Cryptococcal meningitis: A neglected NTD?

Molloy, Síle F.; Chiller, Tom; Greene, Gregory S.; Burry, Jessica; Govender, Nelesh P.; Kanyama, Cecilia; Mfinanga, Sayoki; Lesikari, Sokoine; Mapoure, Yacouba Njankouo; Kouanfack, Charles; Sini, Victor; Temfack, Elvis; Boulware, David R.; Dromer, Françoise; Denning, David W.; Day, Jeremy; Stone, Neil; Bicanic, Tihana; Jarvis, Joseph N; Lortholary, Olivier; Harrison, Thomas S.; Jaffar, Shabbar; Loyse, Angela

doi:10.1371/journal.pntd.0005575

Cited by 53 publications

(52 citation statements)

References 39 publications

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“…Cryptococcal meningitis (CM) is also reported with a high frequency in African HIV‐infected patients 57‐59 . We estimated 560 new cases of CM among adult HIV/AIDS patients yearly in the RoC.…”

Section: Discussionmentioning

confidence: 99%

Current burden of serious fungal infections in Republic of Congo

Amona

Denning

Moukassa

et al. 2020

Mycoses

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Background The Republic of Congo (RoC) is characterised by a high prevalence of tuberculosis and HIV/AIDS, which largely drive the epidemiology of serious fungal infections. Objective We aimed to estimate the current burden of serious fungal infections in RoC. Material and Methods Using local, regional or global data and estimates of population and at‐risk population groups, deterministic modelling was employed to estimate national incidence or prevalence of the most serious fungal infections. Results Our study revealed that about 5.4% of the Congolese population (283 450) suffer from serious fungal infections yearly. The incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia and disseminated histoplasmosis in AIDS patients was estimated at 560, 830 and 120 cases per year. Oral and oesophageal candidiasis collectively affects 12 320 HIV‐infected patients. Chronic pulmonary aspergillosis, 67% post‐tuberculosis, probably has a prevalence of 3420. Fungal asthma (allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation) probably has a prevalence of 3640 and 4800, although some overlap due to disease definition is likely. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 85 440 and 178 400 respectively. Mostly related to agricultural activity, fungal keratitis affects an estimated 700 Congolese yearly. Conclusion These data underline the urgent need for an intensified awareness towards Congolese physicians to fungal infections and for increased efforts to improve diagnosis and management of fungal infections in the RoC.

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Section: Discussionmentioning

confidence: 99%

Current burden of serious fungal infections in Republic of Congo

Amona

Denning

Moukassa

et al. 2020

Mycoses

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“…The ease in diagnosing the disease by morphological and physiological tests allowed us to recover the fungus in almost 97.0% of the cases, and as expected, the majority of the isolates were associated with CSF, which is considered the sample of choice for the diagnosis of cryptococcosis. CSF sampling must be done by lumbar puncture with measurement of the opening pressure in those patients with a suspicion of cryptococcal meningitis [ 33 , 34 ]. On the other hand, testing the CSF cryptococcal circulating antigen is very sensitive and specific for the diagnosis of meningitis and a very useful tool in those patients with a negative India ink test, providing a suggestion of the presence of the disease well the before the yeast grows in culture.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcosis in Colombia: Compilation and Analysis of Data from Laboratory-Based Surveillance

Escandón

Lizarazo

Agudelo

et al. 2018

JoF

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The passive and voluntary surveillance of cryptococcosis in Colombia since 1997 has seen an increasing participating rate, revealing its importance to both in immunosuppressed and immunocompetent people. The present work details the national data gathered in 1997–2016, through a retrospective analysis of the information collected in the survey. From a total of 1974 cases reported, an overall incidence of 0.23 cases per 100,000 people was found. This incidence rose to 1.1 cases per 1000 people in the Acquired Immunodeficiency Syndrome (AIDS) population. Cryptococcosis was most common in male young adults (26–40 years), with a male:female ratio of 3.9:1 in the general population and 5.4:1 in Human Immunodeficiency Virus (HIV) patients. Culture was the most common form of diagnosis in 96.3% of cases, recovering C. neoformans species in 87.5% and C. gattii in 3.1% of samples. VNI was the most prevalent (96.1%) molecular type, while VGII predominated in C. gattii isolates (54.3%). Early mortality was reported as the outcome in 47.5% of patients. Cryptococcosis remains an important opportunistic disease in Colombia and is gaining status as a primary pathogen in apparently immunocompetent patients. Our findings show the importance of including cryptococcosis as a notifiable disease, which will allow for improving opportune diagnosis and treatment, resulting in better patient outcomes.

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“…Furthermore, despite the strong evidence supporting the use of flucytosine for the treatment of CM, flucytosine remains unregistered and unavailable in African and Asian LMICs with very few companies manufacturing the drug. It is hoped that with an increasing acknowledgement of the role of flucytosine its production, registration and distribution will broaden (52).…”

Section: Advocacymentioning

confidence: 99%

Emerging concepts in HIV-associated cryptococcal meningitis

Lawrence

Boyer-Chammard

Jarvis

2019

Current Opinion in Infectious Diseases

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Purpose of review: HIV-associated cryptococcal meningitis (CM) remains a significant contributor to AIDS-related mortality despite widened access to antiretroviral therapy. Even in clinical trial settings 10-week mortality is roughly 40%. A number of important clinical trials have either recently concluded or are actively recruiting. Recent findings: Global burden of disease etimates suggest CM causes 181,100 deaths annualy. Screening blood for cryptococcal antigen (CrAg) in HIV-infected individuals with CD4 cell counts <100 cells/µL and pre-emptive antifungal treatment for those with detectable CrAg reduces the incidence of CM and is likely to reduce mortality. CM treatment with conventional 14-day courses of amphotericin are associated with high toxicity and mortality and can be reduced to seven days if given alongside flucytosine. Flucytosine is a significantly superior adjunct to amphotericin treatment compared to fluconazole. In settings without amphotericin B dual oral antifungal combinations of flucytosine and fluconazole offer an effective alternative treatment. A single, high-dose of liposomal amphotericin is effective at reducing fungal burden and is being tested in a phase III trial. Summary: Recently completed and ongoing clinical trials are increasing our understanding of how to optimise induction therapy for CM. Advocacy efforts are needed to broaden access to amphotericin formulations and flucytosine.

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Cryptococcal meningitis: A neglected NTD?

Cited by 53 publications

References 39 publications

Current burden of serious fungal infections in Republic of Congo

Current burden of serious fungal infections in Republic of Congo

Cryptococcosis in Colombia: Compilation and Analysis of Data from Laboratory-Based Surveillance

Emerging concepts in HIV-associated cryptococcal meningitis

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