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Volume 26, Number 9—September 2020

Research

Risk-Based Estimate of Human Fungal Disease Burden, China

Ling-Hong Zhou1, Ying-Kui Jiang1, Ruo-Yu Li, Li-Ping Huang, Ching-Wan Yip, David W. Denning2, and Li-Ping Zhu2Comments to Author 
Author affiliations: Huashan Hospital, Shanghai, China; and Fudan University, Shanghai (L.-H. Zhou, Y.-K. Jiang, L.-P. Huang, C.-W. Yip, L.-P. Zhu); Peking University First Hospital, Beijing, China (R.-Y. Li); Peking University, Beijing (R.-Y. Li); National Clinical Research Center for Skin and Immune Diseases, Beijing (R.-Y. Li); Wythenshawe Hospital, Manchester, UK (D.W. Denning); University of Manchester, Manchester (D.W. Denning); Global Action Fund for Fungal Infections, Geneva, Switzerland (D.W. Denning)

Main Article

Table 2

Assumptions and calculations for the estimations of fungal disease burden, China*

Fungal diseases† Assumptions Calculations
Candidemia 1. Candidemia episodes in ICU = (ICU beds × 365/median length of ICU stay) × (rate of candidemia in ICU/1,000 admissions) Candidemia = Candidemia episodes in ICU/0.20
2. 20% of candidemia episodes in Asia occur in ICU
Candida peritonitis
 Rate of Candida peritonitis is 50% of cases of candidemia in ICU
 Candida peritonitis = candidemia in ICU × 50%
Candida peritonitis CAPD 1. 3.7% were Candida peritonitis in all episodes of infection Candida peritonitis CAPD = peritoneal dialysis × 0.27 × 3.7%
2. Overall infection incidence was 0.27 episodes/patient/ year
Oral candidiasis
 Assumed to occur in 45% of AIDS cases annually
 Oral candidiasis = AIDS × 45%
Esophageal candidiasis
 Assumed to occur in 20% of HIV patients not on ART and 5% of patients taking ART annually
 Esophageal candidiasis = (0.2 × HIV patients not on ART) + (0.05 × HIV patients on ART)
RVVC
 Assumed to occur in 7.2% of the female population 15–49 years of age
 RVVC = (female population 15–49) × 7.2%
IA 1. In hematologic malignancy, annual incidence of all leukemias and multiple myeloma × 40% × 13% IA = IA in hematologic malignancy + IA in solid and HSCT recipients + IA in lung cancer patients + IA in COPD patients + IA in HIV/AIDS patients
a. Acute myeloid leukemia estimated at 40% of annual incidence of leukemias and multiple myeloma
b. 13% of patients with acute myeloid leukemia developed IA
2. IA in solid and HSCT recipients: assumed 10% in a-HSCT recipients, 2% of renal transplants, 6% of heart transplants, 4% of liver transplants, 20% of lung transplants
3. IA in 2.6% of patients with lung cancer
4. IA in COPD: COPD patients × 20.9% × 3.9%
a. Annual hospitalization rate for COPD = 20.9%
b. 3.9% of hospitalized COPD patients developed IA
5. IA in 4% of HIV/AIDS patients
CPA 1. TB-related CPA: assuming rate of 22% among patients with lung cavities, 2% of patients without cavities Total CPA = TB-related CPA × 3
2. 22% of patients with pulmonary TB have residual lung cavities
3. One third of underlying diseases of CPA are TB
ABPA 1. 4.2% of adults in China have asthma ABPA = adults with asthma × 2.5%
2. 2.5% of adults with asthma have ABPA
SAFS 1. Assume a conservative 33% rate of fungal sensitization in patients with severe asthma SAFS = adult population × 33% × 10%
2. 10% of adults with asthma have severe asthma
CM 1. 7.1% of patients with HIV/AIDS CM = (7.1% × HIV/AIDS patients / 21%) + 0.43/100,000 × child population
2. HIV-related CM is 21% of total CM
3. Annual incidence of 0.43/100,000 in children
PCP 1. 22.4% of HIV-positive patients during a 2y period PCP = 22.4% × HIV/AIDS patients / 2 / 70.22%
2. HIV-related PCP is 70.22% of total PCP
Talaromycosis
 Assume 20% of AIDS patients geographically exposed, attack rate 15%
 Talaromycosis = HIV/AIDS patients × 20% × 15%
Histoplasmosis
 Assume 67% of AIDS patients geographically exposed, attack rate 5%
 Histoplasmosis = HIV/AIDS patients × 5% × 67%
Mucormycosis
 Assume prevalence is 0.2/100,000 in total population
 Mucormycosis = total population × 0.2/100,000
Fungal keratitis
 0.007% of total population
 Fungal keratitis = total population × 0.007%
Onychomycosis 2.6% of total population Onychomycosis = total population × 2.6%

*ABPA, allergic bronchopulmonary aspergillosis; ART, antiretroviral therapy; CAPD, continuous ambulatory peritoneal dialysis; CM, cryptococcal meningitis; CPA, chronic pulmonary aspergillosis; HSCT, hematopoietic stem cell transplant: IA, invasive aspergillosis; ICU, intensive care unit; PCP, pneumocystis pneumonia; RVVC, recurrent Candida vaginitis; SAFS, severe asthma with fungal sensitization.
†Example for reading the table: burden of candidemia = candidemia episodes in ICU / 0.20 = (ICU beds × 365 / median length stay in ICU) × (rate of candidemia in ICU/1000 admissions) /0.20 = (86,027 × 365 / 6.126) × (3.2 / 1000) / 0.20 = 82,011.

Main Article

1These authors contributed equally to this article.

2These authors contributed equally to this article.

Page created: May 26, 2020
Page updated: August 18, 2020
Page reviewed: August 18, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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