Summary
Background
The burden of fungal disease in the UK is unknown. Only limited data are systematically
collected. We have estimated the annual burden of invasive and serious fungal disease.
Methods
We used several estimation approaches. We searched and assessed published estimates
of incidence, prevalence or burden of specific conditions in various high risk groups.
Studies with adequate internal and external validity allowed extrapolation to estimate
current UK burden. For conditions without adequate published estimates, we sought
expert advice.
Results
The UK population in 2011 was 63,182,000 with 18% aged under 15 and 16% over 65. The
following annual burden estimates were calculated: invasive candidiasis 5142; Candida peritonitis complicating chronic ambulatory peritoneal dialysis 88; Pneumocystis pneumonia 207–587 cases, invasive aspergillosis (IA), excluding critical care patients
2901–2912, and IA in critical care patients 387–1345 patients, <100 cryptococcal meningitis
cases. We estimated 178,000 (50,000–250,000) allergic bronchopulmonary aspergillosis
cases in people with asthma, and 873 adults and 278 children with cystic fibrosis.
Chronic pulmonary aspergillosis is estimated to affect 3600 patients, based on burden
estimates post tuberculosis and in sarcoidosis.
Conclusions
Uncertainty is intrinsic to most burden estimates due to diagnostic limitations, lack
of national surveillance systems, few published studies and methodological limitations.
The largest uncertainty surrounds IA in critical care patients. Further research is
needed to produce a more robust estimate of total burden.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of InfectionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Voluntary surveillance of candidaemia in England, Wales and Northern Ireland: 2012.HPA. 2013; (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/356740/hpr3614_cnddm13.pdf)
- Emerging trends in the epidemiology of invasive mycoses in England and Wales (1990–9).Epidemiol Infect. 2001 Jun; 126: 397-414
http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1196942156347 [Now archived: http://webarchive.nationalarchives.gov.uk/20080728173910/http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947363235].
- ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections.Clin Microbiol Infect. 2014 Apr; 20 (PubMed PMID: 24102785): 76-98https://doi.org/10.1111/1469-0691.12360
- ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures.Clin Microbiol Infect. 2012 Dec; 18 (PubMed PMID: 23137134): 9-18https://doi.org/10.1111/1469-0691.12038
- ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients.Clin Microbiol Infect. 2012 Dec; 18 (PubMed PMID: 23137135): 19-37https://doi.org/10.1111/1469-0691.12039
- British Association of Dermatologists' guidelines for the management of onychomycosis 2014.Br J Dermatol. 2014 Nov; 171 (PubMed PMID: 25409999): 937-958https://doi.org/10.1111/bjd.13358
- British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases.Lancet Infect Dis. 2015 Apr; 15 (Epub 2015 Mar 12. Review. PubMed PMID: 25771341): 461-474https://doi.org/10.1016/S1473-3099(15)70006-X
- 2011 Census: population estimates for the United Kingdom, March 2011.ONS, Dec 2012
- Organ donation and transplantation activity report 2013/14. NHSBT, 2014
- Pneumocystis carinii pneumonia in heart transplant recipients.Eur J Cardiothorac Surg. 2001; 20: 799-802
- Pneumocystis pneumonia in solid organ transplant recipients: not yet an infection of the past.Transpl Infect Dis. 2012; 14: 519-525
- Increasing Pneumocystis pneumonia, England, UK, 2000–2010.Emerg Infect Dis [Internet]. 2013; https://doi.org/10.3201/eid1903.121151
- Trends in bacterial, mycobacterial, and fungal meningitis in England and Wales 2004–11: an observational study.Lancet Infect Dis. 2014 Apr; 14: 301-307
- HIV in the United Kingdom: 2014 report.PHE, 2014
- The prevalence of cryptococcal antigenemia in newly diagnosed HIV patients in a southwest London cohort.J Infect. 2013; 66: 75-79
- BSBMT registry: 2013 activity.BSBMT, 2013
UK Cancer Registry, accessed via Cancer Research UK CancerStats web page: http://www.cancerresearchuk.org/cancer-info/cancerstats/.
