Trends of pulmonary fungal infections from 2013 to 2019: an AI-based real-world observational study in Guangzhou, China

Abstract

Recently, the prevalence trend of pulmonary fungal infection (PFI) has rapidly increased. Changes in the risk factors for, distributions of underlying diseases associated with and clinical characteristics of some individual PFIs have been reported in the past decade. However, data regarding PFIs remain uncertain. This study reports the epidemiological characteristics and trends of PFIs over time in recent years. We applied an automated natural language processing (NLP) system to extract clinically relevant information from the electronic health records (EHRs) of PFI patients at the First Affiliated Hospital of Guangzhou Medical University. Then, a trend analysis was performed. From January 1, 2013, to December 31, 2019, 40,504 inpatients and 219,414 outpatients with respiratory diseases were screened, in which 1368 inpatients and 1313 outpatients with PFI were identified. These patients were from throughout the country, but most patients were from southern China. Upward trends in PFIs were observed in both hospitalized patients and outpatients ( P <0.05). The stratification by age showed that the incidence of hospitalized patients aged 14–30 years exhibited the most obvious upward trend, increasing from 9.5 per 1000 patients in 2013 to 88.3 per 1000 patients in 2019. Aspergillosis (56.69%) was the most common PFI, but notably, the incidence rates of Talaromyces marneffei , which used to be considered uncommon, exhibited the most rapid increases. In younger PFI patients, the incidence and trend of PFIs have increased. Infection by previously uncommon pathogens has also gradually increased. Increased attention should be paid to young PFI patients and uncommon PFI pathogen infections.

Prevalence of Fungal and Bacterial Co-Infection in Pulmonary Fungal Infections: A Metagenomic Next Generation Sequencing-Based Study

“…In our study, among the eight types of fungus isolated, Aspergillus , Pneumocystis , and Rhizopus were the most prevalent. However, results of another study analyzed the pathogens in 1,644 in-patients with pulmonary fungal infection and found Aspergillus , Cryptococcus , and Talaromyces marneffei as the three most common fungi ( Li et al., 2021 ). Comparing their study with ours, only the Aspergillus was commonly observed in patients with bacterial and fungal co-infections, which may be ascribed to the different geographical distribution and the considerably larger number of cases in the earlier study.…”

“…The human respiratory tract is exposed to various microorganisms present in the ambient atmosphere including fungi. In most individuals, immune function can prevent fungal growth and invasion, but a growing number of immunocompromised patients and the widespread use of antibiotics has led to an increase in the incidence of pulmonary fungal infections ( Limper et al., 2011 ; Denning and Chakrabarti, 2017 ; Li et al., 2021 ). Generally, fungal infections are more common in the elderly.…”

“…Generally, fungal infections are more common in the elderly. However, one report provided evidence that the incidence of fungal infections in hospitalized patients aged 14–30 years has shown a clear upward trend from 2013 to 2019 ( Li et al., 2021 ). Invasive fungal infections are associated with high mortality, with mortality rates as high as 67% being reported among patients with acute infections ( Chen et al., 2001 ).…”

Successful Management of Mixed Mycosis in HIV-Negative Patients With Different Immune Status: A Case Series Report

“…On the basis of discharge diagnoses, the incidence of invasive fungal infections in France was 5.9/100 000 cases/year, with a mortality of 27.6%, both of which increased during the observation period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) (von Lilienfeld-Toal et al, 2019). While, the proportion of pulmonary fungal infection increased annually from 26.5 per 1000 inpatients in 2013 to 42.6 in 2019 and from 3.07 per 1000 outpatients in 2013 to 8.48 in 2019 in Guangzhou, China (Li et al, 2021). The most common pulmonary mycoses are Aspergillus, Candida, Cryptococcus species, and Pneumocystis jirovecii (Bongomin et al, 2017;Azoulay et al, 2019;Zhan et al, 2021).…”

Development and clinical application of an electronic health record quality control system for pulmonary aspergillosis based on guidelines and natural language processing technology

“…Aspergillus conidia are the main pathogenic fungi, and they can induce a pulmonary fungal infection called pulmonary aspergillosis (PA). PA has been recognized as a major public health problem in recent years, with a global disease burden of up to 15 million and has become the most common fungal infection (1,2). Colonization of the lower respiratory tract is also common.…”