1. * rate for adult females only An estimation of burden of serious fungal infections in France Jean-Pierre Gangneux 1, Marie-Elisabeth Bougnoux 2, Cendrine Godet 3, David W. Denning 4 and Bertrand Dupont 2 1. Rennes Teaching Hospital, France, 2. Hôpital Necker Enfants maladies Teaching Hospital, Paris, France, 3.Poitiers Teaching Hospital, Poitiers, France, 4. The University of Manchester and National Aspergillosis Centre, University Hospital of South Manchester, UK, in association with the LIFE program at www.LIFE-worldwide.orgwww.LIFE-worldwide.org Introduction Our objective was to estimate the burden of serious fungal diseases in France, based on epidemiological data. Epidemiology of several of them remains unknown, whereas precise data are available for invasive fungal infections such as invasive aspergillosis, candidaemia, cryptococcosis and pneumocystosis. Herein, we report an estimation of the incidence and prevalence of invasive but also chronic and immunoallergic fungal diseases in mainland France in order to provide a basis of reflection in terms of Public Health Methods Published epidemiology papers reporting fungal infection rates from France were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence, depending on the condition. Population statistics were derived from the Institut National de la Statistique et des Etudes Economiques (INSEE-2014). Incidences of invasive fungal infections were derived from Institut National de Veille Sanitaire (InVS) and the National Reference Center for invasive fungal diseases (CNR-MA, Institut Pasteur)(2010) Results 82% of the 65.8 M population (2014) are adults. The asthma prevalence in adults is 6.7% and 7.5% of >45 years old for COPD. In this context, the model predicts 124,678 severe asthma with fungal sensitization (SAFS) episodes (189 cases/100,000 adults per year), 95,361 allergic bronchopulmonary aspergillosis (ABPA) episodes (145/100,000) and 3,450 chronic pulmonary aspergillosis cases (109/100,000)(Table 1). These high estimated burdens indicate that such patients should be better identified and characterized in order to improve their management. Good estimates of incidence rates of documented invasive fungal diseases are available: 3.6/100,000 for candidaemia, 1.8/100,000 for invasive aspergillosis (IA), 1/100,000 for pneumocystosis, 0.2/100,000 for cryptococcosis and 0.12 for mucormycosis. However our estimate of IA complicating COPD is 1,300 cases against a smaller documented number whatever the underlying condition, suggesting a major diagnostic gap, which may be also be true for pneumocystosis. These severe infections have persistently high mortality rates and represent high costs due to hospitalization, diagnostic management and antifungal drugs use. Finally, estimates of Candida peritonitis, oesophageal candidiasis and recurrent vaginal candidiasis rates are O.74/100,000, 13.8/100,000 and 2,220/100,000, underline the need for adjusting such potential high burdens with additional studies Conclusion Using local and literature data of the incidence or prevalence of fungal infections, approximately 1,000,000 (1.47%) people in France are estimated to suffer from serious fungal infections each year. Beside a good evaluation of 5,000 cases/year of invasive fungal diseases, recurrent vaginitis and chronic and immunoallergic pulmonary diseases represent a serious impact on human health. Prospective or comprehensive registry surveys are required to accurately determine their epidemiology and improve the management of these disorders InfectionNumber of infections per underlying disorder per year Rate/100 K Total burden None/ other HIV/AIDSRespiratoryCancer/TxICU Oesophageal candidiasis -9,075-?- 13.89,075 Candidaemia 53328851,134590 3.62,370 Candida peritonitis 249---237 0.74486 Recurrent vaginal candidiasis (4x/year +) 730,690----2,220*730,690 ABPA--95,331--14595,331 SAFS --124,678 189124,678 Chronic pulmonary aspergillosis --3,450--1093,450 Invasive aspergillosis 15117978001201.81,185 Mucormycosis 10--69-0.1279 Cryptococcosis 3276221-0.2131 Pneumocystis pneumonia 614494144-1658 Total burden estimated 731,7269,645223,6472,168947 968,143 References Bitar EID 2014; Bitar BEH 2013; Lortholary CMI 2011; Gangneux RMR 2010; Leroy CCM 2009; Montravers CMI 2011; Rodriguez CMI 2015; Denning Clin Trans Allerg 2014; Denning Med Mycol 2013; Denning Thorax 2015 Websites -Institut National de Veille Sanitaire: www.invs.sante.frwww.invs.sante.fr -Centre National de Référence des Infections fongiques invasives et antifongiques: www.pasteur.fr/fr/sante/centres-nationaux-reference/les-cnr/mycoses-invasives- et-antifongiques www.pasteur.fr/fr/sante/centres-nationaux-reference/les-cnr/mycoses-invasives- et-antifongiques -French Society for Medical mycology: www.sfmm-mycologie-medicale.comwww.sfmm-mycologie-medicale.com Table 1. Burden of serious fungal infections in France Contact Prof J-P Gangneux Laboratoire de Parasitologie-Mycologie, CHU de Rennes 2 rue Henri le Guilloux, 35000 Rennes, France. Jean-pierre.gangneux@chu-rennes.fr Figure 1. Distribution of species responsible for tinea capitis in France The exact count of tinea capitis recorded in 2014 from 30 representative hospitals is 808 cases. The global prevalence remains to be estimated at the level of the French population. A huge predominance of anthropophilic dermatophytes is observed. National Reference Center Teaching hospitals