Fungal Diseases in Taiwan—National Insurance Data and Estimation

Abstract

The burden of fungal diseases based on the real-world national data is limited. This study aimed to estimate the Taiwan incident cases with selected fungal diseases in 2013 using the National Health Insurance Research Database (NHIRD) which covered 99.6% of the 23.4 million population. Over 80,000 incident cases were found and the majority were superficial infections including vulvovaginal candidiasis (477 per 100,000 adult women) and oral candidiasis (90 cases per 100,000 population). Common potentially life-threating fungal diseases were Pneumocystis pneumonia (5.35 cases per 100,000 population), candidemia (3.68), aspergillosis (2.43) and cryptococcal meningitis (1.04). Of the aforementioned cases cancer patients contributed 30.2%, 42.9%, 38.6% and 22.2%, respectively. Of 22,270 HIV-infected persons in NHIRD in 2013, four common diseases were Pneumocystis pneumonia (28.3 cases per 1000 HIV-infected patients), oral candidiasis (17.6), esophageal candidiasis (6.06) and cryptococcal meningitis (2.29). Of pulmonary aspergillosis 32.9% occurred in patients with chronic pulmonary diseases and 26.3% had a prior diagnosis of tuberculosis. There are some notable gaps related to insurance claim data. Cutaneous, urinary tract and eye fungal infections were not captured.

Establishing Aspergillus-Specific IgG Cut-Off Level for Chronic Pulmonary Aspergillosis Diagnosis: Multicenter Prospective Cohort Study

“…Chronic pulmonary aspergillosis (CPA) is an important and emerging clinical infectious disease [1][2][3]. Owing to the growing population of cured TB and chronic lung disease, the disease burden of CPA is in the increase and poses a public health threat [4][5][6][7]. As there is improved awareness of this disease entity among physicians, more patients were being suspected and diagnosed for CPA.…”

Screening for Cryptococcal Antigenemia and Burden of Cryptococcosis at the Time of HIV Diagnosis: A Retrospective Multicenter Study

“…Taiwan, sitting along the west Pacific Island chain, has a similar prevalence of cryptococcal infection compared to those of Southeast Asian countries [ 14 ]. In a single-center study in Taiwan, the prevalence of HIV-associated cryptococcosis among 2022 newly diagnosed PLWH was 1.4% between 2004 and 2015 [ 15 ].…”

Antifungal susceptibilities of opportunistic filamentous fungal pathogens from the Asia and Western Pacific Region: data from the SENTRY Antifungal Surveillance Program (2011–2019)

“…Diagnosis of infection with these miscellaneous fungal pathogens seems to be increasing both worldwide and in the APAC region [ 2 , 3 , 9 , 10 , 12 , 14 , 41 ]. This finding may be due to the increased identification of clinical isolates of molds using MALDI-TOF MS or DNA sequence analysis, but it also could be attributed to both the immunodeficient state of patients in the region, often complicated by cavitary tuberculosis [ 1 , 21 , 24 , 26 ], and the innate resistance of these organisms to antifungal agents [ 9 , 14 , 41 ].…”

“…Emerging at-risk populations include those with chronic lung disease (patients receiving steroids and TNF antagonists) and traumatic injuries [ 3 ]. Significantly, in the APAC region, both invasive pulmonary aspergillosis and chronic forms of aspergillosis are seen in the setting of cavitary tuberculosis [ 1 , 21 , 24 , 26 ]. Traumatic implantation of the non- Aspergillus molds, especially the Mucorales and Scedosporium spp., is another route of infection in immunocompetent individuals [ 3 , 12 ].…”

“…The increasing incidence of IMIs in the APAC regions has spurred both small- and large-scale surveillance efforts in Australia [ 12 , 16 , 17 ], India [ 18 , 19 ], Japan [ 20 ], Korea [ 21 , 22 ], Indonesia [ 23 ], Thailand [ 24 , 25 ], Taiwan [ 14 , 26 ], and several other countries [ 2 , 12 , 15 ]. One of the limitations of the existing surveillance data from the APAC region is that many of these reports are limited to a single institution and most fail to compare results across cities or countries.…”