Canada

Estimating the burden of serious fungal diseases in Canada Merlbourne, Australia, 2015 Poster #460 Simon F. Dufresne1...

11 downloads 221 Views 2MB Size
Estimating the burden of serious fungal diseases in Canada

Merlbourne, Australia, 2015

Poster #460

Simon F. Dufresne1, Donald C. Sheppard2 and David W. Denning3 1. Hôpital Maisonneuve-Rosemont, Department of infectious diseases and medical microbiology, Université de Montréal. 2. Department of microbiology and immunology, McGill University 3. The National Aspergillosis Centre in association with the LIFE program at www.LIFE-Worldwide.org, The University of Manchester.

Introduction Serious fungal diseases represent a growing health concern worldwide. The global burden of these infections in Canada is unknown. In this study, we sought to estimate the national incidence and prevalence of serious fungal diseases in Canada.

Figure 1

Canadian population was 35,540,419 in 2014 with 50.4% female. Median age was 40.4 year-old and 80.5% of the population was over 18 [1].

Methods We aggregated data derived from various sources: • A literature review was conducted in PubMed to identify published reports on local epidemiology. • Data on notifiable fungal diseases were obtained directly from national and provincial public health agencies. • When no local data was available on a specific fungal disease, relevant at-risk populations were used to estimate frequencies, using previously described methodology by LIFE. Population data were obtained from Statistics Canada, Canadian scientific organizations, as well as The Organization for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).

Figure 2

Conclusions • The present study indicates that around 2% of the Canadian population may be affected by a serious fungal infection. • Nearly 3000 cases of invasive fungal infections are expected to occur annually in Canada. • Despite the high estimated burden, there is a paucity of epidemiological data on mycoses in Canada. Further epidemiological studies are needed to validate and extend these estimates.

Figure 3

References 1. CANSIM Table 051-0001. Population by sex and age group. 2014, Statistics Canada.

2. Arendrup, M.C., Epidemiology of invasive candidiasis. Curr Opin Crit Care, 2010. 16(5): p. 445-52. 3. St-Germain, G., et al., Epidemiology and antifungal susceptibility of bloodstream Candida isolates in Quebec: Report on 453 cases between 2003 and 2005. Can J Infect Dis Med Microbiol, 2008. 19(1): p. 55-62. 4. Lortholary, O., et al., Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007). Clin Microbiol Infect, 2011. 17(12): p. 1882-9. 5. Acute myelogenous leukemia statistics. 2015 [cited 2015 April 10]; Available from: http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-acute-myelogenous-aml/statistics/?region=on. 6. Canadian organ replacement register annual report: treatment of end-stage organ failure in Canada, 2003 to 2012. 2014, Canadian Institute for Health Information: Ottawa, Ontario. 7. Barkati, S., et al., Incidence of invasive aspergillosis in remission-induction chemotherapy for acute leukemia: a retrospective cohort study in a single Canadian tertiary care center. Canadian Medical Association Journal Open, 2014. 2(2): p. E86-E93. 8. Health at a glance 2013: OECD Indicators. 2013, OECD. 9. Guinea, J., et al., Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect, 2010. 16(7): p. 870-7. 10. Nicolle, L., et al., Invasive fungal infections in Canada from 1992 to 1994. Can J Infect Dis, 1998. 9(6): p. 347-52. 11. Kidd, S.E., et al., A rare genotype of Cryptococcus gattii caused the cryptococcosis outbreak on Vancouver Island (British Columbia, Canada). Proc Natl Acad Sci U S A, 2004. 101(49): p. 17258-63. 12. British Columbia Annual Summary of Reportable Diseases 2013. 2014, Communicable Disease Prevention and Control Services, Provincial Health Services Authority Vancouver, British Columbia. 13. Jafari, S., et al., Trends in reported AIDS defining illnesses (ADIs) among participants in a universal antiretroviral therapy program: an observational study. AIDS Res Ther, 2011. 8: p. 31. 14. HIV and AIDS in Canada: Surveillance report to December 31, 2013. . 2014, Minister of Public Works and Gorvernment Services Canada: Ottawa, Ontario. 15. Pappas, P.G., et al., Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis, 2010. 50(8): p. 1101-11. 16. Fillatre, P., et al., Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients. Am J Med, 2014. 127(12): p. 1242.e11-7. 17. Bitar, D., et al., Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg Infect Dis, 2009. 15(9): p. 1395-401. 18. Morris, S.K., et al., Blastomycosis in Ontario, 1994-2003. Emerg Infect Dis, 2006. 12(2): p. 274-9. 19. Litvinov, I.V., et al., Endemic human blastomycosis in Quebec, Canada, 1988-2011. Epidemiol Infect, 2013. 141(6): p. 1143-7. 20. Manitoba Annual Summary of Communicable Diseases 2013. 2014, Government of Manitoba. Manitoba Health, Healthy Living and Seniors. Public Health and Primary Health Care Division. Public Health Branch. Epidemiology and Surveillance. 21. Denning, D.W., A. Pleuvry, and D.C. Cole, Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ, 2011. 89(12): p. 864-72. 22. Smith, N.L. and D.W. Denning, Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J, 2011. 37(4): p. 865-72. 23. Tuberculosis country profiles -Canada. 2015 April 10, 2015]; Available from: https://extranet.who.int/sree/Reports? op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT %2FTBCountryProfile&ISO2=CA&LAN=EN&outtype=html. 24. Denning, D.W., A. Pleuvry, and D.C. Cole, Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol, 2013. 51(4): p. 361-70. 25. CANSIM Table 105-0502. Health indicator profile, two year period estimates, by age group and sex, Canada, provinces, territories, health regions (2012 bounderies) and peer groups. 2013, Statistics Canada, Canadian Community Health Services. 26. Sobel, J.D., Vulvovaginal candidosis. Lancet, 2007. 369(9577): p. 1961-71. 27. Matee, M.I., F. Scheutz, and J. Moshy, Occurrence of oral lesions in relation to clinical and immunological status among HIV-infected adult Tanzanians. Oral Dis, 2000. 6(2): p. 106-11. 28. Lima, V.D., R.S. Hogg, and J.S. Montaner, Expanding HAART treatment to all currently eligible individuals under the 2008 IAS-USA Guidelines in British Columbia, Canada. PLoS One, 2010. 5(6): p. e10991. 29. Smith, E. and M. Orholm, Trends and patterns of opportunistic diseases in Danish AIDS patients 1980-1990. Scand J Infect Dis, 1990. 22(6): p. 665-72. 30. Buchacz, K., et al., AIDS-defining opportunistic illnesses in US patients, 1994-2007: a cohort study. Aids, 2010. 24(10): p. 1549-59.

