Serious fungal disease incidence and prevalence in Indonesia.

Wahyuningsih, Retno; Adawiyah, Robiatul; Sjam, Ridhawati; Prihartono, Joedo; At Wulandari, Endah; Rozaliyani, Anna; Ronny, Robertus; Imran, Darma; Tugiran, Mulyati; Siagian, Forman E; Denning, David W

BACKGROUND Indonesia is a tropical country, warm and humid, with numerous environmental fungi. Data on fungal disease burden helps policy makers and clinicians. OBJECTIVES We have estimated the incidence and prevalence of serious fungal diseases. METHODS We found all published and unpublished data and estimated the incidence and prevalence of fungal diseases based on populations at risk. HIV data were derived from UNAIDS (2017), pulmonary tuberculosis (PTB) data from 2013-2019, data on chronic pulmonary aspergillosis (CPA) was used to estimate CPA prevalence and likely deaths, COPD data from Hammond (2020), lung cancer incidence was from Globocan 2018, and fungal rhinosinusitis was estimated using community data from India. RESULTS Overall ~7.7 million Indonesians (2.89%) have a serious fungal infection each year. The annual incidence of cryptococcosis in AIDS was 7,540. Pneumocystis pneumonia incidence was estimated at 15,400 in HIV and an equal number in non-HIV patients. An estimated 1% and 0.2% of new AIDS patients have disseminated histoplasmosis or Talaromyces marneffei infection. The incidence of candidemia is 26,710. The annual incidence of invasive aspergillosis was estimated at 49,500 and the prevalence of CPA is at 378,700 cases. Allergic bronchopulmonary aspergillosis prevalence in adults is estimated at 336,200, severe asthma with fungal sensitization at 443,800, and fungal rhino sinusitis at 294,000. Recurrent vulvovaginal candidiasis is estimated at 5 million/ year (15 - 50 years old). The incidence of fungal keratitis around 40,050. Tinea capitis prevalence in schoolchildren about 729,000. CONCLUSIONS Indonesia has a high burden of fungal infections.