{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:52:05Z","timestamp":1787028725101,"version":"build-2736575974"},"reference-count":59,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T00:00:00Z","timestamp":1516233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"None"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Objective: To estimate the burden of fungal infections in Jordan for the first time. Material and Methods: Population data was from UN 2011 statistics and TB cases from WHO in 2012. Fewer than 100 patients with HIV were recorded in Jordan in 2013. Approximately 100 renal transplants and eight liver transplants are performed annually. There were 12,233 major surgical procedures in Jordan in 2013, of which 5.3% were major abdominal surgeries; candidemia was estimated in 5% of the population based on other countries, with 33% occurring in the ICU. Candida peritonitis\/intra-abdominal candidiasis was estimated to affect 50% of the number of ICU candidemia cases. No adult asthma rates have been recorded for Jordan, so the rate from the Holy Land (8.54% clinical asthma) from To et al. has been used. There are an estimated 49,607 chronic obstructive pulmonary disease (COPD) patients in Jordan, with 64% symptomatic, 25% Gold stage 3% or 4%, and 7% (3472) are assumed to be admitted to hospital each year. No cystic fibrosis cases have been recorded. Literature searches on fungal infections revealed few data and no prevalence data on fungal keratitis or tinea capitis, even though tinea capitis comprised 34% of patients with dermatophytoses in Jordan. Results: Jordan has 6.3 million inhabitants (65% adults, 6% are &gt;60 years old). The current burden of serious fungal infections in Jordan was estimated to affect ~119,000 patients (1.9%), not including any cutaneous fungal infections. Candidemia was estimated at 316 cases and invasive aspergillosis in leukemia, transplant, and COPD patients at 84 cases. Chronic pulmonary aspergillosis prevalence was estimated to affect 36 post-TB patients, and 175 in total. Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) prevalence in adults with asthma were estimated at 8900 and 11,748 patients. Recurrent vulvovaginal candidiasis was estimated to affect 97,804 patients, using a 6% rate among women 15\u201350 years of age. Conclusion: Based on local data and literature estimates of the frequency of mycoses in susceptible populations, at least 1.9% of Jordanians have some form of serious fungal disease.<\/jats:p>","DOI":"10.3390\/jof4010015","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T12:19:48Z","timestamp":1516277988000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Burden of Serious Fungal Infections in Jordan"],"prefix":"10.3390","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2242-6232","authenticated-orcid":false,"given":"Jamal","family":"Wadi","sequence":"first","affiliation":[{"name":"The Medical Center, Jordan Hospital and Medical Center, 29 Adeeb Wahbeh Street, 11118 Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-2251","authenticated-orcid":false,"given":"David","family":"Denning","sequence":"additional","affiliation":[{"name":"Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M23 9LT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,1,18]]},"reference":[{"key":"ref_1","unstructured":"(2017, March 24). WHO TB Stats 2011. Available online: http:\/\/apps.who.int\/iris\/bitstream\/10665\/44728\/1\/9789241564380 eng.pdf."},{"key":"ref_2","unstructured":"(2107, March 24). WHO World Health Stats 2009. Available online: http:\/\/www.who.int\/whosis\/whostat\/2009\/en\/."},{"key":"ref_3","unstructured":"The Hashemite Kingdome of Jordan (2017, May 04). Geography and Environment, Available online: http:\/\/www.kinghussein.gov.jo\/geo_env1.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1023\/A:1007009218316","article-title":"Prevalence of dermatophytoses in the Zarqa district of Jordan","volume":"145","author":"Malek","year":"1999","journal-title":"Mycopathologia"},{"key":"ref_5","unstructured":"(2017, June 04). Atlas of Jordan. Available online: https:\/\/commons.wikimedia.org\/wiki\/Atlas_of_Jordan."