Number of infections per underlying disorder per year ESTIMATING THE BURDEN OF FUNGAL INFECTIONS IN MALAWI Khumbo Kalua1, Boston Zimba1 and David W. Denning2 1.Blantyre Institute for Community Outreach (BICO), Malawi 2.The University of Manchester and The National Aspergillosis Centre in association with the LIFE program at www.LIFE-Worldwide.org. Email – director@bicomalawi.org Table 1. Burden of fungal infections in Malawi Introduction Malawi is a small land locked densely populated poor country in the Southern part of Africa. As no serious attempt has been made to estimate the number of serious fungal infections in Malawi previously, we have attempted this, based on at risk population data and published rates. Infection Number of infections per underlying disorder per year Total burden Rate /100K None HIV/AIDS Respiratory Cancer/Tx ICU Cryptococcal Meningitis   12,000 80 Pneumocystis Pneumonia 10,800 72 Invasive Aspergillosis 90 0.6 Chronic pulmonary Apergillosis post TB 2,329 15.5 Allergic bronchopulmonary aspergillosis ABPA 14,010 93 Severe Asthma with fungal sensitization SAFS 18,493 123 Candideamia 525 225 750 5 Candida Peritonitis 113  113 0.75 Oral Candidiasis 432,000 2,880 Oesophageal Candidiasis 121,000 807 Recurrent Candida vaginitis (>_4x/year) 251,597 3,355 Mucormycosis 3  3 0.02 Histoplasmosis ?  Fungal keratitis 3,650  3,650 20.6 Tinea capitis 670,943  670,943 3,780 Total burden estimated 926,190 575,800 32,503 2,857 338 1,537,688 Methods A full literature search was done to identify all epidemiology papers reporting fungal infection rates from Malawi. We used specific populations at risk and fungal infection frequencies in the population to estimate national incidence or prevalence. Sources included the Malawi National statistical office (NSO), the Ministry of Health Population and Demographic survey of 2016, the 2015/16 HIV infection and AIDS rates from National Aids commission (NAC) WHO TB statistics, 2015; COPD rates from report Prevalence and future approach for prevention and control of Respiratory Diseases Results The Malawi population is approximately 17.7 million with 48% under 15 years of age. Approximately 8% of the population is HIV positive. The total estimated burden of fungal infections is 1,535,678. Among these, the most common infections are present in HIV/AIDS patients, with oral candidiasis (approximately 432,000 cases) being the commonest. Among common life threatening infections among the HIV/AIDS patients include cryptococcal meningitis (with 10% of AIDS patients presenting with the disease), and Pneumocystis pneumonia (9% of AIDS patients presenting with this). Pulmonary TB is present in approximately 11,000 cases per year, but extrapulmonary TB is rare. The prevalence of severe asthma with fungal sensitization SAFS is 14,010. Mucormycosis and histoplasmosis are rarely seen. Tinea capitis is estimated to be present in over 600,000 people. The incidence of fungal keratitis was estimated based on the annual number of cases seen in one department. African histoplasmosis (dubosiii), fungal keratitis, orbital mucormycosis and CPA with an aspergilloma Conclusion Fungal infections in Malawi are very common, and dominated by tinea capitis, recurrent vaginal candidiasis, oral and oesophageal candidiasis, and candidaemia. Among the most serious infections, cryptococcal meningitis and Pneumocystis pneumonia are on the top list. These basic estimates are limited, due to poor record data keeping, and require epidemiological studies to validate or modify the substantial burden. The number of reported cases of chromoblastomycosis in different countries (fromwww.gaffi.org/wp-content/uploads/chromobastomycosis-briefing-document-Nov-2014.pdf ) References 1. Msyamboza et al.: Burden of cancer in Malawi; common types, incidence and trends: National population-based cancer registry. BMC Research Notes 2012 5:149. 2. Lavy C, Tindall A, Steinlechner C, Mkandawire N, Chimangeni S. Surgery in Malawi – A National Survey of Activity in Rural and Urban Hospitals. annals. 2007 Oct 1;89(7):722–4. 3. Banda LT et al. Cancer incidence in Blantyre, Malawi 1994±1998. Tropical Medicine and International Health volume 6 no 4 pp 296±304 April 2001