Diagnosis and Management of Pneumocystis Pneumonia in Resource-poor Settings

Oladele, Rita O.; Otu, Akaninyene; Denning, David W.

doi:10.1353/hpu.2018.0010

Cited by 18 publications

(17 citation statements)

References 245 publications

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“…We estimated 836 cases of PCP per year. The number of cases proven by microscopy or by molecular testing are expected to be substantially less than our estimate, given the limitations in the availability and in the sensitivity of microscopy and molecular diagnostics [73,74]. Undeniably, this diagnostic deficiency compels clinicians to treat patients based on risk factor analysis, clinical and chest radiography evidence [4].…”

Section: Discussionmentioning

confidence: 99%

Estimated Burden of Fungal Infections in Namibia

Dunaiski

Denning

2019

JoF

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Namibia is a sub-Saharan country with one of the highest HIV infection rates in the world. Although care and support services are available that cater for opportunistic infections related to HIV, the main focus is narrow and predominantly aimed at tuberculosis. We aimed to estimate the burden of serious fungal infections in Namibia, currently unknown, based on the size of the population at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports. When no data existed, risk populations were used to estimate the frequencies of fungal infections, using the previously described methodology. The population of Namibia in 2011 was estimated at 2,459,000 and 37% were children. Among approximately 516,390 adult women, recurrent vulvovaginal candidiasis (≥4 episodes /year) is estimated to occur in 37,390 (3003/100,000 females). Using a low international average rate of 5/100,000, we estimated 125 cases of candidemia, and 19 patients with intra-abdominal candidiasis. Among survivors of pulmonary tuberculosis (TB) in Namibia 2017, 112 new cases of chronic pulmonary aspergillosis (CPA) are likely, a prevalence of 354 post-TB and a total prevalence estimate of 453 CPA patients in all. Asthma affects 11.2% of adults, 178,483 people, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) were estimated in approximately 179/100,000 and 237/100,000 people, respectively. Invasive aspergillosis (IA) is estimated to affect 15 patients following leukaemia therapy, and an estimated 0.13% patients admitted to hospital with chronic obstructive pulmonary disease (COPD) (259) and 4% of HIV-related deaths (108) — a total of 383 people. The total HIV-infected population is estimated at 200,000, with 32,371 not on antiretroviral therapy (ART). Among HIV-infected patients, 543 cases of cryptococcal meningitis and 836 cases of Pneumocystis pneumonia are estimated each year. Tinea capitis infections were estimated at 53,784 cases, and mucormycosis at five cases. Data were missing for fungal keratitis and skin neglected fungal tropical diseases such as mycetoma. The present study indicates that approximately 5% of the Namibian population is affected by fungal infections. This study is not an epidemiological study—it illustrates estimates based on assumptions derived from similar studies. The estimates are incomplete and need further epidemiological and diagnostic studies to corroborate, amend them, and improve the diagnosis and management of these diseases.

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Section: Discussionmentioning

confidence: 99%

Estimated Burden of Fungal Infections in Namibia

Dunaiski

Denning

2019

JoF

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“…Definitive diagnosis is based on the identification of P. jirovecii in respiratory samples [ 130 ]. As this microorganism cannot be cultured in laboratory conditions, direct examination and immunofluorescence are used as reference methods with sensitivity rates higher than 90% [ 128 , 131 ], or PCR methods in developed countries [ 132 ]. However, all these methods require trained personnel that are not available in all settings.…”

Section: Estimate Precisionmentioning

confidence: 99%

Global and Multi-National Prevalence of Fungal Diseases—Estimate Precision

Bongomin

Gago

Oladele

et al. 2017

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2,164

1,745

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Fungal diseases kill more than 1.5 million and affect over a billion people. However, they are still a neglected topic by public health authorities even though most deaths from fungal diseases are avoidable. Serious fungal infections occur as a consequence of other health problems including asthma, AIDS, cancer, organ transplantation and corticosteroid therapies. Early accurate diagnosis allows prompt antifungal therapy; however this is often delayed or unavailable leading to death, serious chronic illness or blindness. Recent global estimates have found 3,000,000 cases of chronic pulmonary aspergillosis, ~223,100 cases of cryptococcal meningitis complicating HIV/AIDS, ~700,000 cases of invasive candidiasis, ~500,000 cases of Pneumocystis jirovecii pneumonia, ~250,000 cases of invasive aspergillosis, ~100,000 cases of disseminated histoplasmosis, over 10,000,000 cases of fungal asthma and ~1,000,000 cases of fungal keratitis occur annually. Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious fungal infections country by country for over 5.7 billion people (>80% of the world’s population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations. Here we interrogate the accuracy of these fungal infection burden estimates in the 43 published papers within the LIFE initiative.

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“…It should also be noted that the number of cases proven by microscopy or by molecular testing is anticipated to be considerably fewer than our estimate, given limitations in the availability and the sensitivity of microscopy diagnosis. [86,87] For example, Chiliza et al [87] reported that among adult PLWH hospitalised with suspected PCP at a tertiary hospital in Cape Town, the diagnosis was confirmed in just 55%. We estimated 5 421 episodes of candidaemia in adults each year.…”

Section: Researchmentioning

confidence: 99%

The estimated burden of fungal disease in South Africa

et al. 2019

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Fungal infections are common and diverse in South Africa (SA), driven in large part by the syndemics of HIV, tuberculosis (TB) and poverty. SA has the dubious distinctions of having the largest HIV epidemic, [1] one of the highest incidences of TB, [2] and-by some measures-the most socioeconomic inequity [3] in the world. Each of these conditions on its own or in combination can predispose individuals to fungal disease, but to our knowledge, the burden of such infections in SA has not previously been estimated. Objectives To estimate the prevalence and incidence of fungal infections in SA, excluding cutaneous infections with the sole exception of tinea capitis because of its severity in a significant minority of children. Methods The burden of fungal disease in SA was estimated using the methodologies of LIFE-worldwide.org. [4] Starting estimates for fungal disease or for conditions complicated by fungal disease were obtained This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Diagnosis and Management of Pneumocystis Pneumonia in Resource-poor Settings

Cited by 18 publications

References 245 publications

Estimated Burden of Fungal Infections in Namibia

Estimated Burden of Fungal Infections in Namibia

Global and Multi-National Prevalence of Fungal Diseases—Estimate Precision

The estimated burden of fungal disease in South Africa

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