Burden of Serious Fungal Infections in Germany

Burden of serious fungal infections in Germany

Markus Ruhnke, Andreas Groll, Peter Mayser, Martin Schaller, Werner Mendling, Andrew Ullmann, David W. Denning and The University of Manchester in association with the LIFE program at

Objective

In the late 1980`s, the incidence of invasive fungal diseases (IFD) in Germany was estimated with 36,000 IFD per year (Muller (1987) Mycoses 30, Suppl2). The current number of fungal infections occurring each year in Germany is not known. We have estimated these based on populations at risk, supplemented with existing data.

Methods

All published epidemiology papers reporting fungal infection rates from Germany were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence, depending on the condition. 2011/12 population statistics (ICD10 coding) were derived from the National Institute of Health ( and tuberculosis cases (2011) were obtained from the relevant registries (

Results

Of the 81.84M population (adults 65.47M; 41.64M female), 20% are children (0-14 years) and 16% of population are 65 years old.

In a pan-European survey (Achilles project) on fungal skin disease 33% of patients visiting a general practitioner had evidence of superficial fungal infection (SFI). From these data, it can be calculated, 6,700,000 individuals suffer from SFI in Germany. Estimates of recurrent vaginal candidosis (rVVC) prevalence in adult woman are ~9%, which correlates to3,690,000German women with rVVC. The rate of candidemia (ICD10 B37.7) in Germany was calculated at4.7/100,000 inhabitants, a similar rate toCandida peritonitis (ICD10 B37.8). In 682 ICU´s, the ratio of albicans to non-albicans candidaemia is 381: 142 (63% vs. 37%).

Of the 4,317 cases of TB in 2011, mostly in HIV negative people, it is estimated that 479 new cases of chronic pulmonary aspergillosis (CPA) occurred post-TB. Assuming that TB is the underlying disease in 20% of cases,the5-year period prevalence will be ~10,000 cases.

Estimates of asthma prevalence in adults are between 7-8% (in total 4.9M) and assuming 2.5% of asthmatics have ABPA, 123,960 patients with ABPA are likely and 163,131 with SAFS.Invasive aspergillosis (IA; ICD10 B44) was coded in 1,595 hospitalized patients, many less than the 10% (n= 1,671) only in AML; usually 50% of the total IA caseload in haematology. Mucormycosis (IC10 B46) was coded in 19 cases in 2011. Endemic IFD (e.g. histoplasmosis, blastomycosis, coccidiodomycosis) are rare; 5-10 new (imported) cases/year.Of the 43,000 estimated HIV positive patients, 5 (5%) of 280 new AIDS cases each year develop cryptococcal meningitis. The annual incidence of Pneumocystis jiroveciipneumonia is 1.2 cases/100,000 consistent with 986 cases.

Conclusion:using local data and literature estimates of the incidence or prevalence of fungal infections, almost 10.7 M (9%) people in Germany suffer from a fungal infection each year. Substantial uncertainty surrounds these estimates because fungal infections do not belong to the officially notifiable transmissible infectious diseases.