Cryptococcosis in Colombia: Compilation and Analysis of Data from Laboratory-Based Surveillance

Abstract

The passive and voluntary surveillance of cryptococcosis in Colombia since 1997 has seen an increasing participating rate, revealing its importance to both in immunosuppressed and immunocompetent people. The present work details the national data gathered in 1997–2016, through a retrospective analysis of the information collected in the survey. From a total of 1974 cases reported, an overall incidence of 0.23 cases per 100,000 people was found. This incidence rose to 1.1 cases per 1000 people in the Acquired Immunodeficiency Syndrome (AIDS) population. Cryptococcosis was most common in male young adults (26–40 years), with a male:female ratio of 3.9:1 in the general population and 5.4:1 in Human Immunodeficiency Virus (HIV) patients. Culture was the most common form of diagnosis in 96.3% of cases, recovering C. neoformans species in 87.5% and C. gattii in 3.1% of samples. VNI was the most prevalent (96.1%) molecular type, while VGII predominated in C. gattii isolates (54.3%). Early mortality was reported as the outcome in 47.5% of patients. Cryptococcosis remains an important opportunistic disease in Colombia and is gaining status as a primary pathogen in apparently immunocompetent patients. Our findings show the importance of including cryptococcosis as a notifiable disease, which will allow for improving opportune diagnosis and treatment, resulting in better patient outcomes.

Prevalence of cryptococcosis in Atlántico, department of Colombia assessed with an active epidemiological search

“…The prevalence of C. neoformans and C. gattii detected in this study is in accord with previous studies. Predominant symptoms were headache, fever, and confusion, followed by coughing, seizures, and meningeal signs, which were also reported in previous studies 4,5,7,12,13 .…”

“…Thus, underreporting of cases leads to misinformation and distortion of the real magnitude of this pathology. Different reports have confirmed the importance of this mycosis in Colombia 4,5,[12][13][14] . A strategy of improving the surveillance for cryptococcosis through an active search was implemented in this study with the participation of trained clinical staff in hospitals and health institutions.…”

“…C. neoformans var. grubii was more prevalent (87.5%) than C. gattii (3.1%); VNI was the most prevalent (96.1%) molecular type, while VGII predominated in C. gattii isolates (54.3%) 4 . Previous data based on voluntary notifications indicated 41 cases of cryptococcosis reported between 1997 and 2014 in the Atlántico department of Colombia, with an annual average prevalence of 1.04 per 1 million inhabitants 5 .…”

“…Although notification of the national public health surveillance system in Colombia is not mandatory for cryptococcosis, a national survey designed in accordance with the guidelines of the European Confederation of Mycology has been carried out voluntarily within medical institutions since 1997 4 . According to a report by Escandón et al, the average annual incidence rate of cryptococcosis in the general Colombian population was 0.23 per 100,000 inhabitants (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016), while in AIDS patients, the rate rose to 1.1 per 1000 inhabitants.…”

“…Each survey was submitted with a corresponding isolate/sample to the Universidad Metropolitana in Barranquilla for confirmation using conventional techniques. Species differentiation was performed by culturing samples/isolates in canavanine glycine bromothymol blue (CGB) agar 4,5 . Surveys and samples/isolates were finally submitted to the INS for confirmation and molecular typing.…”