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Home , Enterocytozoon bieneusi, Favus, Fusariosis, Invasive candidiasis, Microsporidiosis

Accepted Article Medical Sciences, Sari, Iran Iran Sari, Sciences, Medical Turkey Adana, Iran Bethesda, MD, USA National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), This by is protectedarticle reserved. Allrights copyright. doi: 10.1111/myc.12842 lead to differences between this version and the throughbeen the copyediting, pagination typesetting, which process, may and proofreading hasThis article been accepted publicationfor andundergone peerfull but review not has 7 6 5 4 3 2 1 Süleyha Hilmio inTurkey diseases fungal human serious of burden Estimated Article :Original type Article 0000-0002-1174-4182)DRILKIT : MACIT ID (Orcid DR SEYEDMOJTABA SEYEDMOUSAVI: 0000-0002-6194-7447) (Orcid ID 402-5139. (301) E-mail:[email protected]+1 Tel: BG 10RM 11C106, 10CENTER DR, Rockville 9000 Pike, Bethesda, MD 20892, United States of *Address correspondence to: UK 9LT, M23 Manchester Centre, Science Health Academic Manchester Hedayati, Department of Medical and Parasitology, Faculty of Medicine, Mazandaran University of University Mazandaran ofMedicine, Faculty Parasitology, and Mycology ofMedical Department ofÇukurova, University Medicine, of Faculty Microbiology, of Department Mycology, of Division Tehran, Pharmacology, Antimicrobial and Biology in Microbiology, Expertise Center of Iran Sari, Sciences, Medical of University Mazandaran Center, Research Fungi Invasive Present address: MolecularMicrobiology Section,Laboratory of Clinical Infectious Diseases (LCID), Department of Microbiology, Faculty of Medicine, University of Ege, Izmir, Turkey The NationalThe Centre, Wythenshawe Hospital, University The of Manchester, 3,6 3,6 Ramazan Inci, ğ lu-Polat, 1 1 Emel Tumbay, Seyedmojtaba Seyedmousavi, Seyedmojtaba Seyedmojtaba Seyedmousavi, PhD, FECMM. FECMM. PhD, Seyedmousavi, Seyedmojtaba 1 David W. Denning, W. David Version of Record. Please Version as this cite of Record. article 2-4* 7

Macit Ilkit, 5 Mohammad Taghi Taghi Mohammad Accepted Article This by is protectedarticle reserved. Allrights copyright. recurrent sensitization, fungal with asthma severe , infection, aspergillosis, fungal invasive Serious Key words modify theseestimates.validate or over-estimated, formal epidemiological and comprehensive surveillance studies are requiredto or under- substantially be might study current in the reported estimates modeling the Given that also estimated: tinea pedis (1.79 million), capitis(43,900), tinea andonychomycosis (1.73million). was fungal superficial burden of three The females. (3,342/100,000) 1,350,371 in to occur about 22.5 million women aged 15-50 years, recurrent vulvovaginal candidiasis (RVVC) is estimated invasiveincidencecases) aspergillosis (4.94/100,000annual for islower(3,991 Amongst annually). (33/100,000), and of chronic pulmonary aspergillosis (5,890 cases) (7.29/100,000). The estimated bronchopulmonary aspergillosis (32,594 cases) (40.33/100,000), of fungal keratitis (26,671 cases) asthma with fungal sensitization (42,989 cases) (53.20 cases/100,000 adults per year), of allergic prevalences of allergic fungal rhinosinusitis episodes (312,994 cases) (392/100,000), of severe infect fungal serious from a suffer to estimated Among population the million Turkey of (80.8 2017), in approximately 1,785,811people(2.21%) are (http://www.LIFE-worldwide.org). mode and to 2017, 1920 from data epidemiological existing risk, at population onthe based diseases fungal human ofserious burden the estimated We unknown. is Turkey yearin each occurring infections fungal numberof The current Abstract vaginitis, Turkey Turkey vaginitis, ion each year. The model used predicts high high predicts used model The year. each ion lling previously described by the LIFE program program LIFE the by described previously lling Accepted Article This by is protectedarticle reserved. Allrights copyright. in Turkey, utilization and infections of fungal epidemiology the have examined studies Several diversity. and socio-economic geographical prominent with Asia andWestern Europe Eastern between the crossroads at in Turkey,located acountry infections of fungal burden on nation-wide data noepidemiological currently are There approaches. for infection, isessential for effective infection control programs and guidingeffective treatment Knowledge of the local epidemiology ofinvasive and serious fungal infections, aswell as risk factors careunits. intensive proc surgical complex require leukemia), myelogenous (e.g., acute diseases underlying severe with hospitalized immunocompromised, whoare patients billion people are believed tofrom suffer a fungal infection, resultinginover 1.6 million deaths in worldwide. concern, health public amajor as considered are infections Fungal Introduction 3 million people, worldwide. about affect to thought – is patients non-immunocompromised in tissue lung destroys that infection and pneumothorax. (COPD), sarcoidosis, disease pulmonary obstructive chronic (ABPA), aspergillosis bronchopulmonary allergic asthma, infection, mycobacterial (TB),non-tuberculous tuberculosis pulmonary due to due to 2010. December and 2001 January Ankara between retrospe evaluated was candidiasis of epidemiology center, or regional and focused on individual infections in specific populations. For instance, the 522 episodes, respectively. haematologicaldisease. Prophylaxisandantifungal therapy were givenonly30.5% and in 23.6% of that incidence of proven and probable invasive fungal infections (IFIs) was6.7% in those with Asingle-center andUniversityDecemberbetween October 2013atEge study in 2012 C. albicans , followed by by , followed 4 If untreated 50–85 % of patients with CPA will die within 5 years. 5 within die will CPA with of patients % 50–85 untreated If 2 In addition, chronic pulmonary aspergillosis (CPA) – a chronic progressive progressive (CPA)–a chronic aspergillosis pulmonary chronic In addition, 2, 3 C. parapsilosis CPA complicates individuals with pre-existing lung disease such as such disease lung pre-existing with individuals CPAcomplicates 8 Another study reported the epidemiological trends in in trends epidemiological the reported study Another (15.2%), Among candidaemia episodes, were 381 58.3% ctively the at Hacettepe University Hospital in edures (e.g., for trauma), and need support in support and need fortrauma), (e.g., edures C. tropicalis (13.4%) and (13.4%) 7-10 but most were local, single- local, were most but C. glabrata C. 1 Annually, over a over Annually, 5, 6 İ zmir showed showed zmir

(6.8%). 9

Accepted Article This by is protectedarticle reserved. Allrights copyright. antifungal treatment on the national level; Turkey. across hospitals education ofall and 16% hospitals University in beds the ofall 26% representing infectionswas recorded.In this study,data were collected from 7major hospitals (7,052 beds), “tinea, “”, “ “onychomycosis”, “tinea, vaginitis”, “”,“”, “”, “”,“mycotickeratitis”, aspergillosis”, “fungalrhinosinusitis”, “ various infectious diseases occurring throughout the country, the throughout occurring diseases infectious various situatio geographical unique Turkey’s Given that “ in “fungal search the “Turkey”, We used terms 2017. to 1920 Turkey in from risk at populations specific and frequencies infections fungal identify to Scholar Google and website PubMed including databases research international and local both in conducted was diseases fungal of andprevalence review forincidence literature A systematic Methods and Materials countries. 50 over to applied previously approach modeling a using Turkey, in infections fungal serious burden of national the of estimate stem cell transplant (HSCT) recipients receivin cumulative incidences of invasive fungal infectio days. mortality).related overallThe mortalitywas (caseforallofIFIrate at types (7/26) fatality) 27% 180 within180 days after HSCT, and fungal infections accountedfor 1.5% of these cases (IFI- (6/408) at 30, 100, and days 180 post-transplantation, respectively. Among patients, 408 (18.9%) 77 died 12

7, 11 However, these data are over 15 years old. In another retrospective study, retrospective another In old. years 15 over are data these However, ”, “invasive aspergillosis”, “chronic pulmonary aspergillosis, “allergic bronchopulmonary bronchopulmonary “allergic aspergillosis, pulmonary “chronic aspergillosis”, ”, “invasive ”, “melanizedfungi”, and “ Candida 11 g prophylaxis, were 2.7%, 5.0%, and 6.5% 408 patients and 505 epis ”, “candidemia”, “candidiasis”, “recurrent “recurrent “candidiasis”, “candidemia”, ”, n has been responsible fo responsible been n has ns in Turkish pediatric allogeneic hematopoietic hematopoietic allogeneic pediatric Turkish in ns fections”, “”, “pneumocystis”, “pneumocystis”, “cryptococcosis”, fections”, 13-15 Scedosporium here we sought to provide an an provide to wesought here odes of invasive fungal fungal invasive of odes r theepidemiology of ”. The search was Candida 12 the the

Accepted Article 100,000 based on the published data in HIV patients. This by is protectedarticle reserved. Allrights copyright. program. LIFE the by described previously methodology and review literature using estimated, then was diseases fungal serious of burden The search. the to applied were restrictions language No retrieved. articles the of bibliographies the of consultation by supplemented cases present this infection, according toreport of Serraino Eastern the al et from Europe. The first case of caseof first The Health Survey published by To et al. by al. Toet published Survey Health data, the estimate of asthma prevalence in adults in Turkey was obtained from the 2003 World local of lack to Due Turkey. for recorded been have studies epidemiology asthma adult no To date, with CPA was considered2.5% (range 0.72%–3.5%). each population to estimate national incidence or prevalence, depending on the condition. condition. the on depending prevalence, or incidence national estimate to each population specific of proportion used we nodata, was there TB, using a previously reported model by Denning et al. et Denning by model reported previously a TB, using aspergillosis (CPA) followingTB was estimated assuming a cavitation 22% following rate therapy in pulmonary of chronic prevalence period 5-year and incidence The (http://www.who.int/en). WHO Estimates oftuberculosis incidence (TB) and mortality weretaken from the 2017 report issued by (WHO) (http://www.who.int/en). issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (http://www.turkstat.gov.tr).Data onthe HIV/AIDS population were derived from the2011report (TurkStat) Institute Statistical Turkish state-run from the obtained were data Demographic methods. diagnostic of efficacy of evaluation directed towards been Turkey in have studies of majority infection. first isolationThe of 21 19 In the current study, the rates of cryptococcal meningitis was estimated at 0.6 at 0.6 per estimated was meningitis currentof cryptococcal the rates study,In the The prevalence of PCP in AIDS patients was assessed assuming that 5.5% of new AIDS Pneumocystis Cryptococcus pneumonia (PCP) in Turkey was reported in 1955. 1955. in reported was Turkey in (PCP) pneumonia from Turkeywasfrom1959 reported in apatient withintestinal 22 The burden of ABPA in adults with asthma and its correlation correlation its and asthma with adults in of ABPA burden The risk groups and fungal infection frequencies in in frequencies infection fungal and groups risk 23 6

The prevalence of severe asthma withfungal 3

18 Since then, the the then, Since 6, 16, 17 20

Where Accepted Article This by is protectedarticle reserved. Allrights copyright. Turkey wasconsidered 4.2 % in those 40years and older, Thenumberof sensitization. fungal 33% have least sensitization (SAFS) was estimated worst as the 10% of total the asthma population, ofwhom at

13 cases per 1000admissions as described previouslyby Guinea al.et 26 was considered of patients as in10% these reported previously inFrance, development IA risk of The patients. haematological other all in considered were cases of number Equal (http://globocan.iarc.fr/Pages/fact_sheets_population.aspx). Cancer on Research for Agency ofInternational database byGLOBOCAN reported estimates to yearaccording and women per prevalenceThe of new cases of acute myeloidleukemia was(AML) estimatedper 2.8 100,000men AFRS. Turkeyare in rhinosinusitis chronic of 5% of proportion conservative methods used. To estimate prevalencethe of allergic fungal rhinosinusitis (AFRS), we assumed that a to 27%, 0.11 to varybetween appears sensitization fungal to attributed rhinosinusitis of allergic proportion (GOLD) criteria. GOLD stage I,COPD II, to(GOLD) IV III, GOLDstage criteria. refer andvery severity mild, of severe moderate, classificationwas done accordingGlobalto the InitiativeforChronic Obstructive Lung Disease severe respectively. severe of the population in North India (rural), the European Union and the respectively. US, and the Union European the (rural), India in North population of the Recentalso data suggests that chronic rhinosinusitis affects approximately 1–1.5%,and 11%12.5% assumed that 2.6% developed IA. and (n=24,489) year each cases cancer lung of number the determine to database GLOBOCAN malign hematological other numberforall equal and 36% reported experiencing an exacerbation of their respiratory condition. respiratory their of exacerbation an experiencing reported 36% and 31-35 depending on the geographic regions favori regions geographic onthe depending 28 The rate of IA in the context of hospitalized patients with COPD was estimated 38

patients withgeneralpatientsthe population COPD in of ancies and lymphomas. We also used the used also We lymphomas. and ancies ng hot and humid climates and diagnostic diagnostic and climates humid and hot ng 24 of whom 19.3% had been hospitalized, 29

36 andAustria, 37 30, 31 27 andan COPD The 25, 25, Accepted Article attributable to fungi. to attributable This by is protectedarticle reserved. Allrights copyright. recommendations. database LIFE previous to according evaluated was mucormycosis IAand of incidence (SOT), the transplantation organ solid and HSCT underwent who patients Among (http://www.irodat.org). transplantation oforgan registry international The information about transplantation all procedures performed inwas 2017 obtained from the (n=6109). 2008 was 756 per million, and were 10% receiving nationally. year per cases reported of number the from estimated was fungi melanized such as mucormycosis, adult women aged between 15 and 50 years. 50 and 15 between aged women adult of 6% RVVC affects that assuming by estimated was (RVVC) candidiasis vulvovaginal from recurrent incidence data previously published in literature. in the published previously data incidence 0.23% amongst children population. children amongst 0.23% estimated by using data obtained from documented studies in in Turkey. studies documented from obtained data byusing estimated 0.148% of general population as previously reported. previously as population general of 0.148% and 0.8% considered was keratitis and infectious diseases corneal ofpresenting The prevalence population incidence data. incidence population 5/100,000 and 1.5/100,000 respectively were used, in the absence of any national or regional and candidemia the of number To estimate from the study published previously. published study from the onychomycosis (2.8%) and tinea(2.9%) pedis in general the adultpopulation ofTurkey was derived 41 We assumed an infection rate of 1.6 episodes/patient-year and that 2% were were 2% that and episodes/patient-year 1.6 of rate aninfection assumed We 42 The burden of oropharyngeal and oesopha and oropharyngeal of The burden Scedosporium 39, 40 In Turkey, the number of patients on renal replacement therapy in therapy replacement renal on of patients number Turkey, the In 51 50 The incidence of uncommon a ofuncommon Theincidence infections, sporotrichosis, and disseminated infections by by infections disseminated and sporotrichosis, infections, The number of patients with was considered considered was capitis tinea with patients of Thenumber 46, 47 Candida Candida

chronic ambulatory peritoneal dialysis (CAPD) dialysis peritoneal ambulatory chronic 43-45 48 The incidence of keratitis fungal was then peritonitis cases, the annual incidence of of incidence annual the cases, peritonitis The number of women probably suffering suffering women probably of number The 6 gealcandidiasis was assessedusing

