Risk-Based Estimate of Human Fungal Disease Burden, China

Abstract

F ungal diseases constitute a growing problem worldwide, causing a large, but poorly quantified, impact on public health (1). The incidence of fungal infections varies according to geographic region, socioeconomic conditions, and the number of persons with underlying conditions. China is one of the largest countries in the world (largest population and third largest land area). It has almost every type of weather niche, from the Pacific coast in the south to the snowy mountains in the Qinghai-Tibet Plateau, and even tropical rain forest. Many endemic fungal infections are present in China, along with globally distributed fungal pathogens. Although China has become the world's second largest economy, it is still a developing country, with millions of impoverished citizens who are susceptible to fungal infections. Fungal keratitis, one of the major causes of avoidable blindness, has been relatively neglected (2). Moreover, old pathogens such as Histoplasma and Talaromyces marneffei (talaromycosis) have expanded (3,4); new hosts contributing to new therapies for malignant and autoimmune disease have increased (5,6); and new patterns, including aspergillosis in pulmonary tuberculosis (PTB) and chronic obstructive pulmonary disease (COPD), are emerging (7,8). In addition, the lack of effective drugs, shortages of well-trained medical care personnel, and unaffordable antifungal drugs result in severe outcomes. Therefore, an estimation of fungal disease burden is needed for China to increase public health awareness and facilitate effective interventions. As in most other countries, fungal infections are not reportable in China, and the incidence and prevalence are difficult to calculate because of the lack of population-based surveillance data and few high quality epidemiology studies. The Chinese National Fungal Diseases Surveillance System (http://www. chifungi.cn) was established on May 18, 2019, but no data have been released yet. Even with this dearth of data, we have attempted to estimate the burden of fungal disease in China. Materials and Methods Study Procedures We conducted a literature review for published epidemiology papers that discussed fungal infections in China. If no epidemiological data existed for a particular fungal disease, we estimated the burden based on fungal infection incidence or prevalence and the specific populations at risk (Figure 1; Appendix Table 1, https://wwwnc.cdc.gov/EID/article/26/9/20-0016-App1.pdf).

Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection

“…Reports of TM disease are common in the AIDS population in the late stage. A meta-analysis [ 12 ] showed that the prevalence of TM among HIV patients in China ranged from 0.2% (95% CI: 0.1–0.5%) to 26.5% (95% CI: 16.2–43.5%). South China had the highest prevalence, estimated at 15.0% (95% CI: 11.0–20.4%), while Southwest China had the lowest prevalence, estimated at 0.3% [ 13 ].…”

“…South China had the highest prevalence, estimated at 15.0% (95% CI: 11.0–20.4%), while Southwest China had the lowest prevalence, estimated at 0.3% [ 13 ]. It is estimated that there will be 4951 TM cases per year in patients with AIDS in southern China by 2050, and the endemic areas are increasing [ 12 ]. The disease is mostly localized to the lungs and skin and is related to exposure by inhalation or direct contact TM [ 14 , 15 ].…”

The Clinical Characteristics and Risk Factors for Poor Prognosis Among HIV Patients with Talaromyces Marneffei Bloodstream Infection

“…South China had the highest prevalence, estimated at 15.0% (95% CI: 11.0-20.4%), while Southwest China had the lowest prevalence, estimated at 0.3% [13]. It is estimated that there will be 4,951 TM cases per year in patients with AIDS in southern China by 2050, and the endemic areas are increasing [12]. The disease is mostly con rmed in the lungs and skin and is related to TM contact by inhalation or direct contact [14,15].…”

“…Reports of TM disease are common in the AIDS population in the late stage. A meta-analysis [12] showed that the prevalence of TM among HIV patients in China ranged from 0.2% (95% CI: 0.1-0.5%) to 26.5% (95% CI: 16.2-43.5%). South China had the highest prevalence, estimated at 15.0% (95% CI: 11.0-20.4%), while Southwest China had the lowest prevalence, estimated at 0.3% [13].…”

Health threat caused by fungi of medical interest: where are we in 2021?

“…Sporotrichosis is mainly found in central and South America: a new epidemic wave has spread from Rio de Janeiro to the North through cat transmission [23]. Only in China, talaromycosis is supposed to concern 20% HIVpositive subjects geographically exposed, resulting in 0.35 cases per 100,000 inhabitants, whereas its worldwide incidence is supposed to be close to 10,000 new cases per year [24]. Coccidioidomycosis due to Coccidioides immitis is largely underestimated: the actual incidence is likely closer to 140,000-150,000 cases per year, most occurring asymptomatically in America [1].…”