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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
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