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Serious fungal infections in Canada

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Abstract

There are currently no nationwide epidemiological data on fungal infections in Canada. We estimated the burden of serious fungal diseases using literature review and modeling, as per a methodology previously described by the LIFE program (http://www.LIFE-worldwide.org). Among the population of Canada (35.5 million in 2014), it was estimated that approximately 1.8% are affected by a serious fungal infection. Recurrent vulvovaginal candidiasis, severe asthma with fungal sensitization, and allergic bronchopulmonary aspergillosis are the most frequent infections, with population prevalences of 498,688 (1403/100,000), 73,344 (206/100,000), and 61,854 (174/100,000) cases, respectively. Over 3000 invasive fungal infections are estimated to occur annually, with incidences of 2068 cases (5.8/100,000) of invasive candidiasis, 566 cases (1.6/100,000) of invasive aspergillosis, 252 cases (0.71/100,000) of Pneumocystis pneumonia, 99 cases (0.28/100,000) of endemic mycoses, and 63 cases (0.18/100,000) of cryptococcosis. These estimates warrant validation through more formal epidemiological studies in Canada.

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References

  1. Nicolle L, Rotstein C, Bourgault A, St-Germain G, Garber G; Canadian Infectious Diseases Society Invasive Fungal Registry (1998) Invasive fungal infections in Canada from 1992 to 1994. Can J Infect Dis 9(6):347–352

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Rodriguez-Tudela JL, Alastruey-Izquierdo A, Gago S, Cuenca-Estrella M, León C, Miro JM, Nuñez Boluda A, Ruiz Camps I, Sole A, Denning DW; University of Manchester in association with the LIFE program (2015) Burden of serious fungal infections in Spain. Clin Microbiol Infect 21(2):183–189. doi:10.1016/j.cmi.2014.07.013

    Article  CAS  PubMed  Google Scholar 

  3. Ruhnke M, Groll AH, Mayser P, Ullmann AJ, Mendling W, Hof H, Denning DW; University of Manchester in association with the LIFE program (2015) Estimated burden of fungal infections in Germany. Mycoses 58(Suppl 5):22–28. doi:10.1111/myc.12392

    Article  PubMed  Google Scholar 

  4. Statistics Canada. Table 051-0001. Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted). CANSIM (database)

  5. Statistics Canada. Table 105-0502. Health indicator profile, two year period estimates, by age group and sex, Canada, provinces, territories, health regions (2013 boundaries) and peer groups, occasional. CANSIM (database)

  6. Canadian Cancer Society (2015) Acute myelogenous leukemia statistics. Available online at: http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-acute-myelogenous-aml/statistics/?region=on. Accessed 10 Apr 2015

  7. Canadian Cancer Society’s AdvisoryCommittee on Cancer Statistics (2015) Canadian Cancer Statistics. Canadian Cancer Society, Toronto, Ontario

  8. Canadian Institute for Health Information (CIHI) (2014) Canadian organ replacement register annual report: treatment of end-stage organ failure in Canada, 2003 to 2012. CIHI, Ottawa, Ontario

  9. Organisation for Economic Co-operation and Development (OECD) (2013) Health at a glance 2013: OECD indicators (2013). OECD Publishing

  10. Public Health Agency of Canada (2014) HIV and AIDS in Canada: surveillance report to December 31, 2013. Minister of Public Works and Government Services Canada, Ottawa, Ontario

  11. World Health Organization (WHO) (2014) Tuberculosis country profiles: Canada. Available online at: https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=CA&LAN=EN&outtype=html. Accessed 16 Aug 2016

  12. Cystic Fibrosis Canada (2015) The Canadian Cystic Fibrosis Registry: 2013 annual report

  13. Laupland KB, Gregson DB, Church DL, Ross T, Elsayed S (2005) Invasive Candida species infections: a 5 year population-based assessment. J Antimicrob Chemother 56(3):532–537. doi:10.1093/jac/dki258