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3314\/jjmm.48.1","article-title":"Trends in the epidemiology of Invasive Fungal Infections","volume":"48","author":"Warnock","year":"2007","journal-title":"Jpn. J. Med. Mycol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"95","DOI":"10.2147\/TCRM.S40160","article-title":"Epidemiology and risk factors for invasive candidiasis","volume":"10","author":"Yapar","year":"2014","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3201\/eid2007.140087","article-title":"Population-Based Analysis of Invasive Fungal Infections, France, 2001\u20132010","volume":"20","author":"Bitar","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Pfaller, M.A., and Diekema, D.J. (2007). Epidemiology of Invasive Candidiasis: A Persistent Public Health Problem. Clin. Microbiol. Rev., 133\u2013163.","DOI":"10.1128\/CMR.00029-06"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"To, T., Stanojevic, S., Moores, G., Gershon, A.S., Bateman, E.D., Cruz, A.A., and Boulet, L.P. (2012). Global asthma prevalence in adults: Findings from the cross-sectional world health survey. BMC Public Health, 19.","DOI":"10.1186\/1471-2458-12-204"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1016\/S0954-6111(12)70016-1","article-title":"Chronic obstructive pulmonary disease and associated healthcare resource consumption in the Middle East and North Africa: The BREATHE study","volume":"106","author":"Polatli","year":"2012","journal-title":"Respir. Med."},{"key":"ref_12","first-page":"753","article-title":"Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers","volume":"9","author":"Omari","year":"2014","journal-title":"Int. J. COPD"},{"key":"ref_13","unstructured":"(2017, June 04). WHO: Tuberculosis. Available online: http:\/\/www.who.int\/tb\/country\/data\/profiles\/en\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1183\/09031936.00054810","article-title":"Underlying pulmonary disease frequency in patients with chronic pulmonary aspergillosis","volume":"37","author":"Smith","year":"2011","journal-title":"Eur. Resp. J."},{"key":"ref_15","unstructured":"(2017, June 04). International Agency for Research on Cancer: All Cancers (Excluding Non-Melanoma Skin Cancer), Estimated Incidence, Mortality and Prevalence Worldwide in 2012. Available online: http:\/\/globocan.iarc.fr\/old\/FactSheets\/cancers\/cervix-new.asp."},{"key":"ref_16","unstructured":"(2017, June 04). Jordan Cancer Registry Reports (2006\u20132010), Available online: http:\/\/www.moh.gov.jo\/Pages\/viewpage.aspx?pageID=248."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1111\/j.1469-0691.2011.03548.x","article-title":"French Mycosis Study Group. Epidemiological trends in invasive aspergillosis in France: The SAIF network (2005\u20132007)","volume":"17","author":"Lortholary","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1097\/QAD.0b013e32833a3967","article-title":"HOPS Investigators. AIDS-defining opportunistic illnesses in US patients, 1994\u20132007: A cohort study","volume":"24","author":"Buchacz","year":"2010","journal-title":"AIDS"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3109\/00365549009027119","article-title":"Trends and patterns of opportunistic diseases in Danish AIDS patients 1980\u20131990","volume":"22","author":"Smith","year":"1990","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/j.1601-0825.2000.tb00110.x","article-title":"Occurrence of oral lesions in relation to clinical and immunological status among HIV-infected adult Tanzanians","volume":"6","author":"Matee","year":"2000","journal-title":"Oral. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s00520-010-0892-z","article-title":"A systematic review of oral fungal infections in patients receiving cancer therapy","volume":"18","author":"Lalla","year":"2010","journal-title":"Support. Care Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1086\/514653","article-title":"Oropharyngeal Candidiasis as a Marker for Esophageal Candidiasis in Patients with Cancer","volume":"27","author":"Samonis","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1111\/j.1469-0691.2010.03360.x","article-title":"A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units","volume":"17","author":"Montravers","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.ijantimicag.2010.08.010","article-title":"The Nationwide Austrian Aspergillus Registry: A prospective data collection on epidemiology, therapy and outcome of invasive mould infections in immunocompromised and\/or immunosuppressed patients","volume":"36","author":"Perkhofer","year":"2010","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3109\/13693786.2012.738312","article-title":"Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults","volume":"51","author":"Denning","year":"2013","journal-title":"Med. Mycol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/S0140-6736(07)60917-9","article-title":"Vulvovaginal candidosis","volume":"369","author":"Sobel","year":"2007","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.1038\/bmt.2008.126","article-title":"Bone marrow and stem cell transplantation at King Hussein cancer center","volume":"42","author":"Hussein","year":"2008","journal-title":"Bone Marrow Transplant."