After decades without an extensive survey of fungal death in America, the results are in. Fungi are more disease, more death, and is severely undercounted. Mitsuru Toda, PhD, Epidemic Intelligence Service officer in the CDC’s Mycotic Diseases Branch and Tom M. Chiller, MD, the chief of the Mycotic Diseases Branch at the CDC evaluated deaths due to fungi by examining data from 1999 to 2018.
Infectious Disease Special Edition’s coverage of the new fungal mortality study said 1 in 500 deaths had fungi as a contributing factor.
“Historically, viruses and bacteria have had the spotlight in infectious diseases, and fungal diseases have taken a back seat”
The highest mortality rates were listed as “unspecified mycoses,” and Toda admitted they are not sure what that means, but it is not uncommon for physicians to list unspecified fungal disease in their records, she said.
Candidiasis and aspergillosis were the second- and third-leading causes of fungal deaths, Toda said.
Rates of coccidioidomycosis, while generally low, have fluctuated greatly over the past 20 years, and have risen strikingly from a low in 2015. “The reasons for the possible changes in coccidioidomycosis deaths are not well understood,” Chiller said. “However, the recent increase in mortality parallels increases in reported cases according to national surveillance data.”
Generally, both Toda and Chiller cautioned that fungal diseases are likely underreported. Fungal disease diagnosis can be difficult; death certificates frequently mention only a vague “unspecified mycoses”; and autopsy rates in the United States are low, being conducted in an average of 7% of annual deaths, so they are less likely to be found postmortem.
“Given the issues that fungal diseases are often misdiagnosed or not diagnosed at all, that training on death certificates may be limited, and that autopsies are not done routinely, we do not actually know what the true death burden may be,” Chiller said. “We believe fungal disease mortality is higher than what we report in the study.”
With Valley Fever’s frequent misdiagnosis and mistreatment, it would be interesting for further studies to see its role in the “unspecified mycoses” that contribute to so many deaths.
Infectious Disease Special Edition’s full story by Ethan Covey is available here:
Valley Fever Survivor presents David Filip’s previous interview with Dr Chiller about the then-recent discovery of Valley Fever in Washington State: