Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 26, Number 9—September 2020
Research

Risk-Based Estimate of Human Fungal Disease Burden, China

Ling-Hong Zhou1, Ying-Kui Jiang1, Ruo-Yu Li, Li-Ping Huang, Ching-Wan Yip, David W. Denning2, and Li-Ping Zhu2Comments to Author 
Author affiliations: Huashan Hospital, Shanghai, China; and Fudan University, Shanghai (L.-H. Zhou, Y.-K. Jiang, L.-P. Huang, C.-W. Yip, L.-P. Zhu); Peking University First Hospital, Beijing, China (R.-Y. Li); Peking University, Beijing (R.-Y. Li); National Clinical Research Center for Skin and Immune Diseases, Beijing (R.-Y. Li); Wythenshawe Hospital, Manchester, UK (D.W. Denning); University of Manchester, Manchester (D.W. Denning); Global Action Fund for Fungal Infections, Geneva, Switzerland (D.W. Denning)

Main Article

Table 1

Population characteristics in China, by age, gender, high-risk factors, and underlying diseases*

Population characteristic No., in thousands Reference
Total population 1,433,784 UN, 2019 (9)
Population of children 0–14 y 254,930 UN, 2020 (9)
Female population, 15–49 y 403,377 UN, 2020 (9)
Population >40 y 688,074 UN, 2020 (9)
People living with HIV 810 UNAIDS, 2017 (10)
Proportion of HIV patients on ART 40% UNAIDS, 2017 (10)
Adults living with HIV and CD4 <200 cells/µL 106 Assumes a 5-y decline in immunity
AIDS related deaths 26 UNAIDS, 2017 (10)
Annual cases of TB 856 WHO 2017 (11)
Annual cases of pulmonary TB who survive 844 WHO 2017 (11)
Adults with asthma (4.2%) population 49,512 Huang, 2019 (13)
Adults with COPD (7.2% of population) 102,377 Zhu, 2018 (14)
Adults with COPD admitted to hospital each year (20.1%) 29,382 Zhu, 2018 (14)
Lung cancer 774.3 GLOBOCAN, 2018 (1)
Liver transplants per year 4.73 COTR (12)
Renal transplants per year 10.8 COTR (12)
Lung transplants per year 0.3 COTR (12)
Heart transplants per year 0.56 COTR (12)
Allogeneic stem cell transplants per year 5.0 Xu, 2016 (15)
Acute myelogenous leukemia 41.2 40% of GLOBOCAN leukemia and multiple myeloma total, 2018 (1)
No. patients on peritoneal dialysis 73.9 Wilkie and Davies, 2017 (16)
Intensive care unit beds 86.0 Murthy, 2012 (17)
Intensive care admissions surviving >24 h 5,126 Du, 2013 (18)

*ART, antiretroviral therapy; COPD, chronic obstructive pulmonary disease; COTR, China Organ Transplantation Registration System; TB, tuberculosis;
UN, United Nations Population Division; UNAIDS, the Joint Nations Program on HIV/AIDS; WHO, World Health Organization.

