Mohammad T Hedayati1,2, Mojtaba Tagizadeh1, Jamshid Yazdani Charati3, David W Denning4

1Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran2Invasive Fungi Research Center, Mazandaran University of Medical sciences, Sari, Iran3Department of Statistics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran4The University of Manchester and the LIFE program at www.LIFE-worldwide.org

University Hospitalof South Manchester

NHS Foundation Trust

Introduction

Table 1

Discussion

Acknowledgement

Materials and Methods

Results

Iran is a Middle East country with a diverse range of climatic conditions in different areas. In the last two decades, Iran has made significant improvements in the health system including applying advanced procedures in management and diagnostic methods. There are many transplants, cancer and intensive care centers. Nowadays, fungal disease diagnosis is not confined to cutaneous mycoses but includes life threatening mycoses because of their importance for survival. Nonetheless, the number of fungal infections occurring each year in Iran is not known. Since knowing the burden of fungal disease affects the outcome of underlying disease in different populations, we have estimated the burden of fungal disease in Iran.

The reported incidence of invasive mycoses among immuno-compromised patients from Iran is high in comparison with those of developed countries. Interestingly, A. flavus is the most prevalent species of Aspergillus in IA patients which is different with the findings of the most other studies from different countries.

Substantial uncertainty surrounds these estimates and epidemiological studies are urgently required to validate or modify these estimates.

This work was supported by grants from Mazandaran University of Medical Sciences.

To identify the literature on fungal diseases in Iran, we searched Medline and several national databases of Iran. We searched meeting abstracts too. We excluded case reports. We used specific populations at risk and fungal infection frequencies in the population to estimate national incidence or prevalence. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence, depending on the condition. Population statistics were derived from Statistics National Organization of Iran.

Of Iran’s 72,874,050 population, 50.9% are male. Recurrent vaginal thrush (4+ times annually) affects 9.3% of women who are at risk, an estimated total of 1,386,213. The tinea capitis rate is approximately 15.6% in children <11 years which gives a total of 1,114,763 current cases of tinea capitis. Estimates for burden of oral candidiasis was 133.6/100,000 adults. Total burden and estimation for burden of IA in cancer patients were 251 and 0.33%, respectively. Based on our review, Aspergillus flavus was the most common isolated species among Aspergillus spp. in IA patients. IA numbers in renal and liver transplantation and numerous other diseases were not estimated. ABPA in asthma patients was found in 4.1% in a 4 year secondary care study. Based on the 24,735 cases of HIV infection with <200 CD4 count reported, an estimated 1,472 annual cases of Pneumocystosis is estimated. Candida albicans was the prevalent species of Candida isolated. Mucormycosis cases were only confirmed by histopathological method and etiologic agents were not identified by culture.

Burden of serious fungal diseases in Iran

ABPA

Predominantgroups at risk

Type of disease Risk population size Estimation forburden (%)

Total burden Most mean age estimates for each disease

Asthma 2,500,000 4.1% 102,500 18-70

CPA Prior TB 7,519/yr 10% 1,872 25-65

IA Cancer 74,791 0.33% 251 15-45

Recurrent vaginal candidiasis

Use of antibiotics, diabetes 14,905,521 9.3% 1,386,213 30-45

Oral candidiasis None 55,988,772 133.6/100,000 23,708 >15

Tinea capitis Poor hygiene 7,164,290 15.6% 1,114,763 <10

Pneumocystosis AIDS (<200 CD4) 24,735 5.9% 1,472 >45

Total burden estimated 2,423,489

UHSM