nd emerging fungal diseases diseases fungal nd emerging 49 The estimates for cases of cases for estimates The Accepted Article ranged between4,000–7,000 withapproximately 56% (45–72%) of patients receiving antiretroviral Turkey in HIV/AIDS with living people report, 2012 UNAIDS the populations. HIV/AIDS to According in occurring infections and opportunistic severe meningitis most Cryptococcal the among are PCP diseases and their incidence or prevalenceper 100,000 inhabitants as estimatedfromour study. eachyear infection in Turkey afungal from suffer prevalence of fungalinfections, approximately 1,785,811 (2.21%)peoplein Turkey areestimatedto Using local data and available national and international literature estimates of the incidence or 1. Table Supplementary in presented is study inthis used 2017 to 1920 from ofdocuments list Complete 1. Table in risk detailed is at population keratitis recorded. Asummary were of extracted This by is protectedarticle reserved. Allrights copyright. cases of tinea capitis, 488cases associated with melanized fungi. In addition, 36,387 cases of tinea pedis, 12,864 cases of onychomycosis, 7,804 by infections of disseminated cases and6 histoplasmosis, of cases 6 ofsporotrichosis, 8 cases 416 cases of mucormycosis, cases 17 of of RVVC, cases 525 candidiasis, oesophageal of cases 120 candidiasis, of oral cases 540 peritonitis, cases of ABPA, 293cases of fungal rhinosinusitis,cases 3,847 of candidemia,67 casesof cases of cryptococcal meningitis, 100 cases of PCP, cases605 of IA, 244 cases of CPA following TB, 39 The documented episodes ofopportunistic fungal infectionsfrom 1920to 2017(Table were: 1) 60 of Turkey person per in was2016 USD 10,788. Turkey population densityshown map is infigure 1. constituted 49.8%. elderlyThe population years(65 and over) was 8.5%. The gross domestic product adults and 23.6% were children 0–14age group. The female population (40,243,641 persons) In 2017, the population Turkeywas of estimated at80,810,525 inhabitants,of which 86.4% were discussion and Results -

Cryptococcal meningitis and PCP Scedosporium . Table 2 summarizes the burden of different fungal fungal ofdifferent the burden 2summarizes . Table data from bibliographical information based on based information frombibliographical data Malassezia infections, cases of disseminated 18 fusariosis, infections, and 94 cases of fungal offungal cases 94 and infections, Candida

Accepted Article disease, which may have a profound impact on general health status and quality of life. and quality status health ongeneral impact profound have a may which disease, diseases orunderlying defect immune apparent no with hosts in reported been also have cases manyIA Turkey, as such countries income middle In 81 cases IA. of of incidence cumulative 12-month estimated an to corresponding transplants, deceased) (all lung 42 (2,649 living + 693 deceased), 1,446 liver (1,087 living + 359 deceased), 76heart (all deceased), and cases (2.6%). In 2017, a total of 4,906 SOTs were performed in theTurkey including kidney 3,342 This by is protectedarticle reserved. Allrights copyright. ofPCP cases 100 and meningitis, cryptococcal of cases 60 study, current the In (ARV). therapy patients across Turkey, each year. year. patients across each Turkey, many as 106and 635 cases of cryptococcal meningitis and PCP, respectively,occur in HIV/AIDS assuming that 10% of AML and all other hematological patients develop IA. develop patients hematological other and all AML of 10% that assuming consideredof 2.8/100,000 AMLwas 453cases indicating susceptible are IA that to annually, chemotherapy hematologicmalignancies. for GLOBOCAN According databasethe to prevalence the extensive under or patients recipients transplantation marrow bone as such malignancies, IA isa common complication in severelyimmunocompromised patients withhematologic ICU. in hospitalized and those COPD severe with bypatients followed patients cancer/immunocompromised in mainly In our study, a total of 3,991 cases (4.94/100,000 annually) of IA were estimated to occur in Turkey, and radiotherapy. may they because IA for risk at are also tumors patients with severe COPD who are receiving broa account and based on the incidence rate published previously, published rate incidence the on based and account 20 to (1998 period overa18-year diagnosed were -

Invasive aspergillosis (IA) 38 The estimated number of IA in the lung cancer population of Turkey is about 637 637 about Turkey is of population cancer lung inthe of IA number Theestimated develop as a result of chemotherapy chemotherapy of result a as neutropenia develop d-spectrum antibiotics and corticosteroids are one are corticosteroids and antibiotics d-spectrum . In addition, COPD is a progressive pulmonary pulmonary a progressive is COPD In addition, . 16). Taking undiagnosed HIV/AIDS infections into into infections HIV/AIDS undiagnosed Taking 16). 6, 20 one might expect onemight yearlyas that, 36, 37 Patients with solid 26 Of note, 52 , Accepted Article Region of Turkey, in which the prevalence of COPD at of at prevalence COPD the Region which in Turkey, of This by is protectedarticle reserved. Allrights copyright. of allcases of asthma and an asthma prevalence and estimated at 42,989 cases, assuming a severeasthma prevalence of 10% 32, of prevalence national calculated a to prevalence rate.proportion The wasestimatedpatients at2.5% asthma ABPAamong of CPA. cavities develop generally without patients of 2% and cavities lung with patients the of 22% that assumption onthe based (n data ABPA IA. develop to groups risk main of the annually in Turkey, assuming 13 cases per 1000 hospitalized COPD. hospitalized 1000 per cases 13 assuming Turkey, in annually allergicpatients. rhinitis of Individuals withchronic respiratory disease are susc ABPA and SAFS are the most common fungal infections among asthmatics with a notably high high anotably with asthmatics among infections common fungal the most are ABPASAFS and andoverall the prevalenceof (7.3/100,000). is5867 CPA old. population general per Turkey’s amongst year cases 21,4005 COPD Turkey in estimated is and non-tuberculous mycobacterial infections, mycobacterial and non-tuberculous asthma, sarcoidosis, pneumothorax, including CPA, with associated are conditions other numerous indicative of ahigh sensitisation of rate to fumigatus Cladosporium rhinitis or asthma of all severities tested in Ankara for sensitization to Aspergillus 24 -

overallOur estimation local agreedwith a st 23 , SAFS

Non-invasive pulmonary aspergillosis = 14,000), the= 14,000), prevalence of CPA following tuberculosiswas estimated cases at 1956 was not tested. 55 spp., largely owing to the development of empty residual lung cavities. lung residual empty of development the to owing largely spp., spp. by skin pick testwere positive in 11.9% and 8.1% of cases respectively; , andCPA. 58 3

Extrapolating from WHO pulmonary tuberculosis 2015 annual incidence incidence annual 2015 tuberculosis pulmonary WHO from Extrapolating 57 This frequency is similar to other European countries. European other to similar is frequency This 3 Post-TBpredisposing a colonisation cavitation the as for acts factor Aspergillus 29, 53 Weestimated develop that COPDaround patients 2,782 IA A. fumigatus A. sensitization prevalence of 33%. 594 cases per year. SAFS burden was derived from from derived was burden SAFS year. per cases 594 6 weestimate that TB contributes 33% of the cases udy in the urban and rural areas of the Elazig Elazig ofthe areas rural and urban the in udy eptible to airborne fungal infections including including infections fungal airborne to eptible ≥ 18 years18 oldwas 4.5%. – 26% in one series of asthmatic (73%) and 29 The number of patients with with patients numberof The 54