Main Article

References
  1. Global Action Fund for Fungal Infections. Publications: key recent contributions to the academic literature and individual country burdens [cited 2019 Oct 7]. http://www.gaffi.org/media/academic-papers
  2. Song  X, Xie  L, Tan  X, Wang  Z, Yang  Y, Yuan  Y, et al. A multi-center, cross-sectional study on the burden of infectious keratitis in China. PLoS One. 2014;9:e113843. DOIPubMedGoogle Scholar
  3. Hu  Y, Zhang  J, Li  X, Yang  Y, Zhang  Y, Ma  J, et al. Penicillium marneffei infection: an emerging disease in mainland China. Mycopathologia. 2013;175:5767. DOIPubMedGoogle Scholar
  4. Pan  B, Chen  M, Pan  W, Liao  W. Histoplasmosis: a new endemic fungal infection in China? Review and analysis of cases. Mycoses. 2013;56:21221. DOIPubMedGoogle Scholar
  5. The Lancet. GLOBOCAN 2018: counting the toll of cancer. Lancet. 2018;392:985. DOIPubMedGoogle Scholar
  6. Hung  ML, Liao  HT, Chen  WS, Chen  MH, Lai  CC, Tsai  CY, et al. Invasive aspergillosis in patients with systemic lupus erythematosus: a retrospective study on clinical characteristics and risk factors for mortality. Lupus. 2018;27:194452. DOIPubMedGoogle Scholar
  7. Chinese State Statistical Bureau. China Statistical Yearbook 2018 [cited 2019 Oct 7]. http://www.stats.gov.cn/tjsj/ndsj/2018/indexch.htm
  8. Wang  C, Xu  J, Yang  L, Xu  Y, Zhang  X, Bai  C, et al.; China Pulmonary Health Study Group. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet. 2018;391:170617. DOIPubMedGoogle Scholar
  9. United Nations Population Division. World population prospects 2019 [cited 2019 Oct 7]. https://population.un.org/wpp/Download/Standard/Population
  10. UNAIDS. AIDS info: people living with AIDS receiving ART [cited 2019 Oct 7]. http://www.unaids.org/en/dataanalysis/datatools/aidsinfo
  11. World Health Organization. Tuberculosis country profiles [cited 2019 Oct 7]. http://www.who.int/tb/country/data/profiles/en/index.html
  12. Chinese Ministry of Health. China Organ Transplantation Registration System [cited 2019 Oct 7]. http://www.cotr.cn
  13. Huang  K, Yang  T, Xu  J, Yang  L, Zhao  J, Zhang  X, et al.; China Pulmonary Health (CPH) Study Group. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet. 2019;394:40718. DOIPubMedGoogle Scholar
  14. Zhu  B, Wang  Y, Ming  J, Chen  W, Zhang  L. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:135364. DOIPubMedGoogle Scholar
  15. Xu  LP, Wu  DP, Han  MZ, Huang  H, Liu  QF, Liu  DH, et al. A review of hematopoietic cell transplantation in China: data and trends during 2008–2016. Bone Marrow Transplant. 2017;52:15128. DOIPubMedGoogle Scholar
  16. Wilkie  M, Davies  S. Insights on peritoneal dialysis in China. Perit Dial Int. 2018;38(Suppl 2):S168. DOIPubMedGoogle Scholar
  17. Murthy  S, Wunsch  H. Clinical review: international comparisons in critical care—lessons learned. Crit Care. 2012;16:218. DOIPubMedGoogle Scholar
  18. Du  B, An  Y, Kang  Y, Yu  X, Zhao  M, Ma  X, et al.; China Critical Care Clinical Trial Group. Characteristics of critically ill patients in ICUs in mainland China. Crit Care Med. 2013;41:8492. DOIPubMedGoogle Scholar
  19. Tan  BH, Chakrabarti  A, Li  RY, Patel  AK, Watcharananan  SP, Liu  Z, et al.; Asia Fungal Working Group (AFWG). Incidence and species distribution of candidaemia in Asia: a laboratory-based surveillance study. Clin Microbiol Infect. 2015;21:94653. DOIPubMedGoogle Scholar
  20. Montravers  P, Mira  J-P, Gangneux  J-P, Leroy  O, Lortholary  O; AmarCand study group. A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units. Clin Microbiol Infect. 2011;17:10617. DOIPubMedGoogle Scholar
  21. Hu  S, Tong  R, Bo  Y, Ming  P, Yang  H. Fungal peritonitis dialysis: 5-year review from a North China center. Infection. 2019;47:3543. DOIPubMedGoogle Scholar
  22. Denning  DW, Kneale  M, Sobel  JD, Rautemaa-Richardson  R. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018;18:e33947. DOIPubMedGoogle Scholar
  23. Gamaletsou  MN, Drogari-Apiranthitou  M, Denning  DW, Sipsas  NV. An estimate of the burden of serious fungal diseases in Greece. Eur J Clin Microbiol Infect Dis. 2016;35:111520. DOIPubMedGoogle Scholar
  24. Matee  MI, Scheutz  F, Moshy  J. Occurrence of oral lesions in relation to clinical and immunological status among HIV-infected adult Tanzanians. Oral Dis. 2000;6:10611. DOIPubMedGoogle Scholar
  25. Chen  CY, Sheng  WH, Tien  FM, Lee  PC, Huang  SY, Tang  JL, et al. Clinical characteristics and treatment outcomes of pulmonary invasive fungal infection among adult patients with hematological malignancy in a medical centre in Taiwan, 2008–2013. J Microbiol Immunol Infect. 2020;53:10614.DOIPubMedGoogle Scholar
  26. Yan  X, Li  M, Jiang  M, Zou  LQ, Luo  F, Jiang  Y. Clinical characteristics of 45 patients with invasive pulmonary aspergillosis: retrospective analysis of 1711 lung cancer cases. Cancer. 2009;115:501825. DOIPubMedGoogle Scholar
  27. Xu  H, Li  L, Huang  WJ, Wang  LX, Li  WF, Yuan  WF. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China. Clin Microbiol Infect. 2012;18:4038. DOIPubMedGoogle Scholar
