Burden of serious fungal infections in the Netherlands

Abstract

Background: Fungal diseases have an ever-increasing global disease burden, although regional estimates for specific fungal diseases are often unavailable or dispersed.Objectives: Here, we report the current annual burden of life-threatening and debilitating fungal diseases in the Netherlands. Methods:The most recent available epidemiological data, reported incidence and prevalence of fungal diseases were used for calculations. Results:Overall, we estimate that the annual burden of serious invasive fungal infections in the Netherlands totals 3 185 patients, including extrapulmonary or disseminated cryptococcosis (n = 9), pneumocystis pneumonia (n = 740), invasive aspergillosis (n = 1 283), chronic pulmonary aspergillosis (n = 257), invasive Candida infections (n = 684), mucormycosis (n = 15) and Fusarium keratitis (n = 8). Adding the prevalence of recurrent vulvo-vaginal candidiasis (n = 220 043), allergic bronchopulmonary aspergillosis (n = 13 568) and severe asthma with fungal sensitisation (n = 17 695), the total debilitating burden of fungal disease in the Netherlands is 254 491 patients yearly, approximately 1.5% of the country's population. Conclusion:We estimated the annual burden of serious fungal infections in the Netherlands at 1.5% of the population based on previously reported modelling of fungal rates for specific populations at risk. With emerging new risk groups and increasing reports on antifungal resistance, surveillance programmes are warranted to obtain more accurate estimates of fungal disease epidemiology and associated morbidity and mortality. K E Y W O R D Saspergillosis, candidemia, cryptococcosis, epidemiology, mucormycosis, pneumocystis

COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series

“…Epidemiological data dominate the choice of primary antifungal therapy, whilst development of resistance to antifungals in Aspergillus species is a growing concern 35 . Based on surveillance data, azole‐resistance in the Netherlands has been estimated to be around 11%, 36,37 in line with our findings in this series. Therefore, if A fumigatus susceptibility is unknown, empiric treatment is started with an echinocandin plus voriconazole or liposomal amphotericin B if toxicity or co‐infection with Mucorales is suspected.…”

COVID‐19 associated pulmonary aspergillosis

“…Risk factors for invasive pulmonary aspergillosis (IPA) are well defined in immunocompromised populations. However, patients with acute respiratory distress syndrome (ARDS) due to viral infection are prone to secondary complications like invasive aspergillosis despite lack of underlying well‐defined immunocompromising disease 2‐4 . Possible explanations for this could be an immune‐paralysis caused by viral infection‐induced ARDS and hypoxia compromising the innate host defence 5 .…”

Azole-Resistant COVID-19-Associated Pulmonary Aspergillosis in an Immunocompetent Host: A Case Report

“…The numbers resemble what has been observed in influenza, where influenza in ICU patients has been identified as an independent risk factor for invasive pulmonary aspergillosis and which is associated with an even higher mortality rate than IPA alone [ 8 ]. In addition, in the Netherlands, an estimated 11.3% of cases with invasive aspergillosis are infected with an azole-resistant isolate [ 9 ], potentially increasing mortality to 50–100% [ 10 ]. We present the first case of azole-resistant Aspergillus fumigatus in a SARS-CoV-2-positive immunocompetent patient admitted to the ICU.…”