At a glance
- Fungal diseases can cause serious illnesses and deaths.
- Many fungal diseases are never diagnosed or reported to public health.
- Severe infections can require extensive hospital stays and expensive treatments.
- Estimates of cost, healthcare visits, and deaths provide an overview of the impact of fungal diseases in the United States.
Estimated burden of fungal diseases
Estimated financial costs, healthcare visits, infections, and deaths provide an overview of the burden of fungal diseases in the United States.
Costs
Direct medical costs are estimated at $6.7 to $7.5 billion yearly. Indirect costs from premature deaths and missed work or school are estimated at $4 billion (Table 1). Total costs are conservatively estimated at $11.5 billion and could be as high as $48 billion.
Number of healthcare visits
More than 75,000 hospitalizations and nearly 9 million outpatient visits occur every year for fungal diseases (Table 1).
Number of infections
About 23,000 cases of invasive candidiasis occurred in 2017. More than 100,000 cases of coccidioidomycosis (Valley fever) occurred in 2014.
Number of deaths
An estimated 7,199 deaths from fungal diseases occurred in 2021 (Table 2).
Data estimates
Table 1. Hospitalizations, outpatient visits, and costs associated with fungal diseases in the U.S.*
| Hospitalizations (2014) | Outpatient visits (2005–2014 average) | Direct medical costs (2019) | Indirect costs (2019) | |
|---|---|---|---|---|
| Aspergillosis | 14,820 | ** | $1.3B | $485M |
| Blastomycosis | 950 | ** | $24M | $49M |
| Candida infection | ||||
| Invasive candidiasis | 12,770 | ** | $1.2B | $522M |
| Non-invasive candidiasis | 13,990 | 3,639,037 | $2.1B | $443M |
| Coccidioidomycosis | 6,670 | ** | $204M | $181M |
| Cryptococcosis | 4,755 | ** | $265M | $269M |
| Dermatophytosis (ringworm) | 690 | 4,981,444 | $845M | $339M |
| Histoplasmosis | 4,630 | 79,993 | $222M | $110M |
| Pneumocystis pneumonia | 10,590 | ** | $489M | $355M |
| Mucormycosis | 1,140 | ** | $129M | $131M |
| Other and unspecified fungal diseases | 7,355 | 222,523 | $897M | $1.2B |
| Total | 75,055 | 8,993,230 | $7.5B | $4B |
* These numbers are based on administrative coding data. Due to underdiagnosis and underreporting, these data likely underestimate the true burden of disease. Numbers of visits and hospitalizations do not equate to totals because some visits had more than one fungal disease listed.** Estimate suppressed because of small numbers.
Table 2. Deaths from fungal infections in the U.S., 2018–2021.*
| 2018 | 2019 | 2020 | 2021 | |||
|---|---|---|---|---|---|---|
| All | COVID-19–associated | All | COVID-19–associated | |||
| Aspergillus | 795 | 723 | 918 | 170 | 1,236 | 498 |
| Candida | 1,010 | 1,171 | 1,439 | 281 | 1,769 | 495 |
| Coccidioides | 253 | 192 | 319 | 33 | 359 | 71 |
| Cryptococcus | 290 | 334 | 341 | 24 | 342 | 49 |
| Histoplasma | 146 | 133 | 130 | 6 | 199 | 21 |
| Mucorales spp. | 151 | 134 | 169 | 17 | 232 | 47 |
| Pneumocystis | 371 | 436 | 381 | 13 | 449 | 48 |
| Other specified pathogens | 116 | 118 | 131 | 3 | 131 | 9 |
| Unspecified | 1,649 | 1,623 | 2,135 | 362 | 2,538 | 746 |
| All | 4,746 | 4,833 | 5,922 | 901 | 7,199 | 1,967 |
*Data were obtained from the National Vital Statistics System Multiple Cause of Death Database. Data for 2021 are provisional and were last updated February 6, 2022. Death certificates could list more than one fungal ICD-10-CM code. This occurred on <1% of death certificates listing a fungal pathogen.
Fungal deaths were defined as deaths where a fungal infection was listed as a contributing or underlying cause of death. COVID-19–associated deaths were defined as deaths where COVID-19 was listed as a contributing or underlying cause of death.
Data limitations
Estimates presented for costs, illnesses, and deaths are lower than the true numbers for each. Fungal diseases are often not diagnosed or misdiagnosed so these cases do not get included in the data.
Personal and social impact
Numerical estimates for disease burden do not capture the substantial impact that fungal infections can have on quality of life.
These nationwide counts and estimates also do not show how some populations face higher fungal disease burdens than others.
Actions for public health professionals
- Educate stakeholders to improve fungal disease diagnoses.
- Monitor the emergence and spread of resistant fungi.
- Implement strategies to limit the spread of antifungal resistance.
- Develop new and expand existing fungal disease surveillance systems.
The number of deaths from fungal infections has increased during the COVID-19 pandemic. Learn more about COVID-19–associated fungal infections.
- Vallabhaneni S, Mody RK, Walker T, Chiller T. The global burden of fungal diseases. Infect Dis Clin North Am. 2016 Mar.
- Benedict K, Jackson BR, Chiller T, Beer KD. Estimation of direct healthcare costs of fungal diseases in the United States. Clin Infect Dis. 2019 May 17.
- Rayens E, Norris KA. Prevalence and healthcare burden of fungal infections in the United States, 2018. Open Forum Infect Dis. Jan 2022.
- Benedict K, Whitham HK, Jackson BR. Economic burden of fungal diseases in the United States. Open Forum Infect Dis. Mar 2022.
- Tsay S, Williams S, Mu Y, Epson E, Johnston H, Farley MM, et al. National burden of candidemia, United States, 2017. Open Forum Infect Dis. 2018 Nov.
- Freedman M, Anderson S, Benedict K, McCotter O, Derado G, Hoekstra R, et al. Preliminary estimates of annual burden of coccidioidomycosis in the United States, 2010–2014. 7th International Coccidioidomycosis Symposium, Stanford, CA; 2017.
- Gold JAW, Ahmad FB, Cisewski JA, Rossen LM, Montero AJ, Benedict K, et al. Increased deaths from fungal infections during the COVID-19 pandemic—National Vital Statistics System, United States, January 2020–December 2021. Clin Infect Dis. 2022.