Fungal infections in Sudan: an underestimated health problem

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs. Author SummaryFungal infections are present globally, but the burden is higher in sub-Saharan Africa. Many of these infections occur because of underline clinical conditions such as HIV, TB, cancer, asthma, and chronic obstructive pulmonary disease (COPD), while some may occur without underline conditions. We used the prevalence of susceptible populations to estimate the burden of fungal diseases in Sudan. Based on that, we found a total of 5 million Sudanese suffering from fungal infection. The most common disease was scalp infection (tinea capitis), followed by recurrent vulvovaginitis. Fungal eye infection was estimated to affect 6,552 patients, and the subcutaneous neglected tropical disease eumycetoma affects 16,837 individuals. We also reported a high burden for HIV- and TB-related mycoses. The study highlighted the need to develop surveillance programs for fungal infections in Sudan.