Maria N. Gamaletsou1,2, David Denning1, and Nikolaos V. Sipsas2

1
Burden of serious fungal infections in Greece
P225
Maria N. Gamaletsou1,2, David Denning1, and
Nikolaos V. Sipsas2 1The National Aspergillosis
Centre, University Hospital of South Manchester
and The University of Manchester, Manchester,
UK, and 2Pathophysiology Department, Medical
School, National and Kapodistrian University of
Athens, Athens, Greece, in association with the
LIFE program at www.LIFE-worldwide.org
Background and Aim
Fungal infections are a growing global problem
that is difficult to calculate in terms of
prevalence, mortality, and impact on public
health and economy, especially in resource
deprived countries. Epidemiological data on
fungal infections are scarce, due to the lack of
surveillance systems and population-based
epidemiological studies. Under- reporting is
common, because superficial fungal infections are
diagnosed and treated by general practitioners,
while invasive fungal infections are notoriously
difficult to be diagnosed. Global estimates of
cutaneous fungal infections, invasive fungal
infections, chronic pulmonary aspergillosis after
pulmonary tuberculosis, and sarcoidosis and
allergic bronchopulmonary aspergillosis
complicating asthma have recently been published
yet, these data on fungal infections worldwide
are crude estimates that have not been
standardized. The aim of this work is to
calculate for the first time the burden of fungal
infections in Greece, a country with an estimated
population of 10.8 million, as part of a
multi-national project that attempts to collect
estimates from several countries worldwide in
order to establish a better understanding of the
current state of fungal infection globally.
Estimates of the incidence and prevalence of
serious fungal infections, based on
epidemiological data, are essential in order to
raise the awareness and design public health
interventions to prevent fungal infections,
given the limited modalities to diagnose and
treat these diseases.
Methods
Results

• A thorough literature search for papers reporting
  epidemiological data on serious fungal infections
  in Greece was performed.
• For fungal infections where no Greek data
  existed, we used a structured set of assumptions
  to estimate their burden, based on specific
  population with risk factors for fungal
  infection, such as immunosuppression, chronic
  disease, and surgical procedures.
• Population statistics were derived from the Greek
  Statistics Authority and the latest (2011)
  population census.
• Data on HIV/AIDS (2014) were obtained from the
  Hellenic Centre for Disease Control and
  Prevention
• Data for transplantations (2012) from the
  National Organization for Transplantation
• Data for tuberculosis from the World Health
  Organization (2012)
• Data on COPD, cystic fibrosis, asthma, abdominal
  surgeries, vulvo-vaginal candidiasis form the
  relevant scientific Greek societies
• Data on the number of critical care beds and
  hospital admissions from the Greek Ministry of
  Health.

• 10.8 M population
• 85.5 are adults,
• 53 are women, 27.4 women are over 60 years and
  40.3 over 50
• 27 of population are gt60 years old.
• Estimates are
• 243,567 Greek women get recurrent vaginal thrush
  (gt4x/yr).
• Of 14,434 HIV positive patients, 1,732 are not
  receiving ARVs. Oral candidiasis is estimated to
  occur at least once in 90 of patients with CD4
  cell counts lt200/uL and oesophageal candidiasis
  in 20. We estimated that there are 1.296 cases
  of oral candidiasis and 353 cases of esophageal
  candidiasis. 2 (2) of 107 new AIDS cases each
  year develop cryptococcal meningitis. Annual
  incidence of Pneumocystis pneumonia is 0.26
  cases/100,000 in HIV patients, 28 cases.
• Of the 500 cases of TB in 2012, 45 with AIDS, it
  is estimated that 22 new cases of chronic
  pulmonary aspergillosis (CPA) occurred and that
  the 5-year period prevalence is 347 cases
  (assuming 15 annual mortality). As CPA occurs in
  multiple other conditions including COPD a
  prevalence of 1,388 cases is estimated.
• Estimates of asthma prevalence in adults are
  about 9 and assuming 2.5 of asthmatics have
  ABPA, 20,805 patients with ABPA are likely and
  26,500 with SAFS.
• Assuming the rate of candidemia in Greece is
  5.0/100,000 population there are 541 cases. We
  have estimated 81 cases of post-surgical candida
  peritonitis (60,000 abdominal surgeries/yr).
• Invasive aspergillosis in immunocompromised
  patients is estimated at 1,125 patients annually
  including 85 cases in intensive care.
• For mucormycosis, there were 12 cases annually,
  and
• We estimated 56 cases of tinea capitis.

References

• Denning DW et al. Med Mycol 2013 51 361370
• Denning DW, et al. Bull World Health Organ
  201189864872
• Gamaletsou MN, et al. Clin Microbiol Infect
  201420O50-57
• Koussidou-Eremondi T, et al. Mycoses
  20054611-16
• Skiada A, et al. Clin Microbiol Infect 2011 17
  18591867
• Pratikaki M, et al. Mycoses. 2011 54 154 -61
• Guinea J, et al.Clin Microbiol Infect 2010
  16870-877

Conclusions

• According to our calculations 300,000 (2.72)
  people in Greece suffer from fungal infections
  each year.
• This is the first attempt to determine the burden
  of fungal disease in Greece and provides a crude
  estimate on its impact on public health.