1. OBJECTIVEMETHODSRESULTS BURDEN OF SERIOUS FUNGAL INFECTIONS IN SERBIA Valentina Arsic Arsenijevic 1, Sandra Sipetic Grujicic 2, Marina Pekmezovic 1, David Denning 3 1 – National Reference Medical Mycology Laboratory, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, dr Subotića 1, Belgrade, Serbia 2 – Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26a, Belgrade, Serbia 3 – National Aspergillosis Centre- University Hospital of South Manchester, in association with LIFE, The University of Manchester, Manchester, United Kingdom Corresponding author: Valentina Arsić Arsenijević, e-mail: mikomedlab@yahoo.com 7 th Trends in Medical Mycology, 6-9 October, Lisbon, Portugal This work has been funded by the Ministry of Education, Science and Technological Development of the Republic of Serbia (grant no. OI175034). To estimate the annual burden of serious fungal infections (SFI) in Serbia based on a size of population at risk and limited available epidemiological databases. National population data were obtained from Statistical Office of the Republic of Serbia, Institute of Public Health of Serbia, National Reference Medical Mycology Laboratory database as well as from National register for cystic fibrosis. Number of serious fungal infections among all underlying disease groups was estimated based on the number of risk patients using previously described methodology by Leading International Fungal Education (LIFE) and Global Action Fund for Fungal Infections (GAFFI). Of the 7.2M population (48.7% male and 51.3% female), 14.3% are children (0-14 years), 67.8% are adults (15-65 years) and 17.8% of population are >65 years old. The current annual burden of SFIs in Serbia was estimated to be 109,283 (1517.8/100,000 population, Table 1). The most common was recurrent vulvovaginal candidiasis (RVVC) with 95,907 cases per year assuming a literature rate 6% in women between 15 and 50 years old (1.6M population). This is followed by severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) that together comprised 10.6% of SFIs in Serbia. Chronic obstructive pulmonary disease (COPD) was common with 320,000 cases, contributing to the total 236 cases of invasive aspergillosis (IA; 0,2% of all SFIs) together with patients with cancer, transplantation (Tx) and stay in intensive care unit (ICU). Using low average literature data for candidemia rate (5/100,000) we estimated 360 candidemia cases annually in Serbia. Based on 1,124 cases of pulmonary tuberculosis, the annual incidence of new chronic pulmonary aspergillosis (CPA) cases was estimated at 371 cases, and prevalence 856 cases. Out of 1,692 HIV patients, Pneumocystis pneumonia was estimated at 26, while oesophageal candidiasis and cryptococcal meningitis were estimated at 212 and 2 cases, respectively. Data on fungal keratitis and tinea capitis was not available. Conclusion Based on these estimates, approximately 1.52% (n=109,283) of the population suffer from a SFIs every year in Serbia. Crude rate for SFIs in Serbia is 1517.8 new cases per 100,000 population per year. This study serves as a basis but further epidemiological studies are necessary to better categorize, validate and extend this estimation. TABLE 1. THE ANNUAL BURDEN OF SERIOUS FUNGAL INFECTIONS (SFIS) IN SERBIA Serious fungal infection (SFI) Number of SFIs per underlying disorder per year Total number of cases % of SFIs Crude rate/ 100,000 NoneHIV/AIDSRespiratoryCancer/TxICU Oesophagial candidiasis212 0.22.90 Candidaemia2521083600.35.00 Candida peritonitis54 0.050.75 Recurrent vulvovaginal candidiasis95,907 87.81332.0 Invasive aspergillosis19634 * 62360.23.28 ABPA5,030 4.669.80 SAFS6,600 6.091.60 Chronic pulmonary aspergillosis856 0.811.90 Cryptococcus meningitis1 ** 2 ** 0.0020.03 Pneumocystis pneumonia26 0.020.36 Total burden estimated95,90723912,682286169109,283100.001517.8 Abbreviations: ABPA - allergic bronchopulmonary aspergillosis; HIV/AIDS – human immunedeficiency virus/acquired immune deficiency syndrome; ICU- intensive care unit; SAFS - severe asthma with fungal sensitization; SFIs – serious fungal infections; Tx – transplantation. * - Some of the transplantations were done in Italy; ** - Data from patient database from National Reference Medical Mycology Laboratory of Serbia; no other data available