    Article  CAS  PubMed  Google Scholar 

  14. St-Germain G, Laverdière M, Pelletier R, René P, Bourgault AM, Lemieux C, Libman M (2008) Epidemiology and antifungal susceptibility of bloodstream Candida isolates in Quebec: Report on 453 cases between 2003 and 2005. Can J Infect Dis Med Microbiol 19(1):55–62

    PubMed  PubMed Central  Google Scholar 

  15. Clancy CJ, Nguyen MH (2013) Finding the “missing 50%” of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis 56(9):1284–1292. doi:10.1093/cid/cit006

    Article  PubMed  Google Scholar 

  16. Barkati S, Dufresne SF, Bélanger S, Vadnais B, Bergeron J, Labbé AC, Laverdière M (2014) Incidence of invasive aspergillosis following remission-induction chemotherapy for acute leukemia: a retrospective cohort study in a single Canadian tertiary care centre. CMAJ Open 2(2):E86–E93. doi:10.9778/cmajo.20130062

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, Pastore D, Picardi M, Bonini A, Chierichini A, Fanci R, Caramatti C, Invernizzi R, Mattei D, Mitra ME, Melillo L, Aversa F, Van Lint MT, Falcucci P, Valentini CG, Girmenia C, Nosari A (2006) The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 91(8):1068–1075

    PubMed  Google Scholar 

  18. Steinbach WJ, Marr KA, Anaissie EJ, Azie N, Quan SP, Meier-Kriesche HU, Apewokin S, Horn DL (2012) Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect 65(5):453–464. doi:10.1016/j.jinf.2012.08.003

    Article  PubMed  Google Scholar 

  19. Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, Anaissie EJ, Brumble LM, Herwaldt L, Ito J, Kontoyiannis DP, Lyon GM, Marr KA, Morrison VA, Park BJ, Patterson TF, Perl TM, Oster RA, Schuster MG, Walker R, Walsh TJ, Wannemuehler KA, Chiller TM (2010) Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis 50(8):1101–1111. doi:10.1086/651262

    Article  PubMed  Google Scholar 

  20. Corzo-León DE, Satlin MJ, Soave R, Shore TB, Schuetz AN, Jacobs SE, Walsh TJ (2015) Epidemiology and outcomes of invasive fungal infections in allogeneic haematopoietic stem cell transplant recipients in the era of antifungal prophylaxis: a single-centre study with focus on emerging pathogens. Mycoses 58(6):325–336. doi:10.1111/myc.12318

    Article  PubMed  Google Scholar 

  21. Harrison N, Mitterbauer M, Tobudic S, Kalhs P, Rabitsch W, Greinix H, Burgmann H, Willinger B, Presterl E, Forstner C (2015) Incidence and characteristics of invasive fungal diseases in allogeneic hematopoietic stem cell transplant recipients: a retrospective cohort study. BMC Infect Dis 15:584. doi:10.1186/s12879-015-1329-6

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wingard JR, Carter SL, Walsh TJ, Kurtzberg J, Small TN, Baden LR, Gersten ID, Mendizabal AM, Leather HL, Confer DL, Maziarz RT, Stadtmauer EA, Bolaños-Meade J, Brown J, Dipersio JF, Boeckh M, Marr KA; Blood and Marrow Transplant Clinical Trials Network (2010) Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation. Blood 116(24):5111–5118. doi:10.1182/blood-2010-02-268151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Montesinos P, Rodríguez-Veiga R, Boluda B, Martínez-Cuadrón D, Cano I, Lancharro A, Sanz J, Arilla MJ, López-Chuliá F, Navarro I, Lorenzo I, Salavert M, Pemán J, Calvillo P, Martínez J, Carpio N, Jarque I, Sanz GF, Sanz MA (2015) Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis. Bone Marrow Transplant 50(11):1465–1472. doi:10.1038/bmt.2015.181