- Chronic granulomatous disease in the United Kingdom and Ireland: a comprehensive national patient-based registry.Clin Exp Immunol. 2008; 152: 211-218
- Emergency Inpatient admissions for COPD in England based on hospital episode Statistics (HES) 2005–2008.Am Thorac Soc Int Conf Abstr. 2011; (Chapter DOI: 10.1164/ajrccm-conference.2011.183.1_MeetingAbstracts.A1731. ISSN: 1073-449X)
- Hospital Episode Statistics, adult critical care in England: April 2013 to March 2014.NHSIC, 2015
- Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005–2007).Clin Microbiol Infect. 2011; 17: 1882-1889
- Health Protection (HPA) mycology network – rapid evaluation of incidence estimates (unpublished).HPA Mycology Network, 2004
- The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study.Haematologica. 2006; 91: 1068-1075
- Epidemiology and outcome of invasive fungal diseases in patients with chronic granulomatous disease a multicenter study in France.Pediatr Infect Dis J. 2011; 30: 57-62https://doi.org/10.1097/INF.0b013e3181f13b23
- Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome.Clin Microbiol Infect. 2010; 16: 870-877
- Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China.Clin Microbiol Infect. 2012; 18: 403-408https://doi.org/10.1111/j.1469-0691.2011.03503.x
- Invasive aspergillosis in the intensive care unit.Clin Infect Dis. 2007; 45: 205-216
- Clinical characteristics of 45 patients with invasive pulmonary aspergillosis: retrospective analysis of 1711 lung cancer cases.Cancer. 2009 Nov 1; 115 (PubMed PMID: 19637340): 5018-5025https://doi.org/10.1002/cncr.24559
- Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes.Crit Care. 2015; 19: 7https://doi.org/10.1186/s13054-014-0722-7
- Clinical relevance of Aspergillus isolation from respiratory tract samples in critically ill patients.Crit Care. 2006; 10: R31
- Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?.Intensive Care Med. 2001; 27: 59-67
- Global burden of chronic pulmonary aspergillosis as a sequel to tuberculosis.Bull WHO. 2011; 89: 864-872
- The value of end-of-treatment chest radiograph in predicting pulmonary tuberculosis relapse.Int J Tuberc Lung Dis. 2008; 12 (PMID: 18713505): 1059-1064
- High resolution chest CT in patients with pulmonary tuberculosis: characteristic findings before and after antituberculous therapy.Eur J Radiol. 2008; 67 (PMID: 17870275): 100-104https://doi.org/10.1016/j.ejrad.2007.07.009
- Pulmonary tuberculosis: tomographic evaluation in the active and post-treatment phases.Sao Paulo Med J. 2003; 121 (PMID: 14666291): 198-202https://doi.org/10.1590/S1516-31802003000500004
- Global burden of chronic pulmonary aspergillosis complicating sarcoidosis.Eur Resp J. 2013; 41: 621-626
- Underlying pulmonary disease frequency in patients with chronic pulmonary aspergillosis.Eur Resp J. 2011; 37: 865-872
NHS England National Commissioning Group Chronic Pulmonary Aspergillosis national service. The National Aspergillosis Centre Annual Report 2013–2014. http://www.nationalaspergillosiscentre.org.uk/.
Public Health England. Public Health Outcomes Framework. http://www.phoutcomes.info/public-health-outcomes-framework#page/3/gid/1000044/pat/6/par/E12000002/ati/102/are/E06000008/iid/40701/age/163/sex/4.
- Annual mid-year population estimates: 2014.ONS, 2015
- Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2163-2196
- Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults.Med Mycol. 2013 May; 51 (Epub 2012 Dec 4. PubMed PMID: 23210682): 361-370https://doi.org/10.3109/13693786.2012.738312
- Global asthma prevalence in adults: findings from the cross-sectional world health survey.BMC Public Health. 2012; 12: 204
- Epidemiology and disease burden from allergic disease in Scotland: analyses of national databases.J R Soc Med. 2009; 102: 431-442
- Prevalence of possible Severe Asthma with Fungal Sensitisation (SAFS) and Allergic Bronchopulmonary Aspergillosis (ABPA) in a UK secondary care hospital.(European Respiratory Society Annual Congress 2013)2013
- Diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients.J Semnan Univ Med Sci. 2001-2002; 3: 39-45
- The diagnostic criteria for allergic bronchopulmonary aspergillosis in children with poorly controlled asthma need to be re-evaluated.Acta Paediatr. 2015 May; 104 (Epub 2015 Mar 13. PubMed PMID: 25620428): e206-e209https://doi.org/10.1111/apa.12930
- UK cystic fibrosis registry annual data report 2011.(London)2013
- Classification of aspergillosis in adult cystic fibrosis.J Allergy Clin Immunol. 2013; 132: 560-566
- UK cystic fibrosis registry annual data report 2012.(London)2013
- Randomized controlled trial of oral antifungal treatment for severe asthma with fungal sensitization: the Fungal Asthma Sensitization Trial (FAST) study.Am J Respir Crit Care Med. 2009; 179: 11-18
