states or in Latin America (with the exception of Argentina) [ 132 , 154 , 155 ]. In 1944, Gonzales-Ochoa was the first to conduct skin testing in Sonora and Baja California demonstrating 16% reactivity rates [ 156 ].…”

“…Within South America, numerous geographically isolated areas of endemicity have been discovered including the northeastern areas of Colombia; Zulia, Lara, and Falcon states in Venezuela; the Chaco region in Argentina and Paraguay including the provinces of Catamarca, La Rioja, and San Luis; and the Piaui, Maranhao, Ceara, and Bahai states of Brazil [ 123 , 155 , 157 ]. In Central America, skin testing was first conducted by Andrade in 1945, reporting a low prevalence of reactors in Guatemala [ 159 ].…”

“…Paracoccidioidomycosis is a rare disease worldwide, but is a frequent AIDS-defining opportunistic infection in Latin America, and is now recognized as a neglected tropical disease by the World Health Organization [ 230 , 231 , 235 , 239 , 242 – 251 ]. P. brasiliensis is endemic in large parts of South America, with the greatest prevalence in southeast, south, and central-west Brazil; Venezuela and Columbia, followed by northern Argentina, eastern Paraguay, and the Cuenca River valley in Ecuador [ 155 , 230 , 232 , 235 , 238 , 239 , 245 , 246 , 252 – 257 ]. Southern Mexico and Central America have lower rates but are also endemic [ 238 , 258 ].…”

“…Southern Mexico and Central America have lower rates but are also endemic [ 238 , 258 ]. Because these data are inferred from case reports and retrospective studies of hospitalized patients, incidence rates are postulated to be higher [ 34 , 155 , 238 , 239 , 248 , 253 , 257 ]. Furthermore, climate change, human migration, the expansion of agricultural activities, and highway construction have affected the epidemiology of Paracoccidioides , which is now expanding from the south and southeast to the central-west and north regions of Brazil [ 238 , 249 , 259 ].…”

The global impact of Aspergillus infection on COPD

“…IA is almost always fatal if not identified and treated early 9 . COPD is one of many underlying risk factors for IA, including neutropenia, liver disease, diabetes mellitus, AIDS, those on immunosuppressive treatment [9][10][11][12] . Prior estimates of the annual global incidence of IA range upwards from 200,000 9 (9), but difficulties in the precise diagnosis of IA in COPD patients has restrained efforts to include this group in the estimates 10 .…”