Prevalence of Fungal Infections in Pemphigus Patients: A Systematic Review and Meta-Analysis.

Background: Pemphigus is a life-threatening autoimmune disease characterised by blistering skin and/or mucous membranes. The present study aimed to determine the prevalence of fungal infections in the pemphigus population.

Methods: Different databases were searched to gain access to all studies on the prevalence of fungal infections published up to the 31st of May 2024. The pooled rate prevalence of fungal infections with a 95% confidence interval (CI) was calculated using the random effects model.

Results: A total of 1012 studies were identified, out of which 18 were included in meta-analyses. The random-effects estimates of the prevalence of fungal infection in the pemphigus population were 0.18% (95% CI: 9%-31%). Based on the findings, it was determined that four genera of fungal infections were related to mucocutaneous lesions of individuals diagnosed with pemphigus. Among these fungi, the most prevalent were those belonging to the Candida species, with a particular emphasis on Candida albicans (87.61%). Additional isolated fungal species include Trichophyton rubrum (4.5%), Aspergillus species (1.8%), Pneumocystis jirovecii (1.2%), Malassezia furfur (0.78%), Microsporum canis (0.75%), Trichophyton mentagrohytes (0.65%), Microsporum audouinii (0.60%), and Trichophyton concentricum (0.45%).

Conclusions: The current study highlights the significance of fungal infection in individuals with pemphigus, suggesting that pemphigus and administration of immunosuppressive medicines such as corticosteroids may trigger an increased risk of fungal infections. Additionally, prompt diagnosis of fungal infections in individuals with pemphigus could help healthcare professionals prevent and treat serious infections, such as Pneumocystis jirovecii pneumonia (PJP), and potentially alleviate the economic impact of this condition.