Cryptococcosis in India: the awakening of a giant?

Abstract

The menace of cryptococcosis has assumed global proportions over the years. The tropical climate of the Indian subcontinent offers a suitable environment for Cryptococcus neoformans, and the onslaught of the acquired immune deficiency syndrome (AIDS) pandemic since the early 1990s has substantially influenced the situation. Coupled with that are the advances in laboratory diagnostic techniques that have made accurate diagnosis increasingly available. These factors together have led to a sharp increase in the number of reported cases of cryptococcosis. This review attempts to present an overview of the status of cryptococcosis in India from its first description to the most recent times. The disease has been reported from almost all parts of the country. C. neoformans var. neoformans is predominantly found in clinical samples, while C. n. var. gattii infection has also been reported. An organ commonly involved is the central nervous system, among others. Both immunocompromised and apparently immunocompetent patients have been affected. Laboratory diagnosis is mostly by conventional methods, while effective therapeutic options are limited. Early diagnosis followed by institution of specific therapy, where possible, has effectively reduced mortality. Awareness of the disease and maintenance of a high index of clinical suspicion is required. An integrated approach to patient management with active interaction between the clinicians and the laboratory personnel would be highly beneficial. The wide variety of presentations of the disease seen in India suggests the possibility of occurrence of strain variation which needs to be investigated fully. Introduction of routine testing of antifungal susceptibility of clinical isolates is also important in order to obtain baseline data on susceptibility patterns and to predict in advance any shift in those patterns in the population. To maintain a high standard in all such endeavours, the establishment of an external quality control system is desirable.

Disseminated cryptococcosis presenting with generalized lymphadenopathy

“…[10] in their review highlighted a case similar to ours that had presented with fever, weight loss and cervical lymphadenopathy and diagnosed as tuberculosis. The patient did not respond to antituberculous therapy.…”

Low Diversity Cryptococcus neoformans Variety grubii Multilocus Sequence Types from Thailand Are Consistent with an Ancestral African Origin

“…The first clinical discovery of Cn was in 1894, and this pathogen has since become one of the leading causes of mycotic morbidity and mortality worldwide [1], [2], [3]. Capable of causing disease among both immunocompetent and immunocompromised individuals, the most common manifestation of cryptococcosis is cryptococcal meningitis (CM) [4], [5]. The HIV/AIDS epidemic has driven increased Cryptococcus infection rates via the rapid increase of immunosuppressed populations [1], [6], [7].…”

Cryptococcus gattii Infections

“…Table 4 summarizes the pertinent epidemiological and clinical features in case series involving three or more patients. In addition, a number of reviews, editorials, and book chapters with substantive discussion on C. gattii clinical epidemiology and infection in humans have been published since 2000 (39,85,122,(254)(255)(256)(257)(258)(259)(260)(261)(262)(263)(264)(265).…”