The annual total of deaths from fungal disease worldwide has risen to 3.75 million, double the previous estimate, according to a new study.

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Source: CDC/ Dr. Hilliard F. Hardin

Photomicrograph revealing some of the ultrastructural morphology exhibited by the fungal organism, Aspergillus niger

In a paper published in the leading journal Lancet Infectious Diseases, David Denning, a professor of infectious disease at The University of Manchester also calculates an annual total at about 6.55 million acute cases using data from more than 80 countries.

Though fungal disease has multiple causes, the updated mortality figures nevertheless dwarf deaths from other single pathogens, killing six times more people than malaria, and almost 3 times as many than tuberculosis.

Direct causes

The work is the result of a collaboration of over 300 professionals across the world who contributed to published estimates for their country and individual fungal diseases.

Previous estimates were imprecise, argues Professor Denning, as many fungal disease exacerbate an existing disorder, itself often severe, such as leukaemia or AIDS.

However according to the study, of the deaths linked to fungal disease, around 68% - or 2.55 million were likely to have been directly caused by it.

Underlying disease

Around 1.2 million deaths (32%) had other underlying disease, with fungal disease contributing.

Around a third of 3.23 million chronic obstructive pulmonary disease (COPD) deaths worldwide are linked to infection with the fungus Aspergillus, finds Professor Denning.

Though pulmonary tuberculosis was classified as the cause of death in 1.2 million people in 2019, as many as 340,000 (28%) of these could actually be fungal disease deaths, he estimates.

Of the estimated 311,594 leukaemia deaths globally in 2020, 14,000 (4.5%) could be attributable to aspergillosis, and some to other fungal infections, they find.

Aspergillosis implicated

Lung and bronchus cancer annual deaths stand at 1.8 million, with the new estimate indicating that aspergillosis is implicated in 49,000 deaths (2.7%) of them.

Candida -  another type of fungal infection-   is a serious problem in intensive care, complex surgical patients, diabetes, cancer and renal failure, as well as premature babies.

The researchers estimate that about 1.57 million people suffer from Candida bloodstream infection or invasive candidiasis with 995,000 deaths (63.6%), each year.

Gaps remain

Professor Denning said: “This work is the first global comprehensive annual incidence estimate of fungal disease, yet many gaps and uncertainties remain.

“Our prior estimates of annual mortality were 1.5 to 2 million, yet we now find the probable number dying with or of a fungal infection is double this at about 3.75 million.

“This estimate was inspired by massive changes in fungal disease awareness and diagnostic capabilities driven by Global Action For Fungal Infections (GAFFI), working in partnership with The University of Manchester, the Fungal Infection Trust, CIFAR’s Fungal Kingdom: Threats and Opportunities program and GAFFI’s global Ambassador network.

“This work would also not have been possible without the remarkable collaboration of over 300 professionals across the world who contributed to published estimates for their country and individual fungal diseases.”

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