56 Alternaria Atopic adultswith 58 Older data is data Older 3 Given that that Given Aspergillus spp. and and spp. 23 ≥ 40years , leading , leading Accepted Article surrounding mucosa. surrounding by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into AFRS is a unique variety of chronic polypoid rhinosinusitis mainly in atopicindividuals, characterized This by is protectedarticle reserved. Allrights copyright. deep-seated model, estimation population-based our using that assumption the making by However, cases. 65 people eachyear people 700,000 than more worldwide affects that infection fungal invasive main the is candidiasis Invasive that affects AFRS 312,994 adults (392/100,000) in Turkey annually (Table 2). incidence of AFRS has been reported worldwide. beenreported has AFRS of incidence candidemia, most commonly affecting those following complex abdominal surgery or pancreatitis. or surgery abdominal complex following those affecting commonly most candidemia, Candida seated infections and candidemia. The disease is particularly diagnosed in intensive care units. intensive in diagnosed particularly is disease The andcandidemia. infections seated sphenoid sinus lesion. sinus sphenoid that revealed sphenoidotomy endoscopic underwent 50% of candidemia cases, ofcandidemia 50% center caseseries. are data published However, predicted. are AFRS described previously. described conser ageneral with agreement in was candidemia incritical care settings andin 1,930 cancer/immunosuppressed patients. incidence The of total incidence of candidemia for Turkey is 3,847 cases/year (4.76/100,000), of which 1,701 occurred In our literature review,In our literature - -

Allergic rhinosinusitis fungal (AFRS) candidiasis Invasive for as as high 38%, least at of rate a mortality with disease asevere still is peritonitis Candida 2 61-63 , with variousclinical presentations from intra-abdominal infections to deep- 39 59 infections such as peritonitis are accompanied by positive blood cultures in cultures blood bypositive accompanied are peritonitis as such infections 60 Assuming 5% population prevalence for allergic rhinosinusitis, we estimated we estimated rhinosinusitis, allergic for prevalence population 5% Assuming and the variation, andregional have diversity a great AFRS causing fungi The Based on geo-climatic characteristics of Turkey, characteristics on geo-climatic Based 40 Candida 387 cases are estimated occurto in Turkey annually as post-surgical peritonitis (intra-abdominal candidiasis), was only reported in 67 67 in reported only was candidiasis), (intra-abdominal peritonitis 30 Histopathologic analysis of Turkish patients who who patients of Turkish analysis Histopathologic limited to microbiological analysis and single- fungal infection is a common cause of (14.1%) common of(14.1%) cause a is infection fungal vative rate of 5 per 100,000 population, as as population, per100,000 of5 rate vative 13-15 high incidence rates of rates incidence high 39 The 64, Accepted Article among oral-contraceptive users (57.5%) than IUCD users (38.5%), coitus interruptus (48.5%) and of rate The isolation (p>0.05). users of non-contraceptive 37.9% and users, frequency of frequency C. albicans This by is protectedarticle reserved. Allrights copyright. (42.8%). condom users Candida Candida colonization’. VVC, however,isas signs defined and symptoms ofinflammation presence in the of ‘asymptomatic as referred is which disease, of any signs with associated not usually is mucosa symptoms ofvulvovaginitis, (42.2%)240 were positive for In asingle center study between January 2004andJune 2005 in Turkey, among 569women with as at least four episodes (>4x/year). year per episodes four least at as defined is RVVC in Turkey. infection common fungal most the considered be RVVC should mycoses, setting. care primary the in complaints vaginal with women of 40% upto in diagnosed is it and vaginosis, bacterial after vaginitis of cause common most the second (VVC)is candidiasis Vulvovaginal episodes. infection of up 6–10% makes peritonitis 10in years patients;795 0.2%) over cases Turkey(15 Northwest in CAPD centers 4 of experience the than more is This population). calculated by applying 6% to the adult women’s population (between 15 and 50 and 50 15 (between population women’s adult the to 6% applying (n by old) years calculated and antigen tests. and antigen culture, fungal examination, microscopic include diagnosis for used methods mycological standard women worldwide and reported to affect 5 to 9% of women of reproductive age. 5 9% to of women reproductive affect to andreported worldwide women 22,506,176),yielding anestimated 1,350,371 casespresent. note, Of RVVCisverycommon among -

Mucosal candidiasis candidiasis Mucosal 67 peritonitis. patients,Among CAPD esti we spp. and in the absence of other infectious etiologies. infectious other of absence the in and spp. The presence of presence The and 134 (55.8%) were non- Candida Candida 46, 47

spp. (23.7%). 67 In another study, the use of antibiotics, intrauterine devices (IUDs), perineal perineal (IUDs), devices intrauterine antibiotics, of use the study, In another Candida 66 , but may be conservative as most studies have found fungal fungal have found studies most as conservative maybe , but in the vagina in the absence of or damaged ordamaged ofimmunosuppression absence in the vagina the in spp. were isolated from 44.2% of contraceptive method spp. The age group 26-30 years old had the highest highest the had old years 26-30 group age The spp. 46, 4746, The Turkish prevalence of RVVC per year wasyear per RVVC of TheTurkish prevalence mate 195 cases (3.2% annually in the CAPD the cases195 in (3.2% annuallymate Candida 46 spp., of which spp.,of106 (44.2%) were Among problematic superficial C. albicans C. 46, 47 46, was higher was higher The gold

= Accepted Article This by is protectedarticle reserved. Allrights copyright. hematological malignancy cases), (223 anddiabetic ketoacidosis cases). (214 from reviewed literature this 1),in study (Table mo made observations the on Based iron. available of levels serum increased and/or transplantation, Turkey. RVVC. Moreover,few studiesare available on superficial fungalinfections male of genitalia the in laceration, short anovaginal distance (< 3cm), a colonisationof rate the decreasing factor significant a as circumcision of benefits medical potential the highlighted also patients who are immunocompromised because of diabetic ketoacidosis, neutropenia, organ organ neutropenia, ketoacidosis, of diabetic because immunocompromised whoare patients Mucormycosis isa life-threatening infection responsible for increasing morbidity and mortality in subjects.yeareach in these occur candidiasis oral of episodes more or two Usually, Turkey. in annually occur to expected are low CD4 cell counts. cell low CD4 with those in 90% in once least at occuring condition frequent a is candidiasis oral patients, HIV In ARV and 5% of patients ARVon and5% ofpatients ARV. Oesophageal candidiasis is another AIDS-defining illness affecting nearly 20% of patients without patients chemotherapy. after immunocompromised as such patients, other multiple in occurs candidiasis oropharyngeal as expect annually are candidiasis oral of cases 4,536 least at So cases. more contribute corticosteroids inhaled cancer, neck and head as such groups risk uncircumcised (62.5%) comparedcircumcised to (37.5%) boys inTurkey ( both -

Candida 68 Mucormycosis In a recent study, Iskit et al. sp and spp. Candida 43, 44 Using this assumption, HIV infection is responsible for 4050 cases, and other Malassezia and 45 Malassezia Thus, at least 618 cases of oesophageal candidiasis (0,76/100,000) (0,76/100,000) candidiasis of oesophageal cases 618 least Thus, at of penis and glans prepuce fromthe samples in spp., 69 . noted a significantly higher prevalence of yeasts, ofyeasts, prevalence higher significantly noted a nd genital epilation were predisposing factors for for factors predisposing were epilation genital nd ed, but these numbers will be an underestimate, underestimate, an be will numbers these but ed, 70

st st of the infections occurred in patients with P

<

0.01). Ar ı dogan et al. Accepted Article increasing, worldwide. increasing, is fungal uncommon and emerging dueto diseases fungal invasive with of patients as such pathogens common fungal against agents of antifungal use expanding the and immunosuppression with population patient increasing the of context the In This by is protectedarticle reserved. Allrights copyright. reported inin Turkey by 1946 Saglam. given that infected mostly are patients asymptomatic. note,caseOfhistoplasmosis first of the was withinthe same country. retrospective a In study, Yilmaz etal. region to region from even and country, to country from differences with location, on geographical depends and varysubstantially microbial keratitis for responsible pathogens of causative spectrum and the pattern epidemiological The factor. risk predisposing most common the as reported patients without HIV had pulmonary pulmonary had HIV without patients that found Turkey in study recent a Moreover, (Table 1). In addition, there are a limited number limited area there In addition, 1). (Table Turkey in infection fungal rare are fungi melanized by infections disseminated and sporotrichosis, that are recently reclassified with the fungi. the with reclassified are recently that patients. immunosuppressed in infections pulmonary of diagnosis differential the in account into taken be should microbial keratitis clinically diagnosed at the Izmir Ataturk Training and Research Hospital from Hospital Research and Training Ataturk Izmir the at diagnosed clinically keratitis microbial including Turkey. including countries, developing in practice ophthalmological in condition challenging a is keratitis Fungal disease. systemic and with associated are and infections human of causes humans, infect - -

