Cryptococcosis epidemiology and demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Serge Korjian M.D., Yazan Daaboul, M.D.

Overview

The prevalence of cryptococcal antigenemia among patients with HIV in the United States is approximately 2900 per 100,000 patients. The overall incidence is estimated to be 0.4 to 1.3 cases per 100,000 persons yearly in the United States. Cryptococcosis has no age, gender, or racial predilections.^[1]

Epidemiology and Demographics

Prevalence

The prevalence of cryptococcal antigenemia in the general population is unknown. Given the low incidence in the general population, it is thought to be very low.
Among HIV patients in the United States, the prevalence of cryptococcal antigenemia is approximately 2900 per 100,000 patients with HIV, indicating that the prevalence of cryptococcal infection may be high enough to consider targeted screening for HIV patients.^[1]

Incidence

Worldwide, the annual incidence of cryptococcosis in HIV/AIDS patients has been estimated to be 220,000 cases.^[2]

Nationally, representative estimates for the incidence of cryptococcosis are difficult to establish because cryptococcosis is only reportable in a few states.
Results from active, population-based surveillance in two U.S. locations in the year 2000 indicated that the annual incidence of cryptococcosis among persons with AIDS ranged from a low of 200 cases per 100,000 patients to a high of 700 cases per 100,000 patients.
The overall annual incidence in the U.S. ranges from a low of 0.4 per 100,000 individuals to a high of 1.3 cases per 100,000 individuals in the United States.^[3]
C. neoformans is a major cause of meningitis in people living with HIV/AIDS, with an estimated 1 million cases of cryptococcal meningitis occurring worldwide each year.^[1]^[4]

Age, Gender, and Race

Cryptococcosis has no age, gender, or racial predilection.^[1]

Developed vs. developing countries

The geographical distribution of endemic fungi causing meningitis are shown below:^[5]

Fungus	Geographic distribution
Blastomyces dermatiditis	Midwest and Southeast of USA, lower Mississippi valley up to the North Central states, and into the Mid-Atlantic states.
Coccidiodes immitis	Mostly in dry, slightly acidic soil, making it common in southwest of USA, parts of Mexico, and Central and South America.
Histoplasma capsulatum:	Ohio, central Mississippi River Valley, and Appalachian Mountains.
Cryptococcus spp.	Cryptococcus neoformans is distributed worldwide with the following specifics: Serotype A is the most common. Found in people with or without HIV worldwide Serotypes B and C are mostly found in Australia, Southeast Asia, Central Africa, and recently in Vancouver, Canada and the Pacific Northwestern United States Serotype D polysaccharide capsule is primarily found in Europe and the United States.
Paracoccidioides brasiliensi	Subtropical areas of Central and South America.
Hyalohyphomycoses	There are numerous molds in this group, including Aspergillus, Scedosporium, and Fusarium species. It has a worldwide distribution.
Candida species	Worldwide distribution
Sporothrix schenckii	Worldwide distribution

Global burden of HIV-related cryptococcal meningitis, source: https://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 C. neoformans Infection Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html Accessed on December 31, 2015
↑ “C. neoformans Infection Statistics | Fungal Diseases | CDC”.
↑ Mirza SA, Phelan M, Rimland D, Graviss E, Hamill R, Brandt ME; et al. (2003). “The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992-2000”. Clin Infect Dis. 36 (6): 789–94. doi:10.1086/368091. PMID 12627365.
↑ Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM (2009). “Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS”. AIDS. 23 (4): 525–30. doi:10.1097/QAD.0b013e328322ffac. PMID 19182676.
↑ Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.

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[cdc-1] 1.0 ^1.1 ^1.2 ^1.3 C. neoformans Infection Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html Accessed on December 31, 2015

[urlC._neoformans_Infection_Statistics_|_Fungal_Diseases_|_CDC-2] “C. neoformans Infection Statistics | Fungal Diseases | CDC”.

[pmid12627365-3] Mirza SA, Phelan M, Rimland D, Graviss E, Hamill R, Brandt ME; et al. (2003). “The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992-2000”. Clin Infect Dis. 36 (6): 789–94. doi:10.1086/368091. PMID 12627365.

[pmid19182676-4] Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM (2009). “Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS”. AIDS. 23 (4): 525–30. doi:10.1097/QAD.0b013e328322ffac. PMID 19182676.

[5] Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.

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