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Cryptococcosis : Epidemiology of cryptococcal disease

Cryptococcosis : Epidemiology of cryptococcal disease. Professor Malcolm D. Richardson Mycology Reference Centre, Manchester Manchester University NHS Foundation Trust. Intended learning outcomes. To be aware of the epidemiology of cryptococcal antigenaemia and meningitis.

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Cryptococcosis : Epidemiology of cryptococcal disease

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  1. Cryptococcosis: Epidemiology of cryptococcal disease Professor Malcolm D. Richardson Mycology Reference Centre, Manchester Manchester University NHS Foundation Trust

  2. Intended learning outcomes To be aware of the epidemiology of cryptococcal antigenaemia and meningitis To be aware of the risk factors for acquiring cryptococcal disease

  3. Cryptococcosis Cryptococcosis refer to infections caused by any species of the genus Cryptococcus. Cryptococcus spp. are capable of causing diseases in both immunocompetent and immunocompromised individuals. Cryptococcal meningitis is the most common clinical manifestation of cryptococcosis. Disseminated cryptococcal disease is largely associated with HIV/AIDS.

  4. Cryptococcus & HIV Cryptococcus is the 2nd or 3rd leading opportunistic infection in patients with HIV/AIDS. Patients with CD4 <100 are the most at risk. Cryptococcus is responsible for up to 15% (13-44%) of the HIV/AIDS deaths. 6% of the global HIV/AIDS population with under 100 CD4 cells are CrAg positive, with substantial geographical variability Rajasingham et al. Lancet Infect Dis. 2017; 3099(17), pp. 1–9

  5. Prevalence of CrAg Nigeria DR Congo Uganda Ethiopia Kenya Globally Prevalence South Africa CD4 T-cell counts

  6. Who are at risk? C. neoformans • HIV (80-90%) • Idiopathic CD4 lymphopenia • Lymphoproliferative malignancies and disorders • Long-term corticosteroid and /or immunosuppressive therapy • Solid organ & bone marrow transplant recipients • Sarcoidosis • Treatment with monoclonal antibodies • Rheumatological diseases • SLE • Rheumatoid arthritis • Hyper-IgM or Hyper-IgE syndromes • Decompensated chronic liver disease • Renal failure and /or peritoneal dialysis • Adult-onset immunodeficiency Williamson PR et al. Nature Rev Neurol. 2017; 13:13-24.

  7. Who are at risk? C. gattii • Predominantly immunocompetent individuals • Other risk factors1 • HIV (10-20%) • Current Smoker • Age (>50 years) • History of invasive cancers 1MacDougall et alEmerg Infect Dis. 2011 Feb;17(2):193-9. DOI: 10.3201/eid1702.101020.

  8. Global burden of cryptococcal disease Parks et al 2009 • Parks et al: • Based on few provider-based cohort studies • Probably an over estimate of the actual burden • Rajasingham et al: • Decreased global burden • Mortality remains unchanged • 65% (2009) vs. 80% (2017) • Sub-Saharan Africa still has majority of cases and deaths Rajasinghamet al 2017 Rajasingham et al. Lancet Infect Dis. 2017; 3099(17), pp. 1–9 Park et al. Aids. 2009;23(4), pp. 525–30.

  9. Cryptococcusis responsible for 15% of AIDS-related mortality globally CRAG prevalence of 6·0% among HIV/AIDS patients with CD4<100 cells/µL Rajasingham et al. Lancet Infect Dis. 2017; 3099(17), pp. 1–9

  10. Summary HIV/AIDS is the most common risk factor for acquiring cryptococcal disease. It accounts for up to 15% (13-44%) of AIDS-related deaths. Global CrAg prevalence is up to 6%.

  11. END

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