Uncommon and emerging fungal diseases diseases fungal emerging and Uncommon Fungal keratitis Enterocytozoon 77 Ocular trauma,particularly trauma contaminated material, vegetative by is 71 However, according to ourestimates, 74

and 76 arehighly specialized obligate intracellular organisms Of the 14 species of Encephalitozoon intestinalis Encephalitozoon of histoplasmosiscasesfrom reported Turkey, 14.2% of the iatrogenically immunosuppressed 75 , which suggests that Candida invasive scedosporiosis, fusariosis, 49 reviewed the medicalrecords of Microsporidia and common most the are Aspergillus currently known to to known currently Microsporidia , the number number , the spp. 72, 73

Accepted Article This by is protectedarticle reserved. Allrights copyright. inTurkey. estimate This is more than expected number ofin cases Italy(0.94/100,000) problem a particular is keratitis fungal suggests which annually, population per Turkey 33 100,000 at 22.3%that dueare of microbialincidence tofungi, estimated the we keratitis fungalkeratitis in of Candida were fungi. 370Pathogens men). from cultures were identified eyes(36.2%), in 225 whichcases) of (50 22.3% January 1990 to December 2005. Microbial keratitis was diagnosed in patients620 (250 women and syndrome’’ was reported for the syndrome’’ for time first the reported was by “Celal in 1892 anOttoman dermatologist Muhtar”. (moccasin) hyperkeratotic chronic the Historically, 3. inTable shown is in Turkey infections fungal ofsuperficial incidence annual The estimated 1). (Table mycose were many superficial of cases documented there literature, andinternational national available and data local Using worldwide. infections, ofhumanfungal most common arethe types infections that dermatophytic considered generally is It (1.3/100,000) (73/100,000) younger than 10 10 years. than younger preadolescent children, accounting for92.5% upto ofcases all ofdermatophytosis in children with a propensity for attacking the shafts scalp, of the infections one of the is capitis of pediatric causes common most Tinea an of cases first the described who Talad by continued was arena dermatophyte the in Muhtar Celal of study The -

Superficial mycoses spp. culture cases; (15 6.6%) and 81 78 . and Egypt (14/100,000) spp. spp. (25 cases; 11%) were the most prevalent fungal species, followed by 86 In addition, the prevalence of asymptomatic scalp carriage (ASC) generally generally (ASC) carriage scalp asymptomatic of prevalence the addition, In d onychomycosis in Turkey, respectively. respectively. Turkey, in onychomycosis d Aspergillus 79 , and less than Pakistan (44/100,000) and follicles. Tinea capitis predominantly affects affects predominantly capitis Tinea follicles. and tinea pedis also known as ‘‘two feet-one hand hand feet-one ‘‘two known as also pedis tinea spp. cases; (10 4.4%). Based on the assumption s including dermatophytic infections in Turkey Turkey in infections dermatophytic including s 84 , and Englaender, , and 80 and Nepal Nepal and 16 , Malaysia , Malaysia 82, 83 85

Accepted Article This by is protectedarticle reserved. Allrights copyright. (15.9%). (n=1). (n=77). only microscopy-positive direct and (n=2), mycological results were as follows: both infections simultaneously, resulting atotal (39%) of cases 180 of dermatomycoses. The Province showed that 136 (29.5%) hadtinea pedis, 23(5%) had tineaunguium and 21 (4.5%) had epidemiological survey among 461subjects regularly attending mosques in the city center of Adana An pedis. tinea of incidence increased to an groups these predisposes areas and communal rate of 29.5%. (50 population male Muslim adult the among problem major bea to seems onychomycosis and pedis Tinea condition. recurring or chronic a be and may the involve can feet, the of infection dermatophytic pr more relatively is capitis tinea whereas world, developed the in common particularly is foot, Athlete’s as known commonly pedis, tinea Notably, in Turkey revealed that prevalence the is 0.1% of ASC in preliminary children. school correlateswith well incidence the ofsymptomatic infectionsregionally. Data Çukurova from region frequency, were were frequency, of order in onychomycosis ofmold agents The patients. (2%) in 8 fungi) different mixed (two globosa genus the The yeastof Turkey. Izmir, in hospital of university clinic a outpatient dermatology the attending cases onychomycoses scrapings from 1,146 patients, non-dermatophytic fungi were responsible for approximately 50% of sterile mycelia Cladosporium 88 88

was the predominant (47.7%), followed by 89 were detected in (48%),175 yeasts in (41%), 150 (9%), in 33 and In another study in Turkey, 49out of 264 (18.5%) folliculitis patients were diagnosed sp. (n=1), (n=1), sp. 87 (n=2), (n=2), The exposure of these specific populations to sweating, trauma, occlusive footwear, footwear, occlusive trauma, to sweating, populations specific these of exposure The A. niger niger A. Alternaria Malassezia (n=7), Paecilomyces Acremonium sp. (n=1), (n=1), sp. rubrum was also in identified 44patients with pityriasis versicolor: spp. (n=1), (n=1), spp. spp. (n=6), (n=6), spp. A. flavus 87 evalent in developing countries. Tinea pedis, is is a pedis, Tinea countries. developing in evalent In another study evaluating 1,222 samples of nail ofnail samples 1,222 evaluating study In another Scopulariopsis interdigital web spaces or the sides of the feetthespaces thesides of web or interdigital (n=1), (n=1), years and and older) years in Turkey, with a prevalence Fusarium (n =69), =69), (n A. fumigatus M. furfur spp. (n=6), T. interdigitale T. and (n=1) sp. (15.9%), (15.9%), and (n=1), Ulocladium (n=32), A. terreus A. Trichoderma spp. (n=4), (n=4), spp. M. sloffiae C. albicans (n=1), (n=1), sp. sp. M.

Accepted Article This by is protectedarticle reserved. Allrights copyright. publication. this to related of interests conflict no declare The authors interest of conflict Potential diseases. fungal formal epidemiological studies warranted are to and surveillance, comprehensive and prospective Additional available. not is natamycin topical and expensive is Medicine) Essential WHO (a voriconazole although good, is availability Antifungal testingisonly performed 38centers atacross country University (24 clinics state and 14 Hospitals). antigen galactomannan and available, routinely not are tests Molecular patchy Turkey. in somewhat is testing diagnostic based Non-culture lacking. is disease fungal of aspects health public the from country, the originating many andthere are publications laboratories in diagnostic mycologists Wh agencies. health amongpublic infections fungal for gap’ ‘diagnostic a cases, suggesting documented the morethan substantially are study current in Turkey. a limitation, As modeling the estimatesreported in theinfections fungal invasive and serious of estimation epidemiological and frequency the of picture first a reports study our Overall, by followed agent, common most tr internal rDNA the of sequencing PCR (using cytological examinations with May-Grünwald-Giemsastain) with Conclusion M. sympodialis,M. restricta M. anscribed spacer region showed that validate these measures ile Turkey has a good network of professional ofprofessional agoodnetwork has Turkey ile , and M. furfur Malassezia towards managementof . 90

