1. Number of infections per underlying disorder per year
ESTIMATING THE BURDEN OF FUNGAL INFECTIONS IN MALAWI
Khumbo Kalua1, Boston Zimba1 and David W. Denning2
1.Blantyre Institute for Community Outreach (BICO), Malawi
2.The University of Manchester and The National Aspergillosis Centre in association with the LIFE program at –
Table 1. Burden of fungal infections in Malawi
Introduction
Malawi is a small land locked densely populated poor country in the Southern part of Africa. As no serious attempt has been made to estimate the number of serious fungal infections in Malawi previously, we have attempted this, based on at risk population data and published rates.
Infection
Number of infections per underlying disorder per year
Total burden
Rate /100K
None
HIV/AIDS
Respiratory
Cancer/Tx
ICU
Cryptococcal Meningitis
12,000 80
Pneumocystis Pneumonia
10,800 72
Invasive Aspergillosis 90
0.6
Chronic pulmonary Apergillosis post TB
2,329
15.5
Allergic bronchopulmonary aspergillosis ABPA
14,010 93
Severe Asthma with fungal sensitization SAFS
18,493
123
Candideamia
525
225
750 5
Candida Peritonitis
113 
113
0.75
Oral Candidiasis
432,000
2,880
Oesophageal Candidiasis
121,000
807
Recurrent Candida vaginitis (>_4x/year)
251,597
3,355
Mucormycosis 3  3
0.02
Histoplasmosis ? 
Fungal keratitis
3,650 
3,650
20.6
Tinea capitis
670,943 
670,943
3,780
Total burden estimated
926,190
575,800
32,503
2,857
338
1,537,688
Methods
A full literature search was done to identify all epidemiology papers reporting fungal infection rates from Malawi. We used specific populations at risk and fungal infection frequencies in the population to estimate national incidence or prevalence. Sources included the Malawi National statistical office (NSO), the Ministry of Health Population and Demographic survey of 2016, the 2015/16 HIV infection and AIDS rates from National Aids commission (NAC) WHO TB statistics, 2015; COPD rates from report Prevalence and future approach for prevention and control of Respiratory Diseases
Results
The Malawi population is approximately 17.7 million with 48% under 15 years of age. Approximately 8% of the population is HIV positive. The total estimated burden of fungal infections is 1,535,678. Among these, the most common infections are present in HIV/AIDS patients, with oral candidiasis (approximately 432,000 cases) being the commonest. Among common life threatening infections among the HIV/AIDS patients include cryptococcal meningitis (with 10% of AIDS patients presenting with the disease), and Pneumocystis pneumonia (9% of AIDS patients presenting with this). Pulmonary TB is present in approximately 11,000 cases per year, but extrapulmonary TB is rare. The prevalence of severe asthma with fungal sensitization SAFS is 14,010. Mucormycosis and histoplasmosis are rarely seen. Tinea capitis is estimated to be present in over 600,000 people. The incidence of fungal keratitis was estimated based on the annual number of cases seen in one department.
African histoplasmosis (dubosiii), fungal keratitis, orbital mucormycosis and CPA with an aspergilloma
Conclusion
Fungal infections in Malawi are very common, and dominated by tinea capitis, recurrent vaginal candidiasis, oral and oesophageal candidiasis, and candidaemia. Among the most serious infections, cryptococcal meningitis and Pneumocystis pneumonia are on the top list. These basic estimates are limited, due to poor record data keeping, and require epidemiological studies to validate or modify the substantial burden.
The number of reported cases of chromoblastomycosis in different countries (fromwww.gaffi.org/wp-content/uploads/chromobastomycosis-briefing-document-Nov-2014.pdf )
References
1. Msyamboza et al.: Burden of cancer in Malawi; common types, incidence and trends: National population-based cancer registry. BMC Research Notes :149.
2. Lavy C, Tindall A, Steinlechner C, Mkandawire N, Chimangeni S. Surgery in Malawi – A National Survey of Activity in Rural and Urban Hospitals. annals Oct 1;89(7):722–4.
3. Banda LT et al. Cancer incidence in Blantyre, Malawi 1994±1998. Tropical Medicine and International Health volume 6 no 4 pp 296±304 April 2001