OPPORTUNISTIC CANDIDIASIS - AN EPIDEMIC OF THE 1980S

Hospital discharge data from 1980 to 1989 from the National Center for Health Statistics, National Hospital Discharge Survey (NHDS), and two commercially generated hospital discharge data sources (PAS and McAut o) were analyzed to document nationally the increased rate of opportun istic candidal infections among hospitalized patients in the 1980s and to identify the major risk factors. National projections were made by year. Age-, sex-, race-, and disease-specific denominators were gener ated from NHDS data. ICD-9-CM codes derived from discharge diagnoses w ere used to identify patients with oropharyngeal candidiasis, dissemin ated candidiasis, human immunodeficiency virus (HIV) infection/AIDS, o r malignancies and transplants. Between 1980 and 1989, rates of oropha ryngeal candidiasis increased 4.7 times (from 0.34 to 1.6 cases per 1, 000 admissions per year), and the number of deaths among patients with oropharyngeal candidiasis increased fivefold. Although the highest ra tes were among pediatric patients (3 cases per 1,000 pediatric admissi ons), the greatest rate increases were among 15- to 44-year-old patien ts (13-fold) and males (fivefold). Between 1983 and 1989, the rates of oropharyngeal candidiasis among patients with HIV infection/AIDS rose more than 22 times (from 0.02 to 0.45 case per 1,000 admissions; NHDS data). Over the whole decade, the rates of disseminated candidiasis i ncreased 11 times (from 0.013 to 0.15 case per 1,000 admissions). Betw een 1985 and 1989, the rate of this complication among patients with H IV infection/AIDS increased 10-fold, compared with only a twofold rate increase among patients with malignancies or transplants. The rate of debilitating and life-threatening candidiasis among hospitalized pati ents increased considerably over the 1980s. This rate increase was sig nificant among patients with HIV infection/AIDS and patients undergoin g transplantation or immunosuppressive therapy for malignancies.