M. globosa M. folliculitis (MF). was the the was Accepted Article This by is protectedarticle reserved. Allrights copyright. (TEO-4). andExpertof Evidence Opinion BogaBolamanCagirgan Z, C, Set al. Recommendations for CategorizationRisk and Prophylaxis ofInvasiveFungal Diseases in 10. and 2010. a tertiary in Epidemiology candidaemia al. Gulmez of et D Arikan-Akdagli S, S, Alp care university hospital: 10-yearwith experience 381 candidaemia episodes 2001between 9. Sci JMed Turk invasive fungal Epidemiology of al. and analysis Fet Vural HD, Unal Kiper Soyer N, infections in patients withhematological malignancies: a real-life experience. single-center 8. suppl.2 Azap Kumbasar inahaematology A, O, Antifungal utilisation AkanH. in unit ofFUNGOBASE p. theR2287, part Study. Turkey: a 7. chronicpulmonary in mortality of Predictors al. PJ et Newton K, Lowes Al-Shair D, aspergillosis. 6. aspergillosis. spectrum pulmonary The clinical of Kosmidis Denning DW. C, 2015; 5. Smith Denning NL, Underlying DW. condi including simpleaspergilloma. 4. aspergillosis chronicpulmonaryof Global burden ColeDC. PleuvryA, Denning DW, assequel a pulmonary to tuberculosis. 3. of Prevalence Multi-National and Global al. RO et Oladele GagoS, BongominF, Fungal Diseases-EstimatePrecision. 2. humans. infects fungi Thespectrum that of A, J. Kohler Perfect Casadevall JR, HarborSpring Perspect Med 1. 8 the at presented was manuscript of this version A preliminary Acknowledgments (TIMM-8), 6-9 October 2017, Belgrade, Serbia no.(Poster 183). Wethank Ramazan Sayg Figure 1. No funding has been received for this project. project. this received for been has funding No 1. Figure in graph and data the use to permission us giving for (www.cografyaharita.com) cografyaharita References 70 : S663. : 270-7. Mycoses Mycoses

Eur Respir J Respir Eur 2017; 2015; 47 : 1535-42. 58 2017; : 498-505. 2015; Eur Respir J Eur Respir 49 . 5 J Fungi : a019273. Bull World Health Organ TurkHaematol J 2011; Hematological Review Malignancies: ACritical 2017; 37 3 tions in chronic pulmonaryaspergillosis chronic in tions : 57. : 865-72. Int J Antimicrob Agents th Trends in Medical Mycology Mycology Medical in Trends 2015; 2011; 32 : 100-17. 89 : 864-72. : 864-72. ı l ı . 2007;. of the of the Thorax Cold 29 Accepted Article This by is protectedarticle reserved. Allrights copyright. Mycol with asthma complicati and its aspergillosis Denning PleuvryDW, Cole A, DC. Global burden of bronchopulmonary allergic 23. Stanojevic MooresS, To T, et Globalprevalence G al. asthma in adults:findings from cross-sectionalthe healthsurvey. world 22. Unat EK, ParsB, Kosyak JP. [A case of cryptococcosis of the colon]. 1959; 21. 2109-16. Mycology (TIMM) in treatment in Turkey. antifungal determine thetrends Akan H, Uzun O, Akova Met FUNGOBASE:al. study An epidemiological to 11. 20. Serraino D, Puro V, D, Serraino PuroV, Boumis E et Epidemiological al. aspects ofmajor opportunistic infections of the respiratory in tract 20. Prevalenceof Koker al. OnderMet M, Ozkoc S, Turkey.in cases in autopsy 19. 1955; Unat EK. [First Pneumocystis cariniinfection in Turkey]. 18. in Canada. infections fungal Serious al. et DC, Cole DenningSF, Dufresne DW MicrobiolClin InfectDis 17. Bassetti A, M, Carnelutti Peghin Estimated burdenItaly. M etal. of infections infungal 16. Leading Akovadiseases H, Turkey. M. Erdem in infectious problems Infect 15. Manag N. Yapar Epidemiology risk invasive and for factors candidiasis. 14. diabetesTurkey. in Oz Oz Qoraan Y, A I, al.Prevalence et and epidemiology pedis oftinea and toenail onychomycosis andantifungal of susceptibility the causative inpatients agents with type 2 13. TransplantationGroup. Study BoneMarrowPediatric Turkish cohortstudythe fluconazole by amulticenter prophylaxis: Tezcan HazarKarasu V, Uygun G, Risks V andoutcomesof et al. invasive fungal infections in pediatric hematopoieallogeneic 12. J Infect 22 21 2012; 2013; 2014; : 1327-30. : 489-95. 18 51 2018; 10 : 1056-67. : 1056-67. : 361-70. : 95-105. . Amsterdam, The Netherlands Int J Dermatol 76 : 103-6. 2017; J Med Microbiol J Microbiol Med Med Mycol Mycol Med 36 : 987-92. 2017; persons with AIDS:1993-2000. Europe, BMC Public BMC Public Health 56 2018: myy015. on chronic pulmonary aspergillosis in adults. : 68-74. 2016; tic stem cell recipientstransplant receiving ,O4.05. p. 65 : 1152-7. Pneumocystis 9th ECMM-1st in Trends 9th ECMM-1st Medical 2012; 12 : 204. TurkCemiy Tip Mecm AIDS AIDS Ther Clin Risk Risk Clin Ther Clin Microbiol Tip Fak Mecm colonization 2003; Eur J Eur Med Med 17 : Accepted Article This by is protectedarticle reserved. Allrights copyright. 9. (2005-2007). network the SAIF France: in aspergillosis trends in invasive K LortholaryEpidemiological JP, Gangneux Sitbon et al. O, 36. 133 refractory chronic Goh Gendeh BS, rhinosinusitis BS, Rose IM et Prevalenceal. of allergic fungal sinusitis in in adult Malaysians. 35. inpatients with FungalF etal. Palombini BC, Anselmi Dall'Ignarhinosinusitis C, chronic sinusaldisease. 34. Ferguson Barnes BJ, L, JMBernstein et al. Geographic rhinosinusitis. variation in allergic fungal 33. amongof Prevalencefungal al. Kasiri MT, rhinosinusitis Hedayati Aet M, Bahoosh patients with rhinosinusitischronic Iran. from 32. fungal in chronic Epidemiology rhinosinusitis al. of India.rural Net Rudramurthy Panda ChakrabartiSM, A, 31. Bakhshaee MN M, Fereidouni M, Mohajer et in The of allergic al. prevalence rhinosinusitis sinonasal polyposis. fungal 30. Infect Pulmonary P Guinea al. J, Torres-Narbona M, Gijon with aspergillosis inpatients et chronic obstructive pulmonary disease: incidence, riskfactors, and outcome. 29. Med Impact obstructivepulmonary et AR disease of chronic Lim al. Muttalif Lam DC, S, EPIC survey.Asia(COPD) the region: population-based theAsia-Pacific in 28. 2012; obstructive pulmonary burden chronic Mahboub B, of M Uzaslan The al. E, Beji et BREATHEthe Africa: results of North study. MiddleEastand the disease in 27. study. BREATHE theAfrica: North M, Ben Polatli Khederand S Wali East Middle A, etal. inthe Chronic obstructive pulmonary consumption disease resource associatedand healthcare 26. 2012; chronicobstructive Management of pulmonary al. Koniski Taright ML, Set IdreesM, BREATHEthe Africa: results of North study. MiddleEastand the disease in 25. 2 in the symptoms COPD-related of Distribution Khan JA al. et S, Nafti MA, Tageldin results of North East theMiddle BREATHEAfrica: and study. 24. : S25-32. : S25-32. : 27-31. 2015; 2010; 106 Suppl 2 106 Suppl 2 14 16 : 4. Otolaryngol Clin North Am : 870-7. : 870-7. : S45-59. : S33-44. : Respir Med Med Respir BrazOtorhinolaryngol J Mycoses 2012; 106 Suppl2 Eur Arch Otorhinolaryngol 2015; 2000; 58 J Mycol Med : 294-302. 33 2005; : S75-85. : 441-9. : 71 Clin Microbiol Infect Clin Microbiol Infect Otolaryngol HeadOtolaryngol Neck Surg : 712-20. 2010; Respir Med Med Respir 2013; 20 : 298-303. 270 : 3095-8. 2012; 2011; Clin MicrobiolClin Asia Pac Fam Pac Asia Respir Med Respir Med 106 Suppl 17 : 1882- 2005; Accepted Article 39. Arendrup MC. Epidemiology of invasive candidiasis. Epidemiology invasive MC. Arendrup of 39. 5018-25. This by is protectedarticle reserved. Allrights copyright. Buchacz K, RK, Baker Palella illnesses FJetal. AIDS-definingin US opportunistic patients, 1994-2007: a cohort study. 45. Trends Orholm M. andPatternsof Smith E, 1980-1990.Patients 44. MI, Matee Scheutz Moshy F, Occurrence of J. oral relation lesions toclinical and in immunological status amongHIV-infected adultTanzanians. 43. Mikrobiyol Bul epidemiological, andclinical the of [Evaluation et al. GR Yilmaz R, Ozturk Bulut C, laboratory findings incontinuous peritonealambulatory dialysis related attacks].peritonitis 42. Altiparmak K, Serdengecti G, Suleymanlar therapy in Turkey, 1996-2008. 41. Infect of outcome and strategies studyof antifungal multicentre A al. JP Gangneux et JP, Mira Montravers P, 40. 445-52. with invasive patients of 45 characteristics Clinical al. Jiang et M LiM, pulmonary aspergillosis: X, Yan retrospective 38. Agents Antimicrob inimmunocompromised mould infections immunosuppressedand/or patients. Registry:prospective invasiveepidemiology, outcome a datacollection of Austrian on therapy and Nationwide The al. Met Hell C, Lass-Florl S, Perkhofer 37. retrospective review. retrospective Yilmaz S, Ozturk I, Maden A. Microbial keratitis in West Anatolia, Turkey: a 49. Cao BMC Ophthalmol J, Yang Y, Yang W et al. Prevalence of infectious keratitis in Central China. 48. survey. Un the countries and 5European candidiasis in vulvovaginalrecurrent Prevalence of Dietz al. JP R, et Muraglia Foxman B, 47. Sobel JD.Vulvovaginal candidosis. 46. 0 Perea S, Ramos MJ, Garau M et al. Prevalence riskand factorstinea of pedis intheSpain.in population tinea general unguium and 50. 2011; J Low Genit Tract Dis Dis Tract J Genit Low 17 : 1061-7. : 1061-7. 2008; 2014; 2010; Scand J Infect Dis Int Ophthalmol 42 : 255-64. 14 36 : 43. Candida Candida : 531-6. 2013; Am J Kidney Dis Dis JKidney Am Aids 17 2007; spp. peritonitis in intensive-care units. units. inintensive-care peritonitis spp. analysis of 1711 lung cancer of lunganalysis cases. 1711 cancer 1990; : 340-5. : 340-5. 2010; Lancet 27 22 : 261-8. J Clin Microbiol 24 : 665-72. 2011; ited States: results from an internet panel internet an from States:results ited : 1549-59. : 2007; MR et al. Trends in renal replacementrenal in Trends al. MR et in Diseases Opportunistic AidsDanish 57 : 456-65. 369 : 1961-71. : Oral Dis Curr Opin Crit CareCurr OpinCrit 2000; 38 2000; : 3226-30. Cancer 6 Clin Microbiol : 106-11. Aspergillus 2009; 2010; Int J 115 16 : :

