The burden of serious fungal infections in Azerbaijan

Abstract

Background: Azerbaijan is an upper middle-income country in South Caucasus with an area of 86,600 km2 and a total population of 10 million people and gross domestic product of US $4480 per capita. The aim of this research is to estimate fungal infection burden and highlight the problem at national and international levels. Methods: Fungal infection burden was estimated using data from epidemiological papers and population at risk and LIFE (Leading International Fungal Education) modelling. Results: The number of people living with human immunodeficiency virus (PLHIV) in 2018 was 6193, 29% of them not receiving antiretroviral therapy. Based on 90% and 20% rates of oral and oesophageal candidiasis in patients with CD4 cell count <200 µl–1 we estimate 808 and 579 patients with oral and oesophageal candidiasis, respectively. The annual incidences of cryptococcal meningitis and Pneumocystis pneumonia are 5 and 55 cases, respectively. We estimated 2307 cases of chronic pulmonary aspergillosis (CPA), 4927 patients with allergic bronchopulmonary aspergillosis (ABPA), and 6504 with severe asthma with fungal sensitization (SAFS). Using data on chronic obstructive pulmonary diseases (COPD), lung cancer, acute myeloid leukaemia rates, and number of transplantations, we estimated 693 cases of invasive aspergillosis following these conditions. Using a low-European rate for invasive candidiasis, we estimated 499 and 75 patients with candidemia and intra-abdominal candidiasis respectively. The number of adult women (15–55 years) in Azerbaijan is ~2,658,000, so it was estimated that 159,490 women suffer from recurrent vulvovaginal candidiasis (rVVC). Discussion: In total, the estimated number of people suffering from fungal diseases in Azerbaijan is 225,974 (2.3% of the population). However, the fungal rate is underestimated due to lack of epidemiological data. The most imminent need is improvement in diagnostic capabilities. This aim should be achieved via establishing a reference laboratory and equipping major clinical centers with essential diagnostics assays.

Management of the fungal infections and challenges associated with it

“…Superficial fungal infections can damage your skin, nails, and mucous membranes, including your mouth, throat, and vagina. These are a few instances of fungal infections that are superficial [5][6][7].…”

“…The infections caused by fungus in your fingernails or toes (onychomycosis). This can result in discolored or damaged nails [5][6][7]. Fungal infections of the nail unit, including nondermatophyte yeasts, dermatophytes and molds cause onychomycosis, which manifests as onycholysis, nail discolouration, and thickening of the nail plate [10,11].…”

“…1.d) Tinea versicolor: Another name for it is Pityriasis versicolor. The Malassezia fungus is responsible for the tinea versicolor or Pityriasis versicolor skin discoloration [5][6][7]. A common skin condition called tinea versicolor, also known as pityriasis versicolor, is brought on by a superficial fungus.…”

“…Subcutaneous fungal infections are more common in tropical and subtropical areas of the world. Here [5][6][7].…”

Fungal diseases in Africa: epidemiologic, diagnostic and therapeutic advances

“…This was attributable to the late-stage presentation of people with HIV to care and high burden of advanced HIV disease in the country. Second, Huseynov et al 23 estimated that fungal diseases affect an estimated 2.3% of the population in Azerbaijan. The need to improve diagnostic capabilities for IFIs of Azerbaijan was highlighted.…”