Fungal infections in Sudan: An underestimated health problem

Abstract

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.

Aflatoxin profiles of Aspergillus flavus isolates in Sudanese fungal rhinosinusitis

“…FRS places a significant burden in arid regions, 4 with around 1.5 million cases annually reported in India and an estimated incidence of 200 cases per 100 000 in Sudan. 5 , 6 An elevated incidence rate has also been observed beyond arid regions, evidenced by 392 cases per 100 000 individuals documented in Turkey. 7 Notably, epidemiologic data on the disease in other countries of the world is scarce.…”

Editorial: Emerging fungal pathogens: perspectives

“…Mycoses are considered neglected diseases since their burden is most significant in tropical countries with an increase in the number of pathogenic species, and consequently, more underfunded than bacterial or viral diseases ( Pathakumari et al., 2020 ; Burgess et al., 2022 ; Ahmed et al., 2023 ). Diverse clinical manifestations have been reported, ranging from self-limiting acute pulmonary syndrome and skin lesions in immunocompetent individuals to inflammatory diseases and life-threatening severe infections in immunosuppressed patients.…”

“…Billions of the world's population are believed to be infected with pathogenic fungi, of which 1.7 million deaths are recorded each year, and we consider this number to be underreported despite being almost nine times higher than the number of deaths from bacterial tuberculosis, for example. However, until 2014, Kohler et al (2014 believed that "few among the millions of fungal species fulfill four basic conditions necessary to infect humans: high temperature tolerance, ability to invade the human host, lysis and absorption of human tissue, and resistance to the human immune system".Mycoses are considered neglected diseases since their burden is most significant in tropical countries with an increase in the number of pathogenic species, and consequently, more underfunded than bacterial or viral diseases (Pathakumari et al, 2020;Burgess et al, 2022;Ahmed et al, 2023). Diverse clinical manifestations have been reported, ranging from selflimiting acute pulmonary syndrome and skin lesions in immunocompetent individuals to inflammatory diseases and life-threatening severe infections in immunosuppressed patients.…”