Accepted Article This by is protectedarticle reserved. Allrights copyright. (Madr)Immunopathol Turkey. Adana, in allergy al. Fet Koksal A, Atici S, Guneser 57. severeThelinkfungi between O'Driscoll Hogaboam and Denning BR, al. CM et DW, asthma: a summarythe of evidence. 56. Agarwal SevereR. with asthma fungal sensitization. 11 55. pulmonary diseaseEastern inElazig, Turkey. Deveci Deveci SE, of F, The chronicTurkoglu S etal. prevalence obstructive 54. 18 Huanget WJ patientspulmonary withchronic al. aspergillosis LiL, in Invasive H, Xu study control China. case a from obstructive pulmonary disease: 53. Tekinsen FF, Koc AN. [Investigation of bymethods]. different 52. of tinea Prevalence al. et A Martinez-Roig JM, Torres-Rodriguez L, Trivino-Duran capitis tineapedisinand Barcelonaschoolchildren. 51. 61. Eyigor H, Eyigor M, Gunel C et al. Characterization of fungi in chronic rhinosinusitischronic in Characterization fungi al. et of C Gunel Eyigor M, H, Eyigor using sequencing. polymerase chain reaction and 61. Anoverlooked Gonuldas sinusdisease: Isolatedsphenoid al. S, Bet Gulsen CelenkF, cause of headache. 60. H. Allergic A, Kaur Chakrabarti 59. 9. childhood hypersensitivity for Skintest al. Yet Camcioglu H, Cokugras N, Akcakaya 16 years. of during aperiod in Istanbul asthma 58. 4 Montravers P, Dupont EggimannH, P. 64. 259-64. endonasal sinus surgery Turkey. in northwestern among withchronic wi rhinosinusitis patients Süo D, Demir 63. ErbekSS, Topal O, ErbekS et polyps].without al. [Fungal allergy inchronic withrhinosinusitis or 62. 5. forgotten non-candidemicforgotten invasive candidiasis. : 403-13. : 403-8. Kulak Burun Bogaz Ihtis Derg J Craniomaxillofac Surg Surg J Craniomaxillofac ğ Mikrobiyol Bul 1994; 1994; lu Y, GüvenY, lu Prevalence Metal. of rhinosinusitis fungal allergic 22 : 52-4. Eur Respir J Eur Respir 2013; Aspergillus 2015; 47 Eur J Intern Med Eur Intern J th th nasalpolyposis or without who underwent : 658-67. Intensive Care Med Care Intensive Allergol Immunopathol (Madr) Immunopathol Allergol 2008 Intra-abdominal candidiasis: the guidelines- Pneumocystis jirovecii Eur Arch Otorhinolaryngol Eur Arch 2006; 43 Kulak Burun Bogaz Ihtis Derg Rhinosinusitis. Rhinosinusitis. Pediatr Infect Dis InfectPediatr J : 1914-7. 18 27 : 153-6. : 615-26. Curr Allergy Asthma Rep Rep Asthma Allergy Curr 2011; Clin Microbiol Infect Infect Microbiol Clin J Fungi 2013; 22 2005; in clinical specimens specimens in clinical : 172-6. 39 2016; : 2226-30. 2008; 2008; 24 2005; : 137-41. 2 : 32. : 32. 2014; 265 Allergol Allergol 33 : 651- 2011; 2012; : 15- : 24 : Accepted Article This by is protectedarticle reserved. Allrights copyright. the importance candidiasis: Intra-abdominal al. RK et Shields CJ, Clancy P, Vergidis of early source controland antifungaltreatment. 65. and management of rare and emerging fungal diseases. European Confederation Medicalof Mycology guidelines (ECMM) 2013joint on diagnosis Microbiology and Infectious Diseases (ESCMID) Fungal StudyInfection Group (EFISG) and Cornely OA, Cuenca-Estrella M, Meis JF et al. European Society of Clinical 71. Glan al. Vet Izol M, Ilkit Aridogan IA, in a paediatric population: pre- andpostcircumcision results. 70. Effect Aet on genitalal. M, Turc-Bicer of colonization of circumcision Ilkit S, Iskit Malassezia 69. genitalia: male A the Superficialfungal infections of M. Izol Aridogan Ilkit V, IA, review. 68. Scand JInfect Dis M, Ocak S, Cetin A Gungoren Distribution of al. et vulvovaginal symptoms with andtheir association ages different contraceptive methods.and 67. PatientsDialysis of F Kazancioglu R, Kirikci AlbazG, M et al. Fungal Peritonitis among the Peritoneal 66. 78. Velayuthan RD, Velayuthan LakhbeerSamudi Singh of C, Estimation HKetal. Burdenof the Serious Human Fungal Infections in Malaysia. 78. et al. H Yagmur Boral M, E, EyeTertiary Erdem Clinic in Turkey. 77. microsporidiosis. Pritt BS. Extraintestinal 3839-44. Ramanan P, 76. Ozkoc Bayram S, Delibas S, AkisuC. Evaluation pulmonary microsporidiosis of in iatrogenically immunosuppressed patients. 75. Saglam T. Histoplasmosis. 74. Histoplasmosis. TurhanU, Aydogan Ozkisa M, T Aet al. RareCase in Turkey: Pulmonary 73. Arab HC,Ucar Yilmaz H, A et al. cavitary AIchronic pulmonary histoplasmosis case from Turkey. 72. 3 79. Zaki SM, Denning DW. Serious fungal infections in Egypt. Egypt. infections in DenningDW.Infect Seriousfungal Zaki Dis SM, 79. : 1-4. Crit Rev Microbiol Microbiol Rev Crit 2017; spp.in apopulation. pediatric J Trop Med Hyg Eurasian J Pulmonol Eurasian J 36 2007; : 971-4. our TurkishCentres. 39 : 584-8. 2011; Mycopathologia 1995; 37 Schweiz Med Wschr Wschr Med Schweiz : 237-44. 98 2016; : 190-1. Med Mycol Mycol Med J Ren Care Tuberk Toraks Toraks Tuberk 18 s penis colonisation and of prepuce fungi : 116-8. J Fungi (Basel)J Fungi Aspergillus flavus 2017; Plos One One Plos 2006; 182 2010; 1946; Clin Microbiol Infect : 379-85. 2016; 2016; 44 36 Mycoses Mycoses Candida Candida 76 : 113-7. : 186-90. 2018; : 1153-6. 64 11 J ClinMicrobiol Keratitis: Experience of Experience a Keratitis: : 9-16. . 4 2009; species in women with women in species . Eur J Clin Microbiol 52 2014; : 49-52. 2014; 20 Suppl 52 : Accepted Article This by is protectedarticle reserved. Allrights copyright. Mycopathologia CasesClinical of Six LaboratoryFeatures and Het al. Kandemir GuranM, M, Durdu Studies. Published of Review a and DermatophyteFolliculitis and Candida of 90. in pityriasis versicolor Epidemiology of al. Turkey. Met Ilkit Turac-Bicer Karakas Adana, A, M, 89. of asagents molds al. Non-dermatophytic R et Inci Metin DY, S, Hilmioglu-Polat inonychomycosis- Turkey Izmir, a prospective study. 88. F,Setal. Hazar M,pedis Tanir Epidemiologytinea Ilkit of andtoenail unguium tinea inin worshippers mosquesAdana, the in Turkey. 87. life. year of first their in ininfants Tinea capitis et al. A, J Y,Gil Rezusta Gilaberte J Dermatol 86. 5. 85. Englaender Talad. Universeller Favus. M. 84. Onychomycosis. to contributions the studyof dermatophytes. M, Muhtar Sehiralti DincG. Ozden Celalettin life, works and (1865-1947):his 83. C. M. Dela PalmairesTrichophytie etPlantaires. 82. Khwakhali Denning US, DW. Burdenof seriousin Nepal. infections fungal 2015; 81. J, Jabeen Mirza K, Serious infections S Farooqi Pakistan. al. fungal in et Microbiol InfectDis 80. 58 Suppl 5 2004; J Dermatol 2016; : 45-50. : 151 2017; : 886-90. 181 : 97-105. 36 2009; : 949-56. 36 Dtsch Med Wochenschr Wochenschr Med Dtsch : 377-82. Eczema des ongles Gaz desonglesEczema Medd’Orient Int J Dermatol J Dermatol Mycopathologia Ann Derm Syph 1908; 2010; 2005; 34 49 : 1311–3. 32 : 705-10. : 698-704. 2005; 1892; 160 3 1916; : 885. : 125-8. Eur J Clin Clin J Eur Mycoses Mycoses 61 : 50- : Br Br Accepted Article This by is protectedarticle reserved. Allrights copyright. programs. Figure1. Figure legends Table 3: Table2. Table 1: legends Table The estimated burden of serious fungal infections in Turkey. Turkey. in infections fungal serious of burden Theestimated The estimated annual incidence of superficial fungal infections in Turkey. inTurkey. infections fungal superficial of incidence annual estimated The Documented episodes of fungal infections inTurkey to from 2017. 1920 Turkey population density map and localization of cities with active organ transplant transplant organ active with cities of localization and map density population Turkey Fungal rhinosinusitisFungal aspergillosis bronchopulmonary Allergic all - aspergillosis Chronic pulmonary TB post aspergillosis Chronic pulmonary aspergillosis Invasive pneumonia Pneumocystis meningitis Cryptococcal melanized fungi infections by Disseminated Onychomycosis Tinea capitis Tinea pedis Fungal keratitis Sporotrichosis fusariosis Invasive Mucormycosis (>4x/year) vaginitis Candida Recurrent candidiasis Oesophageal Candida Candidemia Accepted Article peritonitis This by is protectedarticle reserved. Allrights copyright. 1: Table

