McCarthy KM, Morgan J, Wannemuehler KA, Mirza SA, Gould SM, Mhlongo N, Moeng P, Maloba BR, Crewe-Brown HH, Brandt ME, Hajjeh RA
Population-based surveillance for cryptococcosis in an antiretroviral-naive South African province with a high HIV seroprevalence. [JOURNAL ARTICLE]
AIDS 2006 Nov 14; 20(17):2199-2206.
OBJECTIVES:: To measure the burden of disease and describe the epidemiology of cryptococcosis in Gauteng Province, South Africa.
DESIGN AND METHODS:: The study was an active, prospective, laboratory-based, population-based surveillance. An incident case of cryptococcosis was defined as the first isolation by culture of any Cryptococcus species from any clinical specimen, a positive India ink cryptococcal latex agglutination test or a positive histopathology specimen from a Gauteng resident. Cases were identified prospectively at all laboratories in Gauteng. Case report forms were completed using medical record review and patient interview where possible.
RESULTS:: Between 1 March 2002 and 29 February 2004, 2753 incident cases were identified. The overall incidence rate was 15.6/100 000. Among HIV-infected persons, the rate was 95/100 000, and among persons living with AIDS 14/1000. Males and children under 15 years accounted for 49 and 0.9% of cases, respectively. The median age was 34 years (range, 1 month-74 years). Almost all cases (97%) presented with meningitis. Antifungal therapy was given to 2460 (89%) cases of which 72% received fluconazole only. In-hospital mortality was 27% (749 cases). Recurrences occurred in 263 (9.5%) incident cases. Factors associated with death included altered mental status, coma or wasting; factors associated with survival included employment in the mining industry, visual changes or headache on presentation.
CONCLUSIONS:: This study demonstrates the high disease burden due to cryptococcosis in an antiretroviral-naive South African population and emphasizes the need to improve early recognition, diagnosis and treatment of the condition.
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