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Diagnosis and Management of Cryptococcal Disease in Resource-Limited Settings

  • Current Management of Fungal Infections (L Ostrosky-Zeichner, Section Editor)
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Abstract

Cryptococcal meningitis is one of the most important fungal infections in the developing world, where deaths related to this disease are numerous. In resource-limited settings, mortality is high in large part because of difficulties in the diagnosis and management of this infection. This paper outlines many of the realities in many resource-limited settings, and describes priorities for public health action and research.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ellis DH, Pfeiffer TJ. Ecology, life cycle, and infectious propagule of Cryptococcus neoformans. Lancet. 1990;336(8720):923–5.

    Article  PubMed  CAS  Google Scholar 

  2. Mitchell TG, Perfect JR. Cryptococcosis in the era of AIDS—100 years after the discovery of Cryptococcus neoformans. Clin Microbiol Rev. 1995;8(4):515–48.

    PubMed  CAS  Google Scholar 

  3. •• Park BJ, Wannemuehler KA, et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23(4):525–30. This paper demonstrated the disparity in the burden of cryptococcal disease; it showed that the vast majority of cases were occurring in resource-limited settings.

    Article  PubMed  Google Scholar 

  4. Kaplan JE, Hanson D, et al. Epidemiology of human immunodeficiency virus-associated opportunistic infections in the United States in the era of highly active antiretroviral therapy. Clin Infect Dis. 2000;30 Suppl 1:S5–S14.

    Article  PubMed  Google Scholar 

  5. van Elden LJ, Walenkamp AM, et al. Declining number of patients with cryptococcosis in the Netherlands in the era of highly active antiretroviral therapy. AIDS. 2000;14(17):2787–8.

    Article  PubMed  Google Scholar 

  6. Chen SC. Cryptococcosis in Australasia and the treatment of cryptococcal and other fungal infections with liposomal amphotericin B. J Antimicrob Chemother. 2002;49 Suppl 1:57–61.

    Article  PubMed  CAS  Google Scholar 

  7. Mirza SA, Phelan M, et al. The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992–2000. Clin Infect Dis. 2003;36(6):789–94.

    Article  PubMed  Google Scholar 

  8. Dromer F, Mathoulin-Pelissier S, et al. Epidemiology of HIV-associated cryptococcosis in France (1985–2001): comparison of the pre- and post-HAART eras. AIDS. 2004;18(3):555–62.

    Article  PubMed  Google Scholar 

  9. Okongo M, Morgan D, et al. Causes of death in a rural, population-based human immunodeficiency virus type 1 (HIV-1) natural history cohort in Uganda. Int J Epidemiol. 1998;27(4):698–702.

    Article  PubMed  CAS  Google Scholar 

  10. Bogaerts J, Rouvroy D, et al. AIDS-associated cryptococcal meningitis in Rwanda (1983–1992): epidemiologic and diagnostic features. J Infect. 1999;39(1):32–7.

    Article  PubMed  CAS  Google Scholar 

  11. Hakim JG, Gangaidzo IT, et al. Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients. AIDS. 2000;14(10):1401–7.

    Article  PubMed  CAS  Google Scholar 

  12. Mwaba P, Mwansa J, et al. Clinical presentation, natural history, and cumulative death rates of 230 adults with primary cryptococcal meningitis in Zambian AIDS patients treated under local conditions. Postgrad Med J. 2001;77(914):769–73.

    Article  PubMed  CAS  Google Scholar 

  13. French N, Gray K, et al. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults. AIDS. 2002;16(7):1031–8.

    Article  PubMed  Google Scholar 

  14. Helbok R, Pongpakdee S, et al. Chronic meningitis in Thailand. Clinical characteristics, laboratory data and outcome in patients with specific reference to tuberculosis and cryptococcosis. Neuroepidemiology. 2006;26(1):37–44.

    Article  PubMed  CAS  Google Scholar 

  15. Lortholary O, Poizat G, et al. Long-term outcome of AIDS-associated cryptococcosis in the era of combination antiretroviral therapy. AIDS. 2006;20(17):2183–91.

    Article  PubMed  Google Scholar 

  16. Perfect JR, Dismukes WE, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(3):291–322.

    Article  PubMed  Google Scholar 

  17. McCarthy KM, Morgan J, et al. Population-based surveillance for cryptococcosis in an antiretroviral-naive South African province with a high HIV seroprevalence. AIDS. 2006;20(17):2199–206.

    Article  PubMed  Google Scholar 

  18. Saha DC, Xess I, et al. Evaluation of conventional & serological methods for rapid diagnosis of cryptococcosis. Indian J Med Res. 2008;127(5):483–8.

    PubMed  CAS  Google Scholar 

  19. Mundy C, Ngwira M, et al. Evaluation of microscope condition in Malawi. Trans R Soc Trop Med Hyg. 2000;94(5):583–4.

    Article  PubMed  CAS  Google Scholar 

  20. Bates I, Bekoe V, et al. Improving the accuracy of malaria-related laboratory tests in Ghana. Malar J. 2004;3:38.

    Article  PubMed  Google Scholar 

  21. Perry L, Malkin R. Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world? Med Biol Eng Comput. 2011;49(7):719–22.