Documented episodes of fungal infections in 1920 Turkey2017. to from infections fungal Documented of episodes 8 1 42 17 223 29 1,701+640 55 18 2 65 120 416 2 1 1,930 125 525 525 2 54 600 52 120 1 54 124 252 540 3 3 1 3,847 164 293 16+10 12 10 9 7 8 39 26 531 30 10 35 4 1 38 234 244 2 3 11 605 15 13 35 100 6 14 60 23 339 1,6 6 12,864 13,319 7,804 7,892 36,387 95 37,933 95 8 Totals Totals 76 1 1 67 66 disease disease underlying other / No HIV/AIDS HIV/AIDS disease disease Respiratory immunocompromised immunocompromised + Cancer surgery surgery + care Critical Accepted Article Histoplasmosis infections Scedosporium Malassezia This by is protectedarticle reserved. Allrights copyright. Table2. Total: keratitisFungal Recurrent candidiasis Oesophageal Oral candidiasis Candida Candidaemia rhinosinusitis fungal Allergic asthmaSevere fungal sensitization with aspergillosis bronchopulmonary Allergic Chronic pulmonary aspergillosis aspergillosis Invasive Pneumocystis Cryptococcal meningitis Fungal Diseases Fungal infections

The estimated burden of serious fungal infections in Turkey. in fungal infections serious of burden The estimated peritonitis Candida pneumonia pneumonia 8 8 488 488 2 2 6 4 18

vaginitis(>4x/year) 7.29 5,890 7.29 5,890 4.84 3,911 0.79 635 0.13 106 3,886 1,785,811 3,886 1,785,811 33.00 26,671 3,342 1,350,371 0.76 618 5.61 4,536 0.80 649 4.76 3,847 392 312,994 53.20 42,989 40.33 32,594 Rate/100,000

Total Burden

Accepted Article This by is protectedarticle reserved. Allrights copyright. 3: Table Total: Total: Onychomycosis Tinea capitis Tinea pedis Fungal Diseases Rate/100,000 Total Burden Total Rate/100,000 Diseases Fungal The estimated annual incidence of superficial fungal infections in Turkey. in infections fungal superficial The of incidence estimated annual 4,409 3,563,000 3,563,000 4,409 1,728,699 2,139 54 43,864 1,790,438 2,215