Burden of serious fungal infections in Trinidad and Tobago

The information on the prevalence of fungal infections in the Caribbean region including Trinidad and Tobago (population 1339000 million) is scanty. Tinea capitis is common in children, being predominant in those of African descent, with no definitive estimate. Asthma is also common affecting 77000-139000 adults with an estimated 1927-3491 affected by allergic bronchopulmonary aspergillosis (ABPA) and 2544-4608 with severe asthma and fungal sensitisation (SAFS). An estimated 23763 women have 4 attacks of vaginal candidiasis annually. Among the estimated 14000 HIV-infected patients, 750 cases of oesophageal candidiasis, 400 cases of Pneumocystis pneumonia (PCP) and 50 cases of cryptococcal meningitis are anticipated. Histoplasma capsulatum is endemic in the islands with a 49% skin positivity rate in those <60years old. Three cases of cutaneous histoplasmosis in AIDS patients have been reported. Three cases of pulmonary histoplasmosis were reported among German biologists following exposure to bats in a cave in Trinidad. Using a low mean international incidence figure for candidaemia of 5/100000, 67 cases of candidaemia are estimated. The burden of fungal infections in Trinidad and Tobago is considerable and requires appropriate diagnostic and clinical expertise.