The true burden of fungal infection in Pakistan is
unknown. High-risk populations for fungal infections [tuberculosis
(TB), diabetes, chronic respiratory diseases, asthma,
cancer, transplant and human immunodeficiency virus (HIV)
infection] are numerous. Here, we estimate the burden of fungal
infections to highlight their public health significance.
Whole and at-risk population estimates were obtained from
the WHO (TB), BREATHE study (COPD), UNAIDS (HIV),
GLOBOCAN (cancer) and Heartfile (diabetes). Published data
from Pakistan reporting fungal infections rates in general
and specific populations were reviewed and used when applicable.
Estimates were made for the whole population or specific
populations at risk, as previously described in the LIFE
methodology. Of the 184,500,000 people in Pakistan, an estimated
3,280,549 (1.78%) are affected by a serious fungal
infection, omitting all cutaneous infection, oral candidiasis
and allergic fungal sinusitis, which we could not estimate.
Compared with other countries, the rates of candidaemia
(21/100,000) and mucormycosis (14/100,000) are estimated
to be very high, and are based on data from India. Chronic
pulmonary aspergillosis rates are estimated to be high (39/
100,000) because of the high TB burden. Invasive aspergillosis
was estimated to be around 5.9/100,000. Fungal keratitis is
also problematic in Pakistan, with an estimated rate of 44/
100,000. Pakistan probably has a high rate of certain life- or
sight-threatening fungal infections.