Cryptococcosis‐related deaths and associated medical conditions in the United States, 2000–2010

Abstract

Cryptococcosis is an invasive mycotic infection primarily affecting immunocompromised individuals. The objective of this study was to describe cryptococcosis mortality and associated medical conditions in the US for the period 2000-2010. Cryptococcosis-related deaths were identified from the national multiple-cause-of-death dataset. Mortality trends and comparison analyses were performed on overall cases of cryptococcosis and by subset [i.e. clinical manifestations of disease and human immunodeficiency virus (HIV) status]. A matched case-control analysis was also conducted to describe the associations between this disease and comorbid medical conditions. A total of 3210 cryptococcosis-related deaths were identified. Cerebral cryptococcosis was the most commonly reported clinical manifestation of the disease. Approximately one-fifth of the decedents (n = 616) had a co-diagnosis of HIV. Mortality rates were highest among men, blacks, Hispanics, Native Americans and older adults. Poisson regression analysis indicated a 6.52% annual decrease in mortality rates for the study period. HIV (MOR = 35.55, 95% CI 27.95-45.22) and leukaemia (MOR = 16.10, 95% CI 11.24-23.06) were highly associated with cryptococcosis-related deaths. Cryptococcosis mortality declined significantly during 2000-2010. However, the disease continues to cause appreciable mortality in the US. With the majority of decedents having no HIV co-diagnosis, there is still much to be learned about the epidemiology of this mycosis.

Risk Factors for Cryptococcal Meningitis: A Single United States Center Experience

“…In this mixed population in a low cryptococcal meningitis prevalence U.S.A setting —0.4–1.3 per 100,000 people [21] — the presence of cryptococcal serum antigen showed the highest sensitivity for detecting cryptococcal meningitis. Based on these findings, a positive serum test should prompt immediate evaluation of CSF and initiation of empirical cryptococcal meningitis therapies in high-risk patients.…”

“…Cryptococcosis is estimated to have an overall annual age-adjusted mortality of 0.07 per 100,000 population in 2010 in the U.S.A. [21]. Mortality is highly associated with HIV infection, cirrhosis, malignancy and autoimmune disorders.…”

Cryptococcus and Cryptococcosis in Cuba. A minireview

“…However, cryptococcal meningitis remains as the most common life‐threatening opportunistic fungal infection among HIV‐infected individuals with an estimated annual mortality of 625 000 persons, which ranks cryptococcosis as fourth among the most common infectious causes of death in sub‐Saharan Africa . In addition, it has been reported that up to 6% of people with impaired cellular immunity due to other causes, are at risk of developing clinically apparent infections due to Cryptococcus …”

Rising to the challenge of multiple Cryptococcus species and the diseases they cause

“…For example, the trend presented by John Perfect at the ICCC was for decreased mortality in the HIV positive population in developed countries, but not amongst the “otherwise healthy” group. This is borne out by recent estimates of mortality rates in the United States, with 80% of people succumbing to the disease in the last 11 years not being HIV positive, in contrast to the early days of the AIDS pandemic (Barragan et al, 2014). …”