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Burden of fungal disease in the UK Burden of fungal disease in the UK

November 16 2016

A new report published today is the first comprehensive attempt to estimate the burden of serious fungal disease in the United Kingdom.

Experts are warning of a significant increase in the number of people in the UK who are living with invasive and serious fungal diseases, partly because of increased survival of otherwise fatal illnesses and an increase in immunosuppression resulting from disease treatment.
In the UK there is no formal surveillance programme specific to fungal infections, although an active surveillance network exists for candidaemias and candidaemias in neonates (voluntary reporting).

There is a high degree of uncertainty around the total estimate of burden due to: diagnostic limitations, the lack of a systematic national surveillance system, the limited number of studies published on the topic and the methodological limitations of calculating the burden.
However crude estimates for PCP, cryptococcal meningitis, invasive aspergillosis, chronic pulmonary aspergillosis , allergic pulmonary aspergillosis, severe  asthma with fungal  sensitization, invasive candidiasis, candida peritonitis, oesophageal candidiasis,  and mucormycosis are published  in this report.

Invasive aspergillosis is the commonest missed infectious diagnosis in intensive care in the UK. It is always fatal without therapy and affects from 3,288 to 4,257 patients each year, most undiagnosed. Treated invasive aspergillosis has a 30-85 per cent mortality depending on the patient group

Estimates of allergic pulmonary aspergillosis (175-372 per 100,000 population)  and fungal asthma ( 192-654 per 100,000 population)  were the highest burdens of disease for the UK. Estimates for all aspergillus related or other airborne moulds were higher than any previous estimates.

Asthma in adults is common in the UK with over 4 million reported cases – one of the highest rates of asthma internationally. Fungal asthma is a growing problem, those that are sensitive to fungi usually fall into the group which has poor asthma control and require steroid boosters. Antifungal therapy benefits these people, and may prevent deaths from asthma.

This is the first attempt at a comprehensive estimation of burden of invasive fungal infection in the UK. Further studies will need to combine methods (pragmatic and surveillance-based), take into account any new published information on specific incidence rates, and consider using alternative data sources.

This research from the National Aspergillosis Centre and MAHSC (Manchester Academic Health Sciences Centre), based at The University of Manchester is published in Journal of Infection: http://dx.doi.org/10.1016/j.jinf.2016.10.005 

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