Burden of serious fungal infections in Hungary
Zita Sulyok1, Mihály Sulyok2, David W. Denning4, János Sinkó3
1
St. István and St. Lászlo Hospital, Department of Pediatric Infectious Diseases
Department of Immunology and Infectious Diseases
3
Department of Hematology and Stem-cell Transplantation
4
The University of Manchester in association with the LIFE program at www.LIFEworldwide.org
2
Objectives. The exact number of serious fungal infections in Hungary is not known.
Estimates based on the size of the population at risk and available epidemiological databases
are feasible to indicate the national burden of these conditions.
Methods. Data were derived from The National Center for Epidemiology of Hungary,
National Institute of Quality and Organizational Development in Healthcare and Medicines,
Hungarian Central Statistical Office, patient and disease based registries, and reviewed
hospital documentation. Where exact data were not available, estimations from the risk
population and European prevalence statistics have been made.
Results. Recurrent candida vaginitis (>4x/year): from the total 9.94M population 4.34M are
adult women. Thus the estimated incidence of infection is 2193.4/100,000, this equals
108,980 women annually. HIV related infections: There are 2,064 infected persons, 733 being
on antiretroviral therapy. Pneumocystis pneumonia occurred in 10% of late presenters (5 in
year 2012). Esophageal candidiasis occurs in 155, oral thrush in 312 HIV patients, annually.
Immunocompromised and cancer patient population: The calculated annual incidence of
candidaemia is 348. At least 81 invasive aspergillosis cases and ~10 mucormycosis cases
yearly. Critical care and surgical patients: With 1,306 critical care beds and 7,711 abdominal
surgeries performed the estimated annual incidence of candidaemia and candida peritonitis is
149 and 75, respectively. Pulmonary tuberculosis (TB) and chronic lung conditions: The
annual incidence of TB cases is about 1,800. Thus the prevalence of post TB chronic
pulmonary aspergillosis (CPA) is estimated to be 2.51/100,000 (250 cases), possibly 25% of
the total CPA cases. Invasive aspergillosis in connection with most severe cases of chronic
obstructive pulmonary disease (COPD) occurs in at least 72 cases yearly. The prevalence of
COPD and asthma in adults is 1.4%, and 2.48%, respectively. Therefore, allergic
bronchopulmonary aspergillosis (ABPA) prevalence is estimated at 6,291 and severe asthma
with fungal sensitization (SAFS) at 8,253 cases annually. End stage renal disease: from 800
chronic ambulatory peritoneal dialysis (CAPD) patients the estimated annual incidence of
intra-abdominal candidiasis is 40/year.
Conclusions. Not being on the list of reportable infections the number of patients presenting
with severe mycoses in Hungary can only be roughly estimated. Even with these
approximations up to 1.2% of the total population can be affected. It is imperative to
communicate these figures to authorities and decision makers in order to draw due attention to
this underrecognized problem. Further epidemiological studies are warranted to validate and
extend these estimates.
Keywords: mycosis – Hungary – epidemiology