Serious fungal infections in Egypt

Original Article
Part of the following topical collections:
  1. Global Fungal Disease Burden


We aimed to estimate the burden of serious fungal infections in Egypt, currently unknown, based on the size of the populations at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports with clearcut denominators. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. The population of Egypt in 2011 was ∼82,500,000; 31% children, and 8% women >60 years of age. Amongst about 21.8 million women aged 15–50 years, recurrent vulvovaginal candidiasis (≥4 episodes/year) is estimated to occur in 1.3 million (3,169/100,000 females). Using a low international average rate of 5/100,000, we estimate 4,127 cases of candidaemia, and 619 patients with intra-abdominal candidiasis. Amongst the survivors of pulmonary tuberculosis (TB) in Egypt in 2012, 319 new cases of chronic pulmonary aspergillosis (CPA) are likely, a prevalence of 1,005 post-TB and a total prevalence estimate of 3,015 CPA patients in all. Asthma is common in Egypt, affecting 9.4% of adults, 5.35 million, and so ABPA and SAFS were estimated in around 162/100,000 and 214/100,000 respectively. Invasive aspergillosis is estimated to affect 495 patients following leukaemia therapy, there are an estimated 37 cases in renal and liver transplant recipients, and an estimated 132 patients develop IA in the context of lung cancer. Amongst 641,000 COPD admissions to hospital each year, 8,337 patients develop IA. The total HIV-infected population is small, with an estimated 6,500 patients, 2,500 not on antiretroviral therapy. Amongst HIV-infected patients, 38 (0.6%) cases of cryptococcal meningitis and 125 (1.9%) cases of Pneumocystis pneumonia are estimated each year. Fungal keratitis is common, with 28–55% (mean 40%) of corneal infections being fungal, an estimated total of 11,550 cases. The present study indicates that 2% of the Egyptian population is affected by fungal infections. The estimates are certainly incomplete, and need further epidemiological and diagnostic studies.