    Article  CAS  PubMed  Google Scholar 

  24. Kontoyiannis DP, Marr KA, Park BJ, Alexander BD, Anaissie EJ, Walsh TJ, Ito J, Andes DR, Baddley JW, Brown JM, Brumble LM, Freifeld AG, Hadley S, Herwaldt LA, Kauffman CA, Knapp K, Lyon GM, Morrison VA, Papanicolaou G, Patterson TF, Perl TM, Schuster MG, Walker R, Wannemuehler KA, Wingard JR, Chiller TM, Pappas PG (2010) Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 50(8):1091–1100. doi:10.1086/651263

    Article  PubMed  Google Scholar 

  25. Guinea J, Torres-Narbona M, Gijón P, Muñoz P, Pozo F, Peláez T, de Miguel J, Bouza E (2010) Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect 16(7):870–877. doi:10.1111/j.1469-0691.2009.03015.x

    Article  CAS  PubMed  Google Scholar 

  26. Kidd SE, Hagen F, Tscharke RL, Huynh M, Bartlett KH, Fyfe M, Macdougall L, Boekhout T, Kwon-Chung KJ, Meyer W (2004) A rare genotype of Cryptococcus gattii caused the cryptococcosis outbreak on Vancouver Island (British Columbia, Canada). Proc Natl Acad Sci U S A 101(49):17258–17263. doi:10.1073/pnas.0402981101

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. BC Centre for Disease Control (2014) British Columbia Annual Summary of Reportable Diseases 2013. Communicable Disease Prevention and Control Services (CDPACS), Provincial Health Services Authority Vancouver, British Columbia

  28. Dalcin D, Ahmed SZ (2015) Blastomycosis in northwestern Ontario, 2004 to 2014. Can J Infect Dis Med Microbiol 26(5):259–262

    PubMed  PubMed Central  Google Scholar 

  29. Morris SK, Brophy J, Richardson SE, Summerbell R, Parkin PC, Jamieson F, Limerick B, Wiebe L, Ford-Jones EL (2006) Blastomycosis in Ontario, 1994–2003. Emerg Infect Dis 12(2):274–279. doi:10.3201/eid1202.050849

    Article  PubMed  PubMed Central  Google Scholar 

  30. Litvinov IV, St-Germain G, Pelletier R, Paradis M, Sheppard DC (2013) Endemic human blastomycosis in Quebec, Canada, 1988–2011. Epidemiol Infect 141(6):1143–1147. doi:10.1017/s0950268812001860

    Article  CAS  PubMed  Google Scholar 

  31. Government of Manitoba (2014) Manitoba Annual Summary of Communicable Diseases 2013. Epidemiology & Surveillance, Public Health Branch, Public Health and Primary Health Care Division, Manitoba Health, Healthy Living and Seniors

  32. Guy R, Roy O, Poupart G, Panisset M (1949) Histoplasmin sensitivity; preliminary observations in a group of school children in the Province of Quebec. Can J Public Health 40(2):68–71

    CAS  PubMed  Google Scholar 

  33. Leznoff A, Frank H, Taussig A, Brandt JL (1969) The focal distribution of histoplasmosis in Montreal. Can J Public Health 60(8):321–325

    CAS  PubMed  Google Scholar 

  34. MacEachern EJ, McDonald JC (1971) Histoplasmin sensitivity in McGill University students. Can J Public Health 62(5):415–422

    CAS  PubMed  Google Scholar 

  35. Sekhon AS, Isaac-Renton J, Dixon JM, Stein L, Sims HV (1991) Review of human and animal cases of coccidioidomycosis diagnosed in Canada. Mycopathologia 113(1):1–10

    Article  CAS  PubMed  Google Scholar 

  36. Denning DW, Pleuvry A, Cole DC (2011) Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ 89(12):864–872. doi:10.2471/blt.11.089441

    Article  PubMed  PubMed Central  Google Scholar 

  37. Smith NL, Denning DW (2011) Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J 37(4):865–872. doi:10.1183/09031936.00054810

