Burden of serious fungal infections in Kenya

J.A. Guto*, D.W. Denning, C. Bii


Introduction: Kenya is a developing East African Country with a high rate of TB and a moderate HIV infection burden. The main fungal infections are respiratory, eye and dermatological. Research reports show increased incidence of cryptococcal meningitis (CM), Pneumocystis pneumonia (PCP), Keratitis and skin infections.We have attempted a preliminary estimate of serious fungal infections in Kenya. Methods: A full literature search was done to identify all epidemiology papers reporting fungal infection rates from Kenya. We used specific populations at risk and fungal infection frequencies in the population to estimate national incidence or prevalence. WHO population statistics of 2010, the 2010 WHO HIV infection and ARV treatment rates; Kenya AIDS Epidemic Update 2012, Kenya Facts and figures 2012, 2008-2009 Kenya Demographic and Health Survey, WHO 2010 TB statistics, ISAAC estimate of asthma prevalence are some of the databases used and the GINA Report. Results: Kenya population is about 39.8 million with 43% under 15 years of age and 4% over the age of 60. Estimates are: Kenyan women get (5%) of 4 episodes or more of Candida vaginitis per year, a total of 566,271. HIV/AIDS population estimated at 710,000 with 61% on ARV therapy so population at risk of OIs 277,000. Estimates are: oral thrush 249,210, oesophageal candidiasis 77,035, CM rate of 7% in all HIV patients with <100 -200 CD4 count in Kenya, so 7,810 cases, PCP 27,690 cases (10% not treated with ARVs), with a high mortality. Pulmonary TB cases resulting in prevalence of 10,848 cases of chronic pulmonary aspergillosis, using a 15% annual mortality rate, perhaps 67% of the total CPA caseload. The adult asthma population prevalence is 7% (4% of GP consultations) and assuming 2.5% have ABPA 39,702 cases would be expected. Severe asthma with fungal sensitisation (SAFS) is estimated to affect 54,407 people. Invasive aspergillosis, candidaemia and candida peritonitis are probably uncommon. Tinea capitis is common 9.6% in Kenya a prevalence of 1,712,267. Fungal keratitis is difficult to estimate. Conclusion: At any one time, 6.25% of the Kenyan population suffers from a fungal infection, with recurrent vaginitis and tinea capitis accounting for 88% of the infections. These basic estimates require epidemiological studies to validate or modify the substantial burden estimates.

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23rd European Congress of Clinical Microbiology and Infectious Diseases