Epidemiology of Visceral Mycoses in Autopsy Cases in Japan: Comparison of the Data from 1989, 1993, 1997, 2001, 2005 and 2007 in <I>Annual of Pathological Autopsy Cases in Japan</I>

Abstract

The data on visceral mycoses reported in the " Annual of Pathological Autopsy Cases in Japan " were analyzed epidemiologically every four years from 1989 to 2005, and in 2007. The frequency rates of visceral mycoses dropped sharply between 1989 (4.5%) and 1994 (3.2%), but by 2001 had risen again and have remained (4.4-4.6%) generally stable since then. The predominant causative agents were Candida and Aspergillus. Although the rate of candidosis showed a gradual decrease, the rate of aspergillosis showed an increase by degrees. Furthermore, the rate of aspergillosis exceeded that of candidosis in 1994, and the difference in the rates between the two conditions apparently further increased until 2001. After 2005, however no changes in this difference were observed. For complicated infections, the incidence of coinfection with Aspergillus and Candida showed a decreasing, and that with Aspergillus and Zygomycetes showed an increasing tendency. Severe infections with Zygomycetes showed a clear increase from 57.4% in 1989 to 88.9% in 2007. Comparing underlying diseases with mycoses in 1989 and 2007, leukemia (including myelodysplastic syndrome) decreased from 26.1% to 18.8% and bacterial infections (including interstitial pneumonia) increased from 11.1% to 22.1%. By age, the highest frequency rate of mycoses was observed in the range of 60-79 years, and the frequency rate of exogenous fungal infections such as aspergillosis, cryptococcosis, zygomycosis and trichosporonosis showed an increasing trend in the less than one-year old group.

A double-blind comparative study of the safety and efficacy of caspofungin versus micafungin in the treatment of candidiasis and aspergillosis

“…and Aspergillus spp. are the most important causative pathogens in Japan, the same as in other countries [1, 2]. …”

Epidemiology of invasive fungal diseases on the basis of autopsy reports

“…*includes mixed IFD;**to calculate this percentage, mixed infections were excluded;***one study excluded HIV patients [5];****data on aspergillosis only available for 2 studies [16,19]. …”

Invasive fungal infections in hematology: epidemiology and risk factors

“…In una casistica giapponese recentemente pubblicata [17] è stata riscontrata batteriemia o fungemia in 251 pazienti con leucemia mieloide acuta, su 2.585 pazienti analizzati (circa il 10%), con un rapporto di 1:1 per quel che riguarda i Gram+ e i Gram-(49% e 36%), mentre i funghi rappresentavano il 12%. Un altro dato pubblicato di recente riguarda uno studio autoptico giapponese [18] nel quale per la prima volta viene evidenziato un graduale decremento delle infezioni da Candida, con invece un aumento delle infezioni da Aspergillus, trend probabilmente correlati all'utilizzo di fluconazolo. Per quanto riguarda il confronto tra epidemiologia europea e americana dalla review di Cornely del 2011 [19] emerge una netta differenza, con l'incidenza americana che, con 22-29 casi per 100.000 pazienti, è quasi doppia rispetto a quella europea (1,4-11 casi per 100.000).…”