},{"key":"ref_28","unstructured":"Albarrag, A.M., Al-Abdely, H.M., Khalid, N.F.A., and Denning, D.W. (2017, June 05). Burden of Serious Fungal Infections in Saudi Arabia. Available online: http:\/\/life-worldwide.org\/assets\/uploads\/files\/ICAAC%202014_%20Fungal%20BurdenSaudi.pdf."},{"key":"ref_29","unstructured":"Karzan, M.A., Ismael, H.M., Shekhany, K.A., Al-Attraqhchi, A.A.F., Abdullah, S., Aldabbagh, R., and Denning, D.W. (2014, January 10\u201313). Burden of serious fungal infection in Iraq. Proceedings of the 24th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Barcelona, Spain."},{"key":"ref_30","unstructured":"Zaki, S.M., and Denning, D. (2017, June 05). The Burden of Serious Fungal Infections in Egypt. Available online: http:\/\/life-worldwide.org\/assets\/uploads\/files\/Egypt.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Chekiri-Talbi, M., and Denning, D.W. (2017). Burden of fungal infections in Algeria. Eur. J. Clin. Microbiol. Infect. Dis.","DOI":"10.1007\/s10096-017-2917-8"},{"key":"ref_32","unstructured":"(2017, June 05). International Agency for Research on Cancer: Estimated Age-Standardised Incidence and Mortality Rates: Men. Available online: http:\/\/globocan.iarc.fr\/Pages\/fact_sheets_population.aspx."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1097\/MCC.0b013e32833e84d2","article-title":"Epidemiology of invasive candidiasis","volume":"16","author":"Arendrup","year":"2010","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_34","unstructured":"Dufresne, S.F., Sheppard, D.C., and Denning, D.W. (2015). Estimating the Burden of Serious Fungal Diseases in Canada, International Society of Human and Animal Mycology (ISHAM)."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.mycmed.2016.11.001","article-title":"LIFE program, the Soci\u00e9t\u00e9 fran\u00e7aise de mycologie m\u00e9dicale SFMM-study group. An estimation of burden of serious fungal infections in France","volume":"26","author":"Gangneux","year":"2016","journal-title":"J. Mycol. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.respe.2012.03.007","article-title":"Estimating the burden of mucormycosis infections in France (2005\u20132007) through a capture-recapture method on laboratory and administrative data","volume":"60","author":"Bitar","year":"2012","journal-title":"Revue d\u2019E\u00b4 pide\u00b4miologie et de Sante\u00b4 Publique"},{"key":"ref_37","unstructured":"(2017, June 05). Global Action Fund for Fungal Infections: Epidemiological Studies. Available online: www.gaffi.org\/where\/epidemiological-studies\/."},{"key":"ref_38","unstructured":"(2017, June 05). Global Action Fund for Fungal Infections: The Burden of Fungal Disease: New Evidence to Show the Scale of the Problem across the Globe. Available online: www.gaffi.org\/the-burden-of-fungal-disease-new-evidence-to-show-the-scale-of-the-problem-across-the-globe\/."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3314\/jjmm.49.165","article-title":"Overview of Opportunistic Fungal Infections in India","volume":"49","author":"Chakrabarti","year":"2008","journal-title":"Jpn. J. Med. Mycol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1093\/cid\/cis021","article-title":"Impact of Treatment Strategy on Outcomes in Patients with Candidemia and Other Forms of Invasive Candidiasis: A Patient-Level Quantitative Review of Randomized Trials","volume":"54","author":"Andes","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_41","unstructured":"Zhu, L., Wu, J., Perlin, D.S., and Denning, D.W. (2013, January 27\u201330). Burden of serious fungal infections in China. Proceedings of the 23rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Berlin, Germany."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jinf.2016.10.005","article-title":"Estimating the burden of invasive and serious fungal disease in the United Kingdom","volume":"74","author":"Pegorie","year":"2017","journal-title":"J. Infect."