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      Burden of Fungal Infections in Nepal

      editorial
      1
      Nepal Journal of Epidemiology
      International Nepal Epidemiological Association

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          Abstract

          Sir, The national conference of the Society of Indian Human and Animal Mycologists (SIHAM 2016) was held in Shimla between 18-20 March 2016. This conference brought together medical microbiologists, clinicians, researchers, young scientists and students of medicine to one academic platform. A number of national and international faculty, whose passion for the subject was reflected by their presence and active participation in the congress, shared their views and vast experiences with the delegates through their deliberations meticulously covering the most important aspects of medical mycology that were of interest to the mycologists of India. Various current issues of significance like fungal infections in ICUs, allergic fungal diseases, antifungal drug resistance, newer fungal diagnostics were discussed. In this context, I like to draw the kind attention of all concerned that, the burden of fungal infections in Nepal has long been underestimated. Virtually, there is little attempt to explore the epidemiology of invasive, allergic and superficial fungal diseases in Nepal. A few diagnostic microbiology laboratories are equipped with standard facilities to appropriately diagnose these conditions. Not many institutions conduct any form of surveillance and epidemiological studies to estimate the fungal disease burden in the country. Recently, Khwakhali US and Denning DW [1] documented that a significant burden of serious fungal infections existed in Nepal that had a high morbidity and mortality rate. They provided preliminary data on fungal keratitis (73/10000 annually), chronic obstructive pulmonary disease contributing to invasive Aspergillosis ( 1119 cases annually) , in addition to highlighting the overall prevalence of ABPA, chronic pulmonary Aspergillosis, and oral and esophageal candidiasis in HIV/AIDS patients. There are only scanty documentations on emerging fungal diseases in Nepal. However, Supram HS et al [2] from Manipal Teaching Hospital, Pokhara in Western Nepal recently reported invasive infections in a group of hospitalized patients caused by Magnusiomyces capitatus, an emerging yeast. It is, therefore, needless to emphasize that there is a significant burden of existing as well as emerging fungal diseases in Nepal. It is high time that epidemiological studies be conducted to validate these issues. Dr Niranjan Nayak Professor, Department of Microbiolgy Manipal College of Medical Sciences And President SIHAM       Dated the 19th March 2016

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          Burden of serious fungal infections in Nepal.

          There are few reports of serious fungal infections in Nepal though the pathogenic and allergenic fungi including Aspergillus species are common in the atmosphere. Herein, we estimate the burden of serious fungal infections in Nepal. All published papers reporting fungal infection rates from Nepal were identified. When few data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence. Of the 27.3 M population, about 1.87% was estimated to suffer from serious fungal infections annually. We estimated the incidence of fungal keratitis at 73 per 100,000 annually. Chronic obstructive pulmonary disease is common with 215,765 cases, contributing to 1119 cases of invasive aspergillosis annually. Of 381,822 adult asthma cases, we estimated 9546 patients (range 2673-13,364) develop allergic bronchopulmonary aspergillosis and 12,600 have severe asthma with fungal sensitisation. Based on 26,219 cases of pulmonary tuberculosis, the annual incidence of new chronic pulmonary aspergillosis (CPA) cases was estimated at 1678 with a 5 year period prevalence of 5289, 80% of CPA cases. Of 22,994 HIV patients with CD4 counts <350 not on antiretrovirals, Pneumocystis pneumonia was estimated at 990 cases annually. Cases of oral and oesophageal candidiasis in HIV/AIDS patients were estimated at 10,347 and 2950, respectively. There is a significant burden of serious fungal infections in Nepal. Epidemiological studies are necessary to validate these estimates.
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            Emergence of Magnusiomyces capitatus infections in Western Nepal.

            Magnusiomyces capitatus is an emerging opportunistic yeast in the Mediterranean region. We report from Nepal one case of M. capitatus infection and six other cases of colonization/probable infection due to M. capitatus at a tertiary care center. Majority of the patients were immunocompromised, at extreme age, associated with comorbidities, and had history of close contact with livestock and poultry. The isolates were identified by phenotypic and genotypic (ITS and D1/D2 region of 26S rDNA sequence) methods. Molecular typing of the isolates was carried out by amplified fragment length polymorphism. Minimum inhibitory concentration (MIC) of the isolates for amphotericin B, caspofungin, fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, and micafungin were 2, 0.1-4, 2, 0.12-0.5, 0.12-0.5, 0.25, 1-4, and 1-4 μg/ml, respectively. Presence of M. capitatus infection was not known in Nepal, and the study should alert the clinicians and infectious disease specialists.
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              Author and article information

              Journal
              Nepal J Epidemiol
              Nepal J Epidemiol
              NJE
              Nepal Journal of Epidemiology
              International Nepal Epidemiological Association
              2091-0800
              June 2016
              30 June 2016
              : 6
              : 2
              : 584-585
              Affiliations
              [1 ] Department of Microbiology, Manipal College of Medical Sciences, , Pokhara , Nepal.
              Author notes
              Department of Microbiology, Manipal College of Medical Sciences, Pokhara , Nepal niruni2000@ 123456yahoo.com

              Conflict of interest:The author declares that he has no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

              Article
              10.3126/nje.v6i2.15167
              5073177
              07f69d7c-4fd2-433e-94d0-8f6f1fb80e79
              © CEA& INEA

              This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

              History
              : 19 March 2016
              : 20 June 2016
              : 20 June 2016
              Page count
              Figures: 0, Tables: 0, Equations: 0, References: 2, Pages: 2
              Funding
              Funding:The author received no financial support for the research, authorship, and/or publication of this article.
              Categories
              Letter to the Editor

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