    Article  PubMed  Google Scholar 

  22. Bimenya GS, Nzarubara GR, et al. The accuracy of self monitoring blood glucose meter systems in Kampala, Uganda. Afr Health Sci. 2003;3(1):23–32.

    PubMed  Google Scholar 

  23. Harries AD, Michongwe J, et al. Using a bus service for transporting sputum specimens to the Central Reference Laboratory: effect on the routine TB culture service in Malawi. Int J Tuberc Lung Dis. 2004;8(2):204–10.

    PubMed  CAS  Google Scholar 

  24. Frank UK, Nishimura SL, et al. Evaluation of an enzyme immunoassay for detection of cryptococcal capsular polysaccharide antigen in serum and cerebrospinal fluid. J Clin Microbiol. 1993;31(1):97–101.

    PubMed  CAS  Google Scholar 

  25. Tanner DC, Weinstein MP, et al. Comparison of commercial kits for detection of cryptococcal antigen. J Clin Microbiol. 1994;32(7):1680–4.

    PubMed  CAS  Google Scholar 

  26. Feldmesser M, Harris C, et al. Serum cryptococcal antigen in patients with AIDS. Clin Infect Dis. 1996;23(4):827–30.

    Article  PubMed  CAS  Google Scholar 

  27. •• Meya DB, Manabe YC, et al. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count < or = 100 cells/microL who start HIV therapy in resource-limited settings. Clin Infect Dis. 2010;51(4):448–55. This paper is one of the first to demonstrate the effectiveness of early diagnosis and treatment of cryptococcal disease.

    Article  PubMed  Google Scholar 

  28. Petti CA, Polage CR, et al. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis. 2006;42(3):377–82.

    Article  PubMed  Google Scholar 

  29. •• Jarvis JN, Percival A, et al. Evaluation of a novel point-of-care cryptococcal antigen test on serum, plasma, and urine from patients with HIV-associated cryptococcal meningitis. Clin Infect Dis. 2011;53(10):1019–23. This paper demonstrates the utility of a point-of-care test, the lateral flow assay, in the diagnosis of cryptococcal disease.

    Article  PubMed  CAS  Google Scholar 

  30. •• Lindsley MD, Mekha N, et al. Evaluation of a newly developed lateral flow immunoassay for the diagnosis of cryptococcosis. Clin Infect Dis. 2011;53(4):321–5. This paper demonstrates the utility of a point-of-care test, the lateral flow assay, in the diagnosis of cryptococcal disease.

    Article  PubMed  Google Scholar 

  31. Urdea M, Penny LA, et al. Requirements for high impact diagnostics in the developing world. Nature. 2006;444 Suppl 1:73–9.

    Article  PubMed  Google Scholar 

  32. Mock C, Nguyen S, et al. Evaluation of trauma care capabilities in four countries using the WHO-IATSIC Guidelines for Essential Trauma Care. World J Surg. 2006;30(6):946–56.

    Article  PubMed  Google Scholar 

  33. Grimes CE, Bowman KG, et al. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35(5):941–50.

    Article  PubMed  Google Scholar 

  34. • Jackson A, Hosseinipour MC. Management of cryptococcal meningitis in sub-Saharan Africa. Curr HIV/AIDS Rep. 2010;7(3):134–42. This paper summarizes the approach to cryptococcal management in many resource-limited settings.

    Article  PubMed  Google Scholar 

  35. Liechty CA, Solberg P, et al. Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda. Trop Med Int Health. 2007;12(8):929–35.

    Article  PubMed  Google Scholar 

  36. Micol R, Lortholary O, et al. Prevalence, determinants of positivity, and clinical utility of cryptococcal antigenemia in Cambodian HIV-infected patients. J Acquir Immune Defic Syndr. 2007;45(5):555–9.

    Article  PubMed  Google Scholar 

  37. Jarvis JN, Lawn SD, et al. Screening for cryptococcal antigenemia in patients accessing an antiretroviral treatment program in South Africa. Clin Infect Dis. 2009;48(7):856–62.

    Article  PubMed  CAS  Google Scholar 

  38. Pongsai P, Atamasirikul K, et al. The role of serum cryptococcal antigen screening for the early diagnosis of cryptococcosis in HIV-infected patients with different ranges of CD4 cell counts. J Infect. 2010;60(6):474–7.

    Article  PubMed  Google Scholar 

  39. •• Micol R, Tajahmady A, et al. Cost-effectiveness of primary prophylaxis of AIDS associated cryptococcosis in Cambodia. PLoS One. 2010;5(11):e13856. This paper compares public health strategies to reduce the burden of cryptococcal disease in Cambodia.

    Article  PubMed  Google Scholar 

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Disclaimer

The findings and conclusions in this presentation/report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS C-09, Atlanta, GA, 30333, USA

    Michelle Vanselow, Mary E. Brandt & Benjamin J. Park

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  1. Michelle Vanselow
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  2. Mary E. Brandt
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  3. Benjamin J. Park
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Correspondence to Benjamin J. Park.

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Vanselow, M., Brandt, M.E. & Park, B.J. Diagnosis and Management of Cryptococcal Disease in Resource-Limited Settings. Curr Fungal Infect Rep 6, 35–40 (2012). https://doi.org/10.1007/s12281-011-0082-6

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  • DOI: https://doi.org/10.1007/s12281-011-0082-6

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