Is fungal disease in Sri Lanka underestimated? A comparison of reported fungal infections with estimated disease burden using global data

Abstract

Introduction With an increase in the elderly population and developments in medical care, increased numbers of patients with fungal diseases are expected. This necessitates a new vision for fungal diseases in Sri Lanka, a tropical country with a population of 20 million. The objective of this study was to estimate national fungal infection caseloads using global and national epidemiological datasets. Methods We searched national data and surveillance studies published by us and other authors for relevant disease terms. Locally collected incidence data were available for candidaemia, fungal keratitis, cryptococcosis, allergic broncho-pulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS). Global disease estimation was done using international data. Generally, disease estimates were conservative as they assumed the lowest incidence rates reported in the literature and focused only on well-defined risk populations. Results Among the 1,317 HIV/AIDS patients (in 2010), there were 639 estimated oral candidiasis cases, 100 oesophageal candidiasis cases and only 13 cases of cryptococcal meningitis. The estimated prevalence of chronic pulmonary aspergillosis (CPA) post TB is estimated to be 1,443 and all forms of chronic pulmonary aspergillosis (including aspergilloma) 2,886 patients.   We estimated 229 cases of invasive aspergillosis and 41 cases of mucormycosis. The projected annual incidence of candidaemia is 507 and an estimated 76 candida peritonitis cases post-surgery. According to our estimates 10,344 patients were suffering from ABPA and 13,654 were suffering from SAFS. The projected annual incidence of fungal keratitis would be 1,277   and tinea infections would affect 50 children. Pneumocystis incidence could not be estimated. Conclusions Our estimates suggest that candidaemia and invasive aspergillosis could be the leading causes of fungal-associated deaths in Sri Lanka whereas globally it is due to SAFS, ABPA and CPA. More precise data from the whole country is needed to validate these estimates. Such data would be very useful for developing healthcare policies for prevention, diagnosis and treatment of serious fungal infections.