  28. Zhu  B, Wang  Y, Ming  J, Chen  W, Zhang  L. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:135364. DOIPubMedGoogle Scholar
  29. Khoo  S, Denning  DW. Invasive aspergillosis in patients with AIDS. Clin Infect Dis. 1994;19(suppl1):S418.DOIPubMedGoogle Scholar
  30. Denning  DW, Pleuvry  A, Cole  DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ. 2011;89:86472. DOIPubMedGoogle Scholar
  31. Smith  NL, Denning  DW. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J. 2011;37:86572. DOIPubMedGoogle Scholar
  32. Ma  YL, Zhang  WB, Yu  B, Chen  YW, Mu  S, Cui  YL. Prevalence of allergic bronchopulmonary aspergillosis in Chinese patients with bronchial asthma [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi. 2011;34:90913.PubMedGoogle Scholar
  33. Chen  J, Zhang  R, Shen  Y, Liu  L, Qi  T, Wang  Z, et al. Serum cryptococcal antigen titre as a diagnostic tool and a predictor of mortality in HIV-infected patients with cryptococcal meningitis. HIV Med. 2019;20:6973. DOIPubMedGoogle Scholar
  34. Li  Z, Liu  Y, Cao  H, Huang  S, Long  M. Epidemiology and clinical characteristics of cryptococcal meningitis in China (1981–2013): a review of the literature. Med Mycol: Open Access. 2017;3:1. DOIGoogle Scholar
  35. Guo  J, Zhou  J, Zhang  S, Zhang  X, Li  J, Sun  Y, et al. A case-control study of risk factors for HIV-negative children with cryptococcal meningitis in Shi Jiazhuang, China. BMC Infect Dis. 2012;12:376. DOIPubMedGoogle Scholar
  36. Chan  CK, Alvarez Bognar  F, Wong  KH, Leung  CC, Tam  CM, Chan  KC, et al. The epidemiology and clinical manifestations of human immunodeficiency virus-associated tuberculosis in Hong Kong. Hong Kong Med J. 2010;16:1928.PubMedGoogle Scholar
  37. Guo  F, Chen  Y, Yang  SL, Xia  H, Li  XW, Tong  ZH. Pneumocystis pneumonia in HIV-infected and immunocompromised non-HIV infected patients: a retrospective study of two centers in China. PLoS One. 2014;9:e101943. DOIPubMedGoogle Scholar
  38. Prakash  H, Chakrabarti  A. Global epidemiology of mucormycosis. J Fungi (Basel). 2019;5:26. DOIPubMedGoogle Scholar
  39. Sigurgeirsson  B, Baran  R. The prevalence of onychomycosis in the global population: a literature study. J Eur Acad Dermatol Venereol. 2014;28:148091. DOIPubMedGoogle Scholar
  40. United Nations Population Division. Demographic components of future population growth [cited 2019 Oct 7]. https://www.un.org/en/development/desa/population/theme/trends/dem-comp-change.asp
  41. Gong  X, Luan  T, Wu  X, Li  G, Qiu  H, Kang  Y, et al. Invasive candidiasis in intensive care units in China: risk factors and prognoses of Candida albicans and non-albicans Candida infections. Am J Infect Control. 2016;44:e5963. DOIPubMedGoogle Scholar
  42. Alnuaimi  AD, Wiesenfeld  D, O’Brien-Simpson  NM, Reynolds  EC, McCullough  MJ. Oral Candida colonization in oral cancer patients and its relationship with traditional risk factors of oral cancer: a matched case-control study. Oral Oncol. 2015;51:13945. DOIPubMedGoogle Scholar
  43. Choi  JH, Lee  CG, Lim  YJ, Kang  HW, Lim  CY, Choi  JS. Prevalence and risk factors of esophageal candidiasis in healthy individuals: a single center experience in Korea. Yonsei Med J. 2013;54:1605. DOIPubMedGoogle Scholar
  44. Yang  CH, He  XS, Chen  J, Ouyang  B, Zhu  XF, Chen  MY, et al. Fungal infection in patients after liver transplantation in years 2003 to 2012. Ann Transplant. 2012;17:5963. DOIPubMedGoogle Scholar
  45. Zhang  XD, Hu  XP, Yin  H, Wang  W, Zhang  X, Ma  LL, et al. Aspergillus pneumonia in renal transplant recipients. Chin Med J (Engl). 2008;121:7914. DOIPubMedGoogle Scholar
  46. Jiang  YK, Wu  JQ, Zhao  HZ, Wang  X, Wang  RY, Zhou  LH, et al. Genetic influence of Toll-like receptors on non-HIV cryptococcal meningitis: an observational cohort study. EBioMedicine. 2018;37:4019. DOIPubMedGoogle Scholar
  47. Gumbo  T, Kadzirange  G, Mielke  J, Gangaidzo  IT, Hakim  JG. Cryptococcus neoformans meningoencephalitis in African children with acquired immunodeficiency syndrome. Pediatr Infect Dis J. 2002;21:546. DOIPubMedGoogle Scholar
  48. Liu  L, Guo  L, Liu  Y, Chen  T, Li  S, Yang  Y, et al. Clinical characteristics and prognosis of pediatric cryptococcosis in Beijing Children’s Hospital, 2002–2014. Eur J Pediatr. 2017;176:123544. DOIPubMedGoogle Scholar
  49. Chen  W, Ren  K, Isabwe  A, Chen  H, Liu  M, Yang  J. Stochastic processes shape microeukaryotic community assembly in a subtropical river across wet and dry seasons. Microbiome. 2019;7:138. DOIPubMedGoogle Scholar
  50. Yang  S, Wu  J, Ding  C, Cui  Y, Zhou  Y, Li  Y, et al. Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study. Lancet Infect Dis. 2017;17:71625. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

2These authors contributed equally to this article.

Page created: May 26, 2020
Page updated: August 18, 2020
Page reviewed: August 18, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external