- The effects of antifungal therapy on severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis.Respirology. 2009; 14: 1121-1127
- Pharmacological treatment of severe, therapy-resistant asthma in children: what can we learn from where?.Eur Respir J. 2011; 38: 947-958
- Voriconazole and posaconazole improve asthma severity in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization.J Asthma. 2012 May; 49: 423-433
- Pediatric severe asthma with fungal sensitization is mediated by steroid-resistant IL-33.J Allergy Clin Immunol. 2015 Aug; 136 (312–322.e7)
- Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey.Br Med J. 2002; 325: 411-415
- Severe asthma: definition, diagnosis and treatment.Dtsch Arztebl Int. 2014 Dec 12; 111 (PubMed PMID: 25585581; PubMed Central PMCID: PMC4357024): 847-855https://doi.org/10.3238/arztebl.2014.0847
- The prevalence of severe refractory asthma.Am Acad Allergy Asthma Immunol. 2014; https://doi.org/10.1016/j.jaci.2014.08.042
- Mold sensitization is common amongst patients with severe asthma requiring multiple hospital admissions.BMC Pulm Med. 2005; 18: 4
- Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis.Int J Tuberc Lung Dis. 2009; 13: 936-944
- Comparison of skin prick tests with specific serum immunoglobulin E in the diagnosis of fungal sensitization in patients with severe asthma.Clin Exp Allergy. 2009; 39: 1677-1683
- Fungal allergy in asthma-state of the art and research needs.Clin Transl Allergy. 2014 Apr 15; 4: 14https://doi.org/10.1186/2045-7022-4-14
- Voluntary surveillance of candidaemia in England, Wales and Northern Ireland: 2013.Health Prot Rep Wkly Rep. Sept 2014; 8
- PCR diagnosis of invasive candidiasis: systematic review and meta-analysis.J Clin Microbiol. Feb 2011; : 665-670
- Performance of Candida real-time polymerase chain reaction, β-D-glucan assay, and blood cultures in the diagnosis of invasive candidiasis.Clin Infect Dis. 2012 May; 54 (Epub 2012 Mar 19. PubMed PMID: 22431804): 1240-1248https://doi.org/10.1093/cid/cis200
- NICE clinical guideline 125: kidney disease: peritoneal dialysis: costing report, implementing NICE guidance.NICE, 2011
Leading International Fungal Education (LIFE) website: http://www.life-worldwide.org/fungal-diseases/candida-peritonitis/ last accessed on 01.07.13.
- AIDS-defining opportunistic illnesses in US patients, 1994–2007: a cohort study.AIDS. 2010 Jun 19; 24: 1549-1559
- Estimating the burden of mucormycosis infections in France (2005–2007) through a capture-recapture method on laboratory and administrative data.Rev Epidemiol Sante Publique. 2012 Oct; 60 (Epub 2012 Sep 26. PubMed PMID: 23020929): 383-387https://doi.org/10.1016/j.respe.2012.03.007
- Population-based analysis of invasive fungal infections, France, 2001–2010.Emerg Infect Dis. 2014 Jul; 20 (PubMed PMID: 24960557; PubMed Central PMCID: PMC4073874): 1149-1155https://doi.org/10.3201/eid2007.140087
- Invasive aspergillosis in critically ill patients without malignancy.Am J Respir Crit Care Med. 2004; 170: 621-625
- Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation outcome.Crit Care. 2005; 9: R191-R199
- Diagnostic errors in the intensive care unit: a systematic review of autopsy studies.BMJ Qual Saf. 2012 Nov; 21 (Epub 2012 Jul 21. PubMed PMID: 22822241): 894-902https://doi.org/10.1136/bmjqs-2012-000803
- Period prevalence of allergic bronchopulmonary mycosis in a regional hospital outpatient population in Ireland 1985–88.Ir J Med Sci. 1991; 160: 288-290
- Total IgE levels and asthma prevalence in the US population: results from the National Health and Nutrition Examination Survey 2005–2006.J Allergy Clin Immunol. 2009; 124: 447-453
- Why asthma still kills, The National Review of Asthma Deaths (NRAD). Confidential enquiry report.May 2014
- One year prospective survey of Candida bloodstream infections in Scotland.J Med Microbiol. 2007 Aug; 56 (PubMed PMID: 17644714; PubMed Central PMCID: PMC2884937): 1066-1075
- Burden of fungal disease in Ireland.J Med Microbiol. 2015 Apr; 64 (Epub 2015 Jan 16): 423-426https://doi.org/10.1099/jmm.0.000020
- Management and outcome of bloodstream infections due to Candida species in England and Wales.J Hosp Infect. 2003; 54: 18-24
- Health and Social Care information Centre. Hospital Episode Statistics. Admitted patient care, England 2104–15.Health and Social Care Information Centre, November 2015
- The burden of severe asthma in childhood and adolescence: results from the paediatric U-BIOPRED cohorts.Eur Respir J. 2015 Nov; 46: 1322-1333
Article info
Publication history
Published online: October 24, 2016
Accepted:
October 18,
2016
Identification
Copyright
© 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Estimated burden of fungal infections in ItalyJournal of InfectionVol. 76Issue 1
