Burden of serious fungal infection in Nigeria

Abstract

Background: Nigeria is the most populous country in Africa with a high rate of tuberculosis and a moderate HIV infection burden. Cutaneous and mucosal fungal infections are reported from Nigeria but there are few reports of serious fungal infections.

Methods: A literature search was done to identify all epidemiology papers reporting fungal infection rates from Nigeria. We used specific populations at risk derived from the WHO and literature and the fungal infection frequencies were used to estimate national incidence or prevalence.

Results: 1.5M Nigerian women get recurrent vaginal thrush. Tinea capitis occurs in >20% of school age children, translating to over 15.5M children affected. Based on the 3,459,363 cases of HIV infection; an estimated 1,449,166 (55% children) of whom are on ARV therapy; there are 281,180 new AIDS cases, and an estimated 57,866 cases of cryptococcal meningitis. 75,000 patients with AIDS cases are expected to develop Pneumocystis pneumonia (40% rate in children), 253,000 oral candidiasis and 144,000 oesophageal candidiasis. There were 78,032 cases of pulmonary TB in 2010, and we anticipate 19,000 new cases of chronic pulmonary aspergillosis with a 5 year period prevalence of 60,377 cases. Prevalence of asthma in adults is 15.2%, estimated at 3.7M adult asthmatics of which 94,000 (2.5%) will have ABPA and 124,000 severe asthma with fungal sensitisation (SAFS). Rates of candidaemia, Candida peritonitis, invasive aspergillosis and mucormycosis were estimated on a population basis, without supporting data and are probably uncommon or rare.

Conclusion: Our estimates indicate that over 11.8% of the Nigerian population is estimated to suffer from a serious fungal infection each year. If tinea capitis and recurrent vaginal thrush are excluded, over 960,000 are estimated to be affected, with substantial mortality. Epidemiological studies are urgently required to validate or modify these estimates.