Burden of Serious Fungal Infections in Jordan

Abstract

Abstract:Objective: To estimate the burden of fungal infections in Jordan for the first time. Material and Methods: Population data was from UN 2011 statistics and TB cases from WHO in 2012. Fewer than 100 patients with HIV were recorded in Jordan in 2013. Approximately 100 renal transplants and eight liver transplants are performed annually. There were 12,233 major surgical procedures in Jordan in 2013, of which 5.3% were major abdominal surgeries; candidemia was estimated in 5% of the population based on other countries, with 33% occurring in the ICU. Candida peritonitis/intra-abdominal candidiasis was estimated to affect 50% of the number of ICU candidemia cases. No adult asthma rates have been recorded for Jordan, so the rate from the Holy Land (8.54% clinical asthma) from To et al. has been used. There are an estimated 49,607 chronic obstructive pulmonary disease (COPD) patients in Jordan, with 64% symptomatic, 25% Gold stage 3% or 4%, and 7% (3472) are assumed to be admitted to hospital each year. No cystic fibrosis cases have been recorded. Literature searches on fungal infections revealed few data and no prevalence data on fungal keratitis or tinea capitis, even though tinea capitis comprised 34% of patients with dermatophytoses in Jordan. Results: Jordan has 6.3 million inhabitants (65% adults, 6% are >60 years old). The current burden of serious fungal infections in Jordan was estimated to affect~119,000 patients (1.9%), not including any cutaneous fungal infections. Candidemia was estimated at 316 cases and invasive aspergillosis in leukemia, transplant, and COPD patients at 84 cases. Chronic pulmonary aspergillosis prevalence was estimated to affect 36 post-TB patients, and 175 in total. Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) prevalence in adults with asthma were estimated at 8900 and 11,748 patients. Recurrent vulvovaginal candidiasis was estimated to affect 97,804 patients, using a 6% rate among women 15-50 years of age. Conclusion: Based on local data and literature estimates of the frequency of mycoses in susceptible populations, at least 1.9% of Jordanians have some form of serious fungal disease.

Update on invasive fungal infections in the Middle Eastern and North African region

“…In fact, C. auris is closely related to the species of the C. haemulonii complex, leading to a misidentification with other Candida species such Fig. 1 Available estimates of the incidence rate (per 100,000 population) of invasive fungal infections in MENA countries [16][17][18][19][20][21][22] as C. haemulonii or C. famata [69,70]. Even though most of the region belong to the middle-income countries, the total mass of the publication of research is lower than its global proportion of population or income [60].…”

“…IA burden estimates have been done for several MENA countries, and the highest estimated incidence rate in Egypt is 10.7/100,000 [18], followed by Iran with 7.9/100,000 among COPD cases, 0.1/100,000 among lung cancer cases, and 0.03/100,000 among acute myeloid leukemia cases [17]. In Saudi Arabia, incidence rate was 7.6/100,000 [19], followed by Algeria (7.1/100,000) [20], Turkey (4.48/100,000) [21], Iraq (2.62/100,000) [77], Jordan (1.34/100,000) [22], and reached its lowest value (0.6/100,000) in Qatar [16]. Moreover, the incidence of IA in Lebanon was estimated at 1.21 cases/1000 hospital discharges, higher than that found in Saudi Arabia with 0.4 cases/1000 hospital discharges [39].…”

“…Considering CM as a rare fungal infection, it could not be estimated in Jordan [22], Iraq [77], and Egypt [18], in addition to being estimated to probably be affecting under 10 patients in Saudi Arabia [19]. In Qatar, CM had a low estimated incidence rate of 0.43 cases per 100,000 considering the low human immunodeficiency virus (HIV) rate in the country [16].…”

“…Concerning incidence rate estimates, it could not be estimated in both Iraq and Saudi Arabia due to the lack of data on PJP infections [19,77]. In Qatar, the estimated rate was 0.8 per 100,000 population [16], followed by Turkey 0.79 per 100,000 [21], Algeria 0.18 per 100,000 [20], Egypt 0.15 per 100,000 [18], and Jordan 0.1 per 100,000 [22] (Table 3).…”

Invasive Candidiasis: Epidemiology and Risk Factors

“…The incidence rate among patients hospitalized was 0.38 per 1000 admissions, which is lower than that observed in the Latin-American region with 1.08 cases per 1000 admissions [55]. The estimated incidence of candidemia in countries in Asia is shown in Table 5 [90][91][92][93][94][95][96][97][98][99][100]. In Asia, the highest incidence has been observed in Pakistan, followed by Qatar and Israel.…”