Population-based surveillance for cryptococcosis in an antiretroviral-naive South African province with a high HIV seroprevalence

McCarthy, Kerrigan Ma; Morgan, Julietteb; Wannemuehler, Kathleen Ac; Mirza, Sara Ab; Gould, Susan Ma; Mhlongo, Ntombid; Moeng, Portiad; Maloba, Bonnie Rd; Crewe-Brown, Heather Hd; Brandt, Mary Eb; Hajjeh, Rana Ac; for the Gauteng Cryptococcal Surveillance Initiative Group

AIDS:
doi: 10.1097/QAD.0b013e3280106d6a
Epidemiology and Social
Abstract

Objectives: To measure the burden of disease and describe the epidemiology of cryptococcosis in Gauteng Province, South Africa.

Design and 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.

Author Information

From the aMycology Reference Unit, National Institute for Communicable Diseases of the National Health Laboratory Service, and Division of Virology and Communicable Diseases Surveillance, University of the Witwatersrand, South Africa

bMycotic Diseases Branch, USA

cDivision of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

dDepartment of Clinical Microbiology and Infectious Diseases, Chris Hani Baragwanath Laboratory, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.

*See Appendix.

Received 7 February, 2006

Accepted 9 May, 2006

Correspondence to Dr Kerrigan McCarthy, Mycology Reference Unit, National Institute for Communicable Diseases of the National Health Laboratory Service, and Division of Virology and Communicable Diseases Surveillance, University of the Witwatersrand, Johannesburg 2000, South Africa. E-mail: kerriganm@nicd.ac.za

© 2006 Lippincott Williams & Wilkins, Inc.