Population-based surveillance for cryptococcosis in an antiretroviral-naive South African province with a high HIV seroprevalence.
OBJECTIVE
To measure the burden of disease and describe the epidemiology of cryptococcosis in Gauteng Province, South Africa.


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.
McCarthy
Kerrigan M
KM
Mycology Reference Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Division of Virology and Communicable Diseases Surveillance, University of the Witwatersrand, Johannesburg 2000, South Africa. kerriganm@nicd.ac.za
Morgan
Juliette
J
Wannemuehler
Kathleen A
KA
Mirza
Sara A
SA
Gould
Susan M
SM
Mhlongo
Ntombi
N
Moeng
Portia
P
Maloba
Bonnie R
BR
Crewe-Brown
Heather H
HH
Brandt
Mary E
ME
Hajjeh
Rana A
RA
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003453:Cryptococcosis / Q000188:drug therapy / Q000401:mortality*; D015528:HIV Seroprevalence; D006801:Humans; D015994:Incidence; D007223:Infant; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000401:mortality; D008875:Middle Aged; D011159:Population Surveillance; D012008:Recurrence; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome
D000935:Antifungal Agents