Results

Figure 4

Invasive fungal infections (Figure 1): • Invasive candidiasis (IC) annual incidence was estimated at 1,983 cases (candidemia, n=1724; peritonitis, n=259), based on published incidence data [2] applied to the Canadian population, corroborated by local data for the Province of Québec [3]). • Invasive aspergillosis (IA) annual incidence was estimated at 659 cases, based on at-risk population estimates [4-6]. Recently published data on local incidence among acute leukemia patients supports these estimates [7]. A total of approximately 59,514 hospital admissions for chronic obstructive pulmonary disease (COPD) [8] account for 214 of IA cases [9]. • Cryptococcal disease incidence was estimated at 64 cases per year. Investigators have found 81 cases during a 2-year period in 1992-1994 [10], prior to the C. gattii outbreak [11]. Between 2010 and 2013, a mean of 23 cases of C. gattii infections were notified annually to the British Columbia CDC [12]. Specifically, cryptococcal meningitis was estimated to occur in 12 AIDS patients annually, representing 6% [13] of 200 new AIDS cases in Canada [14]. Data derived from the TRANSNET study [15] translated to 6 cases among Canadian solid organ transplant recipients. • Pneumocystis pneumonia (PCP) was estimated to occur in 34 AIDS patients annually, representing 17% [13] of 200 new AIDS cases in Canada [14]. Considering that approximately 50% of PCP cases occur in HIV-negative patients [16], we estimated a total number of 68 cases. • No data was available for mucormycosis, but an incidence of 43 cases was inferred from a 0.12/100,000 incidence reported in the literature [17]. Endemic mycoses (Figure 2): • Blastomycosis is endemic in Ontario, Québec and Manitoba. In the former 2 provinces, a mean of 44 culture-proven cases occur annually, as per recently published data [18, 19]. In the latter province where the infection is notifiable, 19 cases were reported in 2013 [20], for a national incidence of at least 63 cases. • Histoplasmosis incidence was estimated at 27 cases per year based published data from 1992-1994 in Canada [10]. • Coccidioidomycosis incidence was limited at 9 cases annually [10]. Noninvasive pulmonary aspergillosis (Figure 3): • Chronic pulmonary aspergillosis (CPA) prevalence was estimated at 1,514 cases, including 227 cases following tuberculosis [21-23]. • Allergic bronchopulmonary aspergillosis (ABPA) prevalence was estimated at 61,120 cases, derived from the number of Canadian adults with asthma estimated at 2,444,804 [24, 25]. • Severe asthma with fungal sensitization (SAFS) prevalence was estimated at 80,679 cases, based on Canadian asthma prevalence data [24, 25]. • There is likely some duplication between ABPA and SAFS depending on the severity of asthma in ABPA and the relative frequency of Aspergillus sensitization in SAFS. Mucosal candidiasis (Figure 4): • Recurrent vulvovaginal candidiasis (RVVC) was the most frequent serious fungal infection with an estimated prevalence of 498,689 cases, representing 6% [26] of adult women (between 15 and 50 years old; n=8,311,477 [1]). • Oropharyngeal candidiasis (OPA) prevalence was estimated at 26,310 cases, representing approximately 90% of untreated HIVpositive patients. There were 71,300 HIV-positive patients in 2013 in Canada, among which 59% received antiretroviral treatment [14, 27, 28]. • Esophageal candidiasis (EC) prevalence was estimated at 7,950 cases, representing approximately 20% of untreated HIV-positive patients [14, 28-30].