The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis.

Abstract

Abstract. In Europe before the advent of the acquired immunodeficiency syndrome (AIDS), fatal cases of infection with Cryptococcus neoformans resembling acute meningitis were rarely described and never in young adults. However, rapidly fatal cryptococcal meningitis in young Africans has been known to exist in central Africa for at least 30 years, mainly in the lower area of the Congo River basin. Cases have been reported in this area since 1953, particularly in young patients during the 1950s. It is also known that central African AIDS patients frequently suffer from cryptococcosis, and there is a possibility that earlier clinical reports of encephalitis were actually fatal cases of AIDS in young Africans. It appears possible that the central part of the African continent is the area where human immunodeficiency virus originated.

Host Immunity to Cryptococcus Neoformans

“…Hence, the rise in fungal diseases in the last quarter of the 20th century paralleled the emergence of an expanded population of patients with immune impairment. The degree to which cryptococcosis and HIV-associated immune deficiency are intertwined is illustrated by a report in the 1950s of cryptococcosis in young people in sub-Saharan Africa, the area where the HIV/AIDS pandemic is thought to have begun [52]. …”

Cryptococcus gattii, No Longer an Accidental Pathogen?

“…In Africa, cryptococcosis is associated with an increased occurrence of meningitis in an unusually younger cohort of patients. The increased awareness of cryptococcosis in the Congo River Basin led to the initial identification of cryptococcosis caused by an atypical strain with elongated-morphology later recognized as C. gattii [1, 91–93]. Today, infections caused by Cryptococcus are recognized as a significant cause of morbidity and mortality in HIV/AIDS patients and are annually responsible for >1,000,000 infections, >620,000 deaths, and up to one-third of all AIDS associated deaths [94, 95].…”

The Spectrum of Fungi That Infects Humans

“…In the 1950s, increasing numbers of cryptococcal meningoencephalitis were reported from central Africa, viewed in retrospect as sentinels of the emergence of AIDS around the Congo River (Molez 1998). AIDS is still the setting in which the vast majority of cryptococcosis occurs (Mitchell and Perfect 1995;Pukkila-Worley and Mylonakis 2008); for 2006, 957,900 cases of cryptococcal meningitis associated with AIDS were estimated, resulting in 624,700 deaths (Park et al 2009).…”

“…Basidiomycete yeast with a worldwide distribution, cryptococci, in the past century, infected humans only rarely (Molez 1998). In the 1950s, increasing numbers of cryptococcal meningoencephalitis were reported from central Africa, viewed in retrospect as sentinels of the emergence of AIDS around the Congo River (Molez 1998).…”