Table 2.
Epidemiology of invasive aspergillosis in the MENA region
| Country | Study period | Setting | Incidence | Age of patients (% gender) | Number of isolates | Predisposing condition(s) | Causative agent | Sample type | Diagnostic tool | Mortality rate | Ref. |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Lebanon and KSA | 2011–2012 | Five hospitals (3 in Lebanon and 2 in KSA) |
1.21 cases/1000 discharges (Lebanon) 0.4 cases/1000 discharges (KSA) |
55.2 ± 25.1 y (54.9% males) |
102 with IFIs |
Diabetes (41%) Coronary artery disease (24%) Leukemia (19%) Moderate to severe renal disease (16%) Congestive heart failure and chronic pulmonary disease (15%) |
A. fumigatus (60%) A. niger (10%) A. flavus (10%). |
– |
Culture Chest radiograph CT Galactomannan PCR |
IFIs-related (33%) | [39] |
| Bahrain | 2009—2013 | The Salmaniya Medical Complex | – | 52.85 y | 60 |
Diabetes (23%) COPD (17%) Malignancy (15%) SOT (2%) Corticosteroid therapy (23%) Radiotherapy/chemotherapy (12%) Immunosuppressive therapy (7%) |
A. fumigatus (53%) A. niger (28%) A. flavus (12%) Aspergillus spp. (7%) |
Sputum (50%) ETA (30%) BAL (20%) |
Gram stain Direct sputum smear Culture Chest X-ray/CT |
Colonized patients (25%) Probable cases (44%) Putative cases (32%) |
[78] |
| Tunisia | December 2009 to November 2011 | Farhat Hached Hospital | 7.5% | 1–65 y* | 56 |
ALL AML |
A. niger (35%) A. flavus (38%) A. tubingensis (19%) A. fumigatus (4%) A. westerdijkiae (2%) A. ochraceus (2%) |
– |
Microscopy MALDI-TOF MS PCR CT scan |
– | [80] |
| Tunisia | December 2004–September 2007) | Hedi Chaker Hospital | 15% | – | 1680 |
AML ALL Neutropenia Medullar aplasia |
A. flavus (79.2%) A. niger (10%) A. ochraceus (2.3%) A. fumigatus (2.3%) |
BAL Effusion drainage Biopsies |
Microscopy Galactomannan detection by ELISA PCR |
– | [81] |
A.fumigatus Apergillus fumigatus, A. niger Aspergillus niger, A. flavus Aspergillus flavus, A. ochraceus Aspergillus ochraceus, A. westerdjikiae Aspergillus westerdjikiae, A. tubingensis Aspergillus tubingensis, AML acute myeloid leukemia, ALL acute lymphocytic leukemia, SOT solid organ transplantation, COPD chronic obstructive pulmonary disease, BAL bronchoalveolar lavage, CT computerized tomography, MALDI-TOF MS matrix-assisted laser desorption ionization time-of-flight mass spectrometry, ELISA enzyme-linked immunosorbent assay, PCR polymerase chain reaction, ETA endotracheal aspiration, IFIs invasive fungal infections, y years, KSA Kingdom of Saudi Arabia
*Significant association (p < 0.05)