Global incidence and mortality from invasive fungal disease is substantially higher than previously thought, according to a systematic review published last week in The Lancet Infectious Diseases.
Using data from literature published from 2010 through 2023, along with 85 papers on individual country and global disease burden, the review estimates that over 6.55 million people annually are affected by invasive fungal infection, including over 2.1 million with invasive aspergillosis, 1.8 million with chronic pulmonary aspergillosis, and 1.5 million with a Candida bloodstream infection or invasive candidiasis, 500,000 with Pneumocystis pneumonia, and 194,000 with Cryptococcal meningitis. These infections lead to more than 3.75 million deaths annually, of which 2.55 million are directly attributable to the fungal disease.
The review also estimates that fungal asthma affects approximately 11.5. million people annually, with 92,000 asthma deaths linked to fungal allergy and 46,000 directly attributable.
Higher than previous estimates
The mortality figures are higher than the prior estimates of 1.5 million to 2 million annual deaths, in part because many fungal infections exacerbate diseases such as leukemia, lung cancer, and AIDS, and deaths have often been attributed to those diseases. In addition, many fungal diseases go undiagnosed and untreated because of limited access to diagnostics.
But the new estimates, based on a combination of untreated mortality, the proportion of patients who are treated, and percentage survival in treated patients, suggest that invasive aspergillosis could be responsible for up to one-third of the 3.23 million annual deaths from chronic obstructive pulmonary disease, while 340,000 (28%) of the more than 1.2 million deaths from tuberculosis may have been attributable to chronic pulmonary aspergillosis.
David Denning, PhD, author of the study and a professor at the University of Manchester, says that while the estimates are "necessarily crude" and limited by the scarcity of adequate epidemiologic data from many countries and uncertainty in the mortality rate of undiagnosed and untreated patients, they're "critical to health system capacity building."
"Improved clinical awareness, appropriate sampling, and timely laboratory diagnostic testing, combined with imaging, could definitively reduce the substantial number of mostly avoidable premature deaths from life-threatening fungal disease," he wrote.