    Article  CAS  PubMed  Google Scholar 

  38. Denning DW, Pleuvry A, Cole DC (2013) Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol 51(4):361–370. doi:10.3109/13693786.2012.738312

    Article  PubMed  Google Scholar 

  39. Baxter CG, Dunn G, Jones AM, Webb K, Gore R, Richardson MD, Denning DW (2013) Novel immunologic classification of aspergillosis in adult cystic fibrosis. J Allergy Clin Immunol 132(3):560–566.e10. doi:10.1016/j.jaci.2013.04.007

    Article  PubMed  Google Scholar 

  40. Agarwal R (2011) Severe asthma with fungal sensitization. Curr Allergy Asthma Rep 11(5):403–413. doi:10.1007/s11882-011-0217-4

    Article  CAS  PubMed  Google Scholar 

  41. Foxman B, Muraglia R, Dietz JP, Sobel JD, Wagner J (2013) Prevalence of recurrent vulvovaginal candidiasis in 5 European countries and the United States: results from an internet panel survey. J Low Genit Tract Dis 17(3):340–345. doi:10.1097/LGT.0b013e318273e8cf

    Article  PubMed  Google Scholar 

  42. Lalla RV, Latortue MC, Hong CH, Ariyawardana A, D’Amato-Palumbo S, Fischer DJ, Martof A, Nicolatou-Galitis O, Patton LL, Elting LS, Spijkervet FK, Brennan MT; Fungal Infections Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO) (2010) A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 18(8):985–992. doi:10.1007/s00520-010-0892-z

    Article  PubMed  PubMed Central  Google Scholar 

  43. Matee MI, Scheutz F, Moshy J (2000) Occurrence of oral lesions in relation to clinical and immunological status among HIV-infected adult Tanzanians. Oral Dis 6(2):106–111

    Article  CAS  PubMed  Google Scholar 

  44. Buchacz K, Baker RK, Palella FJ Jr, Chmiel JS, Lichtenstein KA, Novak RM, Wood KC, Brooks JT; HOPS Investigators (2010) AIDS-defining opportunistic illnesses in US patients, 1994–2007: a cohort study. AIDS 24(10):1549–1559. doi:10.1097/QAD.0b013e32833a3967

    Article  PubMed  Google Scholar 

  45. Zhu YX, Li T, Fan SR, Liu XP, Liang YH, Liu P (2016) Health-related quality of life as measured with the Short-Form 36 (SF-36) questionnaire in patients with recurrent vulvovaginal candidiasis. Health Qual Life Outcomes 14:65. doi:10.1186/s12955-016-0470-2

    Article  PubMed  PubMed Central  Google Scholar 

  46. Fong IW (1996) Clinical and cost considerations in the pharmacotherapy of vulvovaginal candidiasis. Pharmacoeconomics 9(6):497–505

    Article  CAS  PubMed  Google Scholar 

  47. Public Health Agency of Canada (2016) Surveillance. Available online at: http://www.phac-aspc.gc.ca/surveillance-eng.php. Accessed 16 Sep 2016

  48. Azie N, Neofytos D, Pfaller M, Meier-Kriesche HU, Quan SP, Horn D (2012) The PATH (Prospective Antifungal Therapy) Alliance® registry and invasive fungal infections: update 2012. Diagn Microbiol Infect Dis 73(4):293–300. doi:10.1016/j.diagmicrobio.2012.06.012

    Article  PubMed  Google Scholar 

  49. Haider S, Rotstein C, Horn D, Laverdiere M, Azie N (2014) The Prospective Antifungal Therapy Alliance(®) registry: A two-centre Canadian experience. Can J Infect Dis Med Microbiol 25(1):17–23

    PubMed  PubMed Central  Google Scholar 

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Dufresne, S.F., Cole, D.C., Denning, D.W. et al. Serious fungal infections in Canada. Eur J Clin Microbiol Infect Dis 36, 987–992 (2017). https://doi.org/10.1007/s10096-017-2922-y

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