An estimation of burden of serious fungal infections in France

Jean-Pierre Gangneux1, Marie-Elisabeth Bougnoux2, Cendrine Godet3, David W. Denning4 and Bertrand Dupont2
1. Rennes Teaching Hospital, France, 2. Hôpital Necker Enfants maladies Teaching Hospital, Paris, France, 3.Poitiers Teaching Hospital, Poitiers, France, 4.
The University of Manchester and National Aspergillosis Centre, University Hospital of South Manchester, UK,
in association with the LIFE program at www.LIFE-worldwide.org

Table 1. Burden of serious fungal infections in France

Introduction Our objective was to estimate the burden of
serious fungal diseases in France, based on epidemiological Infection Number of infections per underlying disorder per Rate/ Total
data. Epidemiology of several of them remains unknown, year 100K burden
None/ HIV/AIDS Respiratory Cancer/Tx ICU
whereas precise data are available for invasive fungal other
infections such as invasive aspergillosis, candidaemia, Oesophageal
cryptococcosis and pneumocystosis. Herein, we report an candidiasis - 9,075 - ? -
13.8 9,075
estimation of the incidence and prevalence of invasive but Candidaemia 533 28 85 1,134 590 3.6 2,370
also chronic and immunoallergic fungal diseases in mainland Candida peritonitis
249 - - - 237
0.74 486
France in order to provide a basis of reflection in terms of Recurrent vaginal
Public Health candidiasis
730,690 - - - - 2,220* 730,690
(4x/year +)

Methods Published epidemiology papers reporting fungal ABPA - - 95,331 - - 145 95,331
infection rates from France were identified. Where no data SAFS - - 124,678     189 124,678
existed, we used specific populations at risk and fungal Chronic pulmonary
infection frequencies in those populations to estimate aspergillosis - - 3,450 - - 109 3,450
national incidence or prevalence, depending on the Invasive
condition. Population statistics were derived from the aspergillosis 151 17 97 800 120 1.8 1,185
Institut National de la Statistique et des Etudes Economiques Mucormycosis 10 - - 69 - 0.12 79
(INSEE-2014). Incidences of invasive fungal infections were Cryptococcosis 32 76 2 21 - 0.2 131
derived from Institut National de Veille Sanitaire (InVS) and Pneumocystis
pneumonia 61 449 4 144 - 1 658
the National Reference Center for invasive fungal diseases
Total burden
(CNR-MA, Institut Pasteur)(2010) estimated 731,726 9,645 223,647 2,168 947   968,143
* rate for adult females only M. gypseum; 0% Microsporon sp.; 0%

Results 82% of the 65.8 M population (2014) are adults. The

asthma prevalence in adults is 6.7% and 7.5% of >45 years Figure 1. Distribution of species
old for COPD. In this context, the model predicts 124,678 responsible for tinea capitis in
severe asthma with fungal sensitization (SAFS) episodes (189 France M. langeronii/M. audouinii; 20%

cases/100,000 adults per year), 95,361 allergic The exact count of tinea capitis T. soudanense/T. violaceum; 32%

bronchopulmonary aspergillosis (ABPA) episodes recorded in 2014 from 30

M. canis; 11%
(145/100,000) and 3,450 chronic pulmonary aspergillosis representative hospitals is 808 cases. Tri-

cases (109/100,000)(Table 1). These high estimated burdens The global prevalence remains to be chophy-
ton sp.;
1%

indicate that such patients should be better identified and estimated at the level of the French T.
rubrum;
2%

characterized in order to improve their management. Good population. A huge predominance of T. ver-
ruco-
sum; 0%

estimates of incidence rates of documented invasive fungal anthropophilic dermatophytes is T. men-

tagro-
phytes;
T. tonsurans; 30%

diseases are available: 3.6/100,000 for candidaemia, observed.

2%

1.8/100,000 for invasive aspergillosis (IA), 1/100,000 for

pneumocystosis, 0.2/100,000 for cryptococcosis and 0.12 for Conclusion Using local and literature data of the incidence or prevalence
mucormycosis. However our estimate of IA complicating of fungal infections, approximately 1,000,000 (1.47%) people in France
COPD is 1,300 cases against a smaller documented number are estimated to suffer from serious fungal infections each year. Beside a
whatever the underlying condition, suggesting a major good evaluation of 5,000 cases/year of invasive fungal diseases, recurrent
diagnostic gap, which may be also be true for vaginitis and chronic and immunoallergic pulmonary diseases represent a
pneumocystosis. These severe infections have persistently serious impact on human health. Prospective or comprehensive registry
high mortality rates and represent high costs due to surveys are required to accurately determine their epidemiology and
hospitalization, diagnostic management and antifungal drugs improve the management of these disorders
use. Finally, estimates of Candida peritonitis, oesophageal References
candidiasis and recurrent vaginal candidiasis rates are Bitar EID 2014; Bitar BEH 2013; Lortholary CMI 2011; Gangneux RMR 2010; Leroy
O.74/100,000, 13.8/100,000 and 2,220/100,000, underline CCM 2009; Montravers CMI 2011; Rodriguez CMI 2015; Denning Clin Trans Allerg
the need for adjusting such potential high burdens with 2014; Denning Med Mycol 2013; Denning Thorax 2015
additional studies Websites
-Institut National de Veille Sanitaire: www.invs.sante.fr
-Centre National de Référence des Infections fongiques invasives et antifongiques:
www.pasteur.fr/fr/sante/centres-nationaux-reference/les-cnr/mycoses-invasives-e
t-antifongiques
-French Society for Medical mycology: www.sfmm-mycologie-medicale.com

Contact
Prof J-P Gangneux
Laboratoire de Parasitologie-Mycologie, CHU de Rennes
2 rue Henri le Guilloux, 35000 Rennes, France.
Jean-pierre.gangneux@chu-rennes.fr
Teaching hospitals
National Reference Center