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.cmi.2014.07.013","article-title":"Burden of serious fungal infections in Spain","volume":"21","author":"Gago","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/myc.12382","article-title":"Estimating the Burden of Fungal Disease in Vietnam","volume":"58","author":"Beardsley","year":"2015","journal-title":"Mycoses"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/myc.12394","article-title":"Burden of serious fungal infections in Mexico","volume":"58","author":"Denning","year":"2015","journal-title":"Mycoses"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Medina, N., Samayoa, B., Lau-Bonilla, D., Denning, D.W., Herrera, R., Mercado, D., Guzm\u00e1n, B., P\u00e9rez, J.C., and Arathoon, E. (2017). Burden of serious fungal infections in Guatemala. Eur. J. Clin. Microbiol. Infect. Dis., 27.","DOI":"10.1007\/s10096-017-2920-0"},{"key":"ref_47","first-page":"107","article-title":"Burden of serious fungal infection in Nigeria","volume":"33","author":"Oladele","year":"2014","journal-title":"West Afr. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1111\/myc.12390","article-title":"Burden of serious fungal infections in Tanzania","volume":"58","author":"Faini","year":"2015","journal-title":"Mycoses"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/myc.12381","article-title":"Burden of fungal infections in Senegal","volume":"58","author":"Badiane","year":"2015","journal-title":"Mycoses"},{"key":"ref_50","unstructured":"Chen, S.-A., Slavin, M.A., Morrissey, C.O., Marriott, D., Thursky, K., Denning, D., and Sorrell, T.C. (2017, June 05). Burden of Serious Fungal Infections in Australia. Available online: http:\/\/life-worldwide.org\/assets\/uploads\/files\/ICAAC%20poster%20burdenaustralia.pdf."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S1473-3099(14)70068-4","article-title":"Access to antifungal medicines in resource-poor countries\u2013Authors\u2019 reply","volume":"14","author":"Loyse","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4103\/0022-3859.65276","article-title":"Liposomal amphotericin B (FungisomeTM) for the treatment of cryptococcal meningitis in HIV\/AIDS patients in India: A multicentric, randomised controlled trial","volume":"56","author":"Jadhav","year":"2010","journal-title":"J. Postgrad. Med."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Brown, G.D., Denning, D.W., Gow, N.A.R., Levitz, S.M., Netea, M.G., and White, T.C. (2012). Hidden Killers: Human Fungal Infections. Sci. Transl. Med., 4.","DOI":"10.1126\/scitranslmed.3004404"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1128\/JCM.02016-14","article-title":"Name Changes in Medically Important Fungi and Their Implications for Clinical Practice","volume":"53","author":"Chaturvedi","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.tim.2014.01.001","article-title":"A neglected epidemic: Fungal infections in HIV\/AIDS","volume":"22","author":"Meintjes","year":"2014","journal-title":"Trends Microbiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1093\/cid\/cix059","article-title":"World Health Organization Ranking of Antimicrobials According to Their Importance in Human Medicine","volume":"64","author":"Cohen","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.jiph.2013.08.002","article-title":"Clinical practice guidelines for the management of invasive Candida infections in adults in the Middle East region: Expert panel recommendations","volume":"7","author":"Alothmana","year":"2014","journal-title":"J. Infect. Public Health"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jiph.2013.08.002","article-title":"Clinical practice guidelines for the treatment of invasive Aspergillus infections in adults in the Middle East region: Expert panel recommendations","volume":"7","author":"Alothman","year":"2014","journal-title":"J. Infect. Public Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2147\/IDR.S97413","article-title":"Burden and treatment patterns of invasive fungal infections in hospitalized patients in the Middle East: Real-world data from Saudi Arabia and Lebanon","volume":"10","author":"Alothman","year":"2017","journal-title":"Infect. Drug Resist."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/4\/1\/15\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:51:41Z","timestamp":1760194301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/4\/1\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,18]]},"references-count":59,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,3]]}},"alternative-id":["jof4010015"],"URL":"https:\/\/doi.org\/10.3390\/jof4010015","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,18]]}}}