The estimated burden of fungal disease in South Africa

I S Schwartz, T H Boyles, C R Kenyon, J C Hoving, G D Brown, D W Denning


Background. With a population of 56.5 million, over 7 million persons living with HIV, one of the world’s highest rates of tuberculosis (TB) and a large proportion of the population living in poverty, South Africa (SA)’s fungal disease burden is probably substantial and broad in scope.

Objectives. To estimate the burden of fungal disease in SA.

Methods. Using total and at-risk populations and national, regional and occasionally global data, we estimated the incidence and prevalence of the majority of fungal diseases in SA.

Results. Estimates for the annual incidence of HIV-related life-threatening fungal disease include cryptococcal meningitis (8 357 cases), Pneumocystis pneumonia (4 452 cases) and endemic mycoses (emergomycosis, histoplasmosis and blastomycosis, with 100, 60 and 10 cases per year, respectively). We estimate 3 885 cases of invasive aspergillosis annually. The annual burden of candidaemia and Candida peritonitis is estimated at 5 421 and 1 901 cases, respectively. The epidemic of pulmonary TB has probably driven up the prevalence of chronic pulmonary aspergillosis to 99 351 (175.8/100 000), perhaps the highest in the world. Fungal asthma probably affects >100 000 adults. Mucosal candidiasis is common, with an annual prevalence estimated at 828 666 and 135 289 oral and oesophageal cases, respectively, complicating HIV infection alone (estimates in other conditions not made), and over a million women are estimated to be affected by recurrent vulvovaginal candidiasis each year. Tinea capitis in children is common and conservatively estimated at >1 000 000 cases. The inoculation mycoses sporotrichosis, chromoblastomycosis and eumycetoma occur occasionally (with 40, 40 and 10 cases estimated, respectively). Overall, we estimate that over 3.2 million South Africans are afflicted by a fungal disease each year (7.1% of the population).

Conclusions. Significant numbers of South Africans are estimated to be affected each year by fungal infections, driven primarily by the syndemics of HIV, TB and poverty. These estimates emphasise the need for better epidemiological data, and for improving the diagnosis and management of these diseases.

Authors' affiliations

I S Schwartz, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

T H Boyles, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa

C R Kenyon, University of Cape Town, South Africa; Institute of Tropical Medicine, Antwerp, Belgium

J C Hoving, AFGrica Unit, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa

G D Brown, AFGrica Unit, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Medical Research Council Centre for Medical Mycology at the University of Aberdeen, Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, UK

D W Denning, University of Manchester and National Aspergillosis Centre, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester Academic Health Science Centre, UK; Global Action Fund for Fungal Infections, Geneva, Switzerland

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Fungal infection; Mycosis; Mycoses; Mycology; Public health; Epidemiology; Estimate

Cite this article

South African Medical Journal 2019;109(11):885-892. DOI:10.7196/SAMJ.2019.v109i11.13718

Article History

Date submitted: 2019-10-31
Date published: 2019-10-31

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