Impact of Fungal Diseases in the United States

Fungal diseases can cause serious illness and death. Scientists are still learning about how many people in the United States are affected.

The impact, or burden, of these diseases is difficult to estimate because:1

  • Many fungal diseases go undiagnosed.
  • There is no national public health surveillance for common fungal infections, such as ringworm and vaginal candidiasis.
  • There is no national public health surveillance for certain serious fungal infections, such as aspergillosis and cryptococcosis.

Ways to measure the burden of fungal diseases include:

  • Cost
    • Direct medical costs are estimated at $6.7 to $7.5 billion yearly.2,3
    • Indirect costs from premature deaths and missed work or school are estimated at $4 billion (Table 1).4
    • Total costs are conservatively estimated at $11.5 billion and could be as high as $48 billion.4
  • 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 2017.5
    • More than 100,000 cases of coccidioidomycosis (Valley fever) occurred in 2014.6
  • Number of deaths
    • An estimated 7,199 deaths from fungal diseases occurred in 2021 (Table 2).7

Many of these numbers likely underestimate costs, illnesses, and deaths by a large amount. Because fungal diseases may not be diagnosed, they may not show up in the key data used to prepare these estimates. Also, these numbers do not capture the substantial impact that fungal infections can have on quality of life.

Researchers have also identified disparities in the way fungal diseases affect some groups of people. Learn more about these disparities and priorities for addressing them.

Table 1. Estimated hospitalizations, outpatient visits, and costs associated with fungal diseases in the United States.*

Estimated hospitalizations, outpatient visits, and direct medical costs associated with fungal diseases in the United States in 2017.
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 and likely underestimate the true burden of disease because of underdiagnosis and undercoding. Numbers of visits and hospitalizations do not equal the totals because some visits had more than one fungal disease listed on the record.
** Estimate suppressed because of small numbers

Table 2. Number of deaths from fungal infections in the United States during 2018–2021.*

Table 2. Number of deaths from fungal infections in the United States during 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.

The number of deaths from fungal infections has increased during the COVID-19 pandemic.7 Learn more about COVID-19–associated fungal infections.

What public health professionals can do to lower the burden of fungal diseases:

  • Continue to raise awareness about fungal diseases to increase early diagnosis and proper treatment
  • Monitor the emergence and spread of resistant fungi and help reduce the spread of antifungal resistance
  • Develop new systems and expand existing systems for fungal disease surveillance
  1. Vallabhaneni S, Mody RK, Walker T, Chiller T. The global burden of fungal diseases. Infect Dis Clin North Am. 2016 Mar.
  2. 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.
  3. Rayens E, Norris KA. Prevalence and healthcare burden of fungal infections in the United States, 2018. Open Forum Infect Dis. Jan 2022.
  4. Benedict K, Whitham HK, Jackson BR. Economic burden of fungal diseases in the United States. Open Forum Infect Dis. Mar 2022.
  5. 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.
  6. 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.
  7. 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.