  1. 1.
    Global Action Fund for Fungal Infections (2015) “95–95 by 2025” Improving outcomes for patients with fungal infections across the world: a roadmap for the next decade. May 2015.
  2. 2.
    Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Diseases Study 2010. Lancet 380:2163–2196CrossRefPubMedGoogle Scholar
  3. 3.
    Zaki SM, Elkholy IM, Elkady NA, Abdelghany K (2014) Mucormycosis in Cairo, Egypt: review of 10 reported cases. Med Mycol 52(1):73–80PubMedGoogle Scholar
  4. 4.
    Zaki SM, Ibrahim N, Aoyama K, Shetaia YM, Abdel-Ghany K, Mikami Y (2009) Dermatophyte infections in Cairo, Egypt. Mycopathologia 167:133–137CrossRefPubMedGoogle Scholar
  5. 5.
    Shabrawy RM, Elbadawy NS, Harb AW (2013) The incidence of fungal keratitis in zagazig university hospitals, Egypt and the value of direct microscopy and PCR technique in rapid diagnosis. J Microbiol Infect Dis 3(4):186–191CrossRefGoogle Scholar
  6. 6.
    Moharram AM, Abdel-Kader MI, Al-Hussaini AK, Alghalibi SM (1999) Studies on mycotic keratitis in Assuit governorate. Proceedings of the Second International Conference on Fungi: Hopes & Challenges 1, pp 133–146Google Scholar
  7. 7.
    Elias ML, Soliman AK, Mahoney FJ et al (2009) Isolation of Cryptococcus, candida, Aspergillus, Rhodotorula, and Nocardia from meningitis patients in Egypt. J Egypt Public Health Assoc 84(1&2):169–180PubMedGoogle Scholar
  8. 8.
    Moharram AM, Abdel-Ati MG, Othman EO (2013) Vaginal yeast infection in patients admitted to Al-Azhar University Hospital, Assiut, Egypt. J Basic Appl Mycol 4:21–32Google Scholar
  9. 9.
    Zaki SM, Elkholy EM, Mohamed SS, Wasfy WM (2015) In-vitro susceptibility testing of dermatophytes isolated in Cairo, Egypt against eight antifungal agents by broth microdilution and disk diffusion methods. J Basic Appl Mycol 6:9–15Google Scholar
  10. 10.
    Elkholy EM, Zaki SM, Mohamed SS, Wasfy WM (2015) In vitro susceptibility testing of clinical zygomycetous species isolated in Cairo, Egypt against ten antifungal agents by broth microdilution, disk diffusion and E-test methods. Egyptian J Bot (accepted for publications)Google Scholar
  11. 11.
    World Health Organisation (2011) World Health Statistics.
  12. 12.
  13. 13.
    World Health Organisation (2014) Global tuberculosis report 2014. World Health Organisation, Geneva, 154ppGoogle Scholar
  14. 14.
    Arendrup MC (2010) Epidemiology of invasive candidiasis. Curr Opin Crit Care 16:445–452CrossRefPubMedGoogle Scholar
  15. 15.
    Montravers F, Mira JP, Gangneux JP, Leroy OI, Lortholary O (2011) A multicenter study of antifungal strategies and outcomes of Candida peritonitis intensive care units. Clin Microbial Infect 17:1061–1067CrossRefGoogle Scholar
  16. 16.
    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 6:106–111CrossRefPubMedGoogle Scholar
  17. 17.
    Smith E, Orholm M (1990) Trends and patterns of opportunistic diseases in Danish AIDS patients 1980–1990. Scand J Infect Dis 22:665–672CrossRefPubMedGoogle Scholar
  18. 18.
    Buchacz K, Baker RK, Palella FJ Jr, Chmiel JS, Lichtenstein KA, Novak RM et al (2010) AIDS-defining opportunistic illnesses in US patients, 1994–2007: a cohort study. AIDS 24:1549–1559CrossRefPubMedGoogle Scholar
  19. 19.
    Sobel JD (2007) Vulvovaginal candidosis. Lancet 369:1961–1971CrossRefPubMedGoogle Scholar
  20. 20.
    Denning D, Pleuvry A, Cole D (2011) Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ 89:864–872CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Polatli M, Kheder A, Wali S, Javed A, Khattab, A, Mahboub B, Iraqi G, Nejjari C, Taright S, Koniski M, Rashid N, El Hasnaoui A (2012) Chronic obstructive pulmonary disease and associated healthcare resource consumption in the middle east and north Africa: the breath study. 106(S2):S75–S85Google Scholar
  22. 22.
    Guinea J, Torres-Narbona M, Gijon P, Munoz P, Pozo F, Peleaz T et al (2010) Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect 16:870–877CrossRefPubMedGoogle Scholar
  23. 23.
    Xu H, Li L, Huang WJ, Wang LX, Li WF, Yuan WF (2012) Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from china. Clin Microbiol Infect 18:403–408CrossRefPubMedGoogle Scholar
  24. 24.
    Ben Abdella F, Taktak S, Chtourou A, Mahouachi R, Ben Kheder A (2011) Burden of chronic respiratory diseases (CRD) in Middle East and North Africa (MENA). WAO J 2011 supplementGoogle Scholar
  25. 25.
    Al-Mobeireek AF, Gad MO, El-Rab SS, Al-Hedaithy A, Alasali K, Al-Majid S, Joharjy I (2001) Allergic bronchopulmonary mycosis in patients with asthma: period prevalence at a university hospital in Saudi Arabia. Respir Med 95:341–347CrossRefPubMedGoogle Scholar
  26. 26.
    Denning D, Pleuvry A, Cole D (2013) Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol 51:361–370CrossRefPubMedGoogle Scholar
  27. 27.
    Yan X, Li M, Jiang M, Zou L, Luo F, Jiang Y (2009) Clinical characteristics of 45 patients with invasive pulmonary aspergillosis. Cancer 1:5018–5025CrossRefGoogle Scholar
  28. 28.
    Taj-Aldeen SJ, Chandra P, Denning DW (2015) Burden of fungal infections in Qatar. Mycoses 58(suppl S5):51–57CrossRefPubMedGoogle Scholar
  29. 29.
    Sinko J, Sulyok M, Denning D (2015) Burden of serious fungal diseases in Hungary. Mycoses 58(Suppl S5):29–33CrossRefPubMedGoogle Scholar
  30. 30.
    Denning DW, Pashley C, Harti D, Wardiaw A, Godet C, Del Giacco Delhaes L, Sergejeva S (2014) Fungal allergy in asthma—state of the art and research needs. Clin Transl Allergy 4:14CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Tageldin MA, Nafti S, Khan JA, Nejjari C, Beji M, Mahboub B et al (2012) Distribution of COPD-related symptoms in the Middle East and North Africa: results of the BREATH study. Repair Med 106(Suppl 2):S25–S32Google Scholar
  32. 32.
    Denning DW, Perlin DS, Muldoon EG, Colombo AL, Chakrabarti A, Richardson MD, Sorrell TC (2016) Delivering on the Antimicrobial Resistance (AMR) agenda is not possible without improving fungal diagnostic capabilities. Emerg Infect Dis. In pressGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Mycology Unit, Microbiology Department, Faculty of ScienceAin Shams UniversityCairoEgypt
  2. 2.The University of Manchester and National Aspergillosis Centre, University Hospital of South ManchesterThe University of ManchesterManchesterUK

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