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Published on: March 9, 2018
Burden of serious fungal infections in Nepal
Ushana Shrestha Khwakhali1, David W Denning2
1Department of Microbiology, Amrit Campus, Tribhuvan University, Kathmandu, Nepal.
Abstract:
There are few reports of serious fungal infections in Nepal though the pathogenic and allergenic fungi including Aspergillus species are common in the atmosphere. Herein, we estimate the burden of serious fungal infections in Nepal. All published papers reporting fungal infection rates from Nepal were identified. When few data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence. Of the 27.3 M population, about 1.87% was estimated to suffer from serious fungal infections annually. We estimated the incidence of fungal keratitis at 73 per 100,000 annually. Chronic obstructive pulmonary disease is common with 215,765 cases, contributing to 1119 cases of invasive aspergillosis annually. Of 381,822 adult asthma cases, we estimated 9546 patients (range 2673-13,364) develop allergic bronchopulmonary aspergillosis and 12,600 have severe asthma with fungal sensitisation. Based on 26,219 cases of pulmonary tuberculosis, the annual incidence of new chronic pulmonary aspergillosis (CPA) cases was estimated at 1678 with a 5 year period prevalence of 5289, 80% of CPA cases. Of 22,994 HIV patients with CD4 counts <350 not on antiretrovirals, Pneumocystis pneumonia was estimated at 990 cases annually. Cases of oral and oesophageal candidiasis in HIV/AIDS patients were estimated at 10,347 and 2950, respectively. There is a significant burden of serious fungal infections in Nepal. Epidemiological studies are necessary to validate these estimates.
Insights
Serious fungal infections pose a significant health burden in Nepal, affecting an estimated 1.87% of the population annually. This study estimates the incidence of various fungal infections, including invasive aspergillosis and Pneumocystis pneumonia.
Area of Science:
- Medical Mycology
- Epidemiology
- Public Health
Background:
- Despite common atmospheric fungi like Aspergillus, serious fungal infections in Nepal are underreported.
- Accurate data on the burden of fungal diseases is crucial for public health planning.
- Existing literature on fungal infections in Nepal is scarce.
Purpose of the Study:
- To estimate the national burden of serious fungal infections in Nepal.
- To quantify the incidence and prevalence of specific fungal infections.
- To highlight the need for further epidemiological research.
Main Methods:
- Systematic review of published papers on fungal infection rates in Nepal.
- Estimation of national incidence/prevalence using data from at-risk populations and known fungal frequencies.
- Calculations based on population data, disease prevalence (COPD, asthma, TB, HIV/AIDS), and estimated fungal infection rates.
Main Results:
- An estimated 1.87% of Nepal's 27.3 million population suffers from serious fungal infections annually.
- Estimated annual incidence: fungal keratitis (73/100,000), invasive aspergillosis (1119 cases), Pneumocystis pneumonia (990 cases).
- Significant burden of allergic bronchopulmonary aspergillosis (9546 cases), severe asthma with fungal sensitization (12,600 cases), chronic pulmonary aspergillosis (1678 new cases annually), oral/esophageal candidiasis in HIV/AIDS (10,347 and 2950 cases respectively).
Conclusions:
- Nepal faces a substantial burden of serious fungal infections across various conditions.
- The estimates highlight significant public health challenges posed by fungal pathogens.
- Urgent need for comprehensive epidemiological studies to validate these findings and inform interventions.
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