1. Maria N. Gamaletsou 1,2, David Denning 1, and Nikolaos V. Sipsas 2 1 The National Aspergillosis Centre, University Hospital of South Manchester and The University of Manchester, Manchester, UK, and 2 Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece, in association with the LIFE program at www.LIFE-worldwide.org Burden of serious fungal infections in Greece Background and Aim Fungal infections are a growing global problem that is difficult to calculate in terms of prevalence, mortality, and impact on public health and economy, especially in resource deprived countries. Epidemiological data on fungal infections are scarce, due to the lack of surveillance systems and population-based epidemiological studies. Under- reporting is common, because superficial fungal infections are diagnosed and treated by general practitioners, while invasive fungal infections are notoriously difficult to be diagnosed. Global estimates of cutaneous fungal infections, invasive fungal infections, chronic pulmonary aspergillosis after pulmonary tuberculosis, and sarcoidosis and allergic bronchopulmonary aspergillosis complicating asthma have recently been published; yet, these data on fungal infections worldwide are crude estimates that have not been standardized. The aim of this work is to calculate for the first time the burden of fungal infections in Greece, a country with an estimated population of 10.8 million, as part of a multi-national project that attempts to collect estimates from several countries worldwide in order to establish a better understanding of the current state of fungal infection globally. Estimates of the incidence and prevalence of serious fungal infections, based on epidemiological data, are essential in order to raise the awareness and design public health interventions to prevent fungal infections, given the limited modalities to diagnose and treat these diseases. Results Methods  A thorough literature search for papers reporting epidemiological data on serious fungal infections in Greece was performed.  For fungal infections where no Greek data existed, we used a structured set of assumptions to estimate their burden, based on specific population with risk factors for fungal infection, such as immunosuppression, chronic disease, and surgical procedures.  Population statistics were derived from the Greek Statistics Authority and the latest (2011) population census.  Data on HIV/AIDS (2014) were obtained from the Hellenic Centre for Disease Control and Prevention  Data for transplantations (2012) from the National Organization for Transplantation  Data for tuberculosis from the World Health Organization (2012)  Data on COPD, cystic fibrosis, asthma, abdominal surgeries, vulvo-vaginal candidiasis form the relevant scientific Greek societies  Data on the number of critical care beds and hospital admissions from the Greek Ministry of Health. Conclusions  According to our calculations ~ 300,000 (2.72%) people in Greece suffer from fungal infections each year.  This is the first attempt to determine the burden of fungal disease in Greece and provides a crude estimate on its impact on public health.  10.8 M population  85.5% are adults,  53% are women, 27.4% women are over 60 years and 40.3% over 50;  27% of population are >=60 years old.  Estimates are:  243,567 Greek women get recurrent vaginal thrush (>=4x/yr).  Of 14,434 HIV positive patients, 1,732 are not receiving ARVs. Oral candidiasis is estimated to occur at least once in 90% of patients with CD4 cell counts <200/uL and oesophageal candidiasis in 20%. We estimated that there are 1.296 cases of oral candidiasis and 353 cases of esophageal candidiasis. 2 (2%) of 107 new AIDS cases each year develop cryptococcal meningitis. Annual incidence of Pneumocystis pneumonia is 0.26 cases/100,000 in HIV+ patients, 28 cases.  Of the 500 cases of TB in 2012, 45 with AIDS, it is estimated that 22 new cases of chronic pulmonary aspergillosis (CPA) occurred and that the 5-year period prevalence is 347 cases (assuming 15% annual mortality). As CPA occurs in multiple other conditions including COPD a prevalence of 1,388 cases is estimated.  Estimates of asthma prevalence in adults are about 9% and assuming 2.5% of asthmatics have ABPA, 20,805 patients with ABPA are likely and 26,500 with SAFS.  Assuming the rate of candidemia in Greece is 5.0/100,000 population there are 541 cases. We have estimated 81 cases of post-surgical candida peritonitis (~60,000 abdominal surgeries/yr).  Invasive aspergillosis in immunocompromised patients is estimated at 1,125 patients annually including 85 cases in intensive care.  For mucormycosis, there were 12 cases annually, and  We estimated 56 cases of tinea capitis. 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