Gugnani H C, Denning D W
Department of Microbiology and Epidemiology, St James School of Medicine, Kralendjik, Bonaire (Dutch Caribbean), West Indies.
The University of Manchester, Manchester Academic Health Science, Manchester, United Kingdom.
West Indian Med J. 2015 Jun;64(3):245-9. doi: 10.7727/wimj.2014.204. Epub 2015 Apr 28.
Jamaica is one of the largest countries in the Caribbean with a population of 2 706 500. Prevalence of human immunodificency virus (HIV) in Jamaica is high, while that of tuberculosis (TB) is recorded to be low. In this study, we have estimated the burden of serious fungal infections and some other mycoses in Jamaica.
All published papers reporting on rates of fungal infections in Jamaica and the Caribbean were identified through extensive search of the literature. We also extracted data from published papers on epidemiology and from the World Health Organization (WHO) TB Programme and UNAIDS. Chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) rates were derived from asthma and TB rates. Where there were no available data on some mycoses, we used specific populations at risk and frequencies of fungal infection of each to estimate national prevalence.
Over 57 600 people in Jamaica probably suffer from serious fungal infections each year, most related to 'fungal asthma' (ABPA and SAFS), recurrent vulvovaginal candidiasis and AIDS-related opportunistic infections. Histoplasmosis is endemic in Jamaica, though only a few clinical cases are known. Pneumocystis pneumonia is frequent while cryptococcosis and aspergillosis are rarely recorded. Tinea capitis is common in children. Recurrent vulvovaginal candidiasis is very common (3154/100 000) and candidaemia occurs. Subcutaneous mycoses such as chromoblastomycosis and mycetoma also seem to be relatively common.
Local epidemiological studies are urgently required to validate or modify these estimates of serious fungal infections in Jamaica.
牙买加是加勒比地区最大的国家之一，人口为2706500。牙买加的人类免疫缺陷病毒（HIV）患病率很高，而结核病（TB）的患病率据记载较低。在本研究中，我们估算了牙买加严重真菌感染和其他一些真菌病的负担。
通过广泛检索文献，找出所有报道牙买加和加勒比地区真菌感染率的已发表论文。我们还从已发表的流行病学论文以及世界卫生组织（WHO）结核病规划和联合国艾滋病规划署提取了数据。慢性肺曲霉病（CPA）、变应性支气管肺曲霉病（ABPA）和真菌致敏性重度哮喘（SAFS）的发病率是根据哮喘和结核病发病率推算出来的。对于某些真菌病若没有可用数据，我们使用特定的高危人群及其各自的真菌感染频率来估算全国患病率。
牙买加每年可能有超过57600人患有严重真菌感染，大多数与“真菌性哮喘”（ABPA和SAFS）、复发性外阴阴道念珠菌病以及艾滋病相关机会性感染有关。组织胞浆菌病在牙买加呈地方性流行，不过已知的临床病例很少。肺孢子菌肺炎很常见，而隐球菌病和曲霉病很少有记录。头癣在儿童中很常见。复发性外阴阴道念珠菌病非常常见（3154/100000），并且会发生念珠菌血症。诸如着色芽生菌病和足菌肿等皮下真菌病似乎也相对常见。
迫切需要开展当地流行病学研究，以验证或修正牙买加这些严重真菌感染的估算数据。
