Deaths from fungal infections increased in the United States in 2020 and 2021 compared with previous years, with Aspergillus and Candida infections driving COVID-19-associated fungal deaths, researchers found.
“We performed this study because we wanted to provide more comprehensive data about the burden of fungal infections in the United States,” Jeremy A.W. Gold, MD, MS, a medical epidemiologist at the CDC and former Epidemic Intelligence Service officer in the CDC’s Mycotic Diseases Branch, told Healio.
“We know that COVID-19-associated fungal infections cause severe illness, but comprehensive data on this problem were lacking,” Gold said.
Gold and colleagues analyzed national data on the number and age-adjusted rates per 100,000 people of fungal deaths by fungal pathogen, COVID-19 association, demographic characteristics and year from January 2018 through December 2021.
Statistics were similar in the first 2 years of the study — 4,746 and 4,833 fungal deaths in 2018 and 2019, respectively, with a rate of 1.2 per 100,000 people in both years. But those numbers jumped to 5,922 and 1.5 in 2020 and continued to rise to 7,199 and 1.8 in 2021, according to the study.
Of the 13,121 fungal deaths recorded in 2020 and 2021, 2,868 (21.9%) were associated with COVID-19.
According to the study, COVID-19-associated fungal deaths more frequently involved Candida (27.1%) and Aspergillus (23.3%) and less frequently involved other specific fungal pathogens. Gold and colleagues also found that fungal death rates were generally highest in non-white and non-Asian populations, although death rates from Aspergillus infections specifically were two times higher in the Pacific U.S. census division compared with most other divisions.
“These data underscore the need for increased efforts to identify at-risk populations and to address conditions that exacerbate disparities in fungal disease burden, including inequities in the social determinants of health — for example, limited access to health care,” Gold said.
He said other factors linked to inequities in social determinants of health likely contributed to the disparities, including underlying conditions that increase a person’s risk for fungal disease.
“We want clinicians to know that fungal diseases cause substantial mortality and that this burden has increased during the COVID-19 pandemic,” Gold said. “We hope that our study will promote increased awareness among clinicians of fungal diseases, particularly in COVID-19 patients, as earlier testing and treatment for fungal infections can save lives.”