User:Phwikiproj/Cryptococcosis

Epidemiology
Cryptococcosis is usually associated with immunosuppressed patients, such as AIDs, corticosteroid use, diabetes, and organ transplant patients. Cryptococcus is found in two species, Cryptococcus neoformans and Cryptococcus gattii. C. gattii was previously thought to only be found in tropical climates and in immunocompetent persons, but recent findings of C. gattii in regions such as Canada and Western regions of North America have challenged this initial presumption of the geographic patterns.

In 2014, amongst people who had low CD4+ cell count, the annual incidence rate was estimated to be 278,000 cases. Of those, 223,100 resulted in cryptococcosis meningitis. About 73% of cryptococcosis meningitis cases occurred in Sub-Saharan Africa. More than 180,000 fatalities are attributed to cryptococcosis meningitis, 135,000 of which occur in sub-Saharan Africa. Case fatality of cryptococcal meningitis varies widely depending on what country the infection occurs. In low-income countries the case fatality from cryptococcal meningitis is 70%. This differs from middle income countries where the case fatality rate is 40%. Lastly, in wealthy countries the case fatality is 20%. Cryptococcosis is the second most common cause of death for patients with AIDs (about 15%), behind tuberculosis. In sub-Saharan Africa approximately 1/3 of HIV patients will develop cryptococcosis.

Cryptococcosis in the United States
In the United States there are between 2-7 cases of cryptococcosis per 1,000 per year. Since 1990 the incidence of AIDs associated cryptococcosis fell by 90% due to the proliferation of antiretroviral therapy. The estimated prevalence of cryptococcosis cases amongst HIV patients in the U.S. is 2.8%. In immunocompetent patients cryptococcus typically presents itself as Cryptococcus gattii. Despite its rarity cryptococcus has been more commonly seen, with upwards of 20% of cases in immunocompetent people. Over 50% of cryptococcosis infections in North America are caused by C. gattii. Though C. gattii was originally thought to be restricted to subtropical and tropical regions it has become more prevalent worldwide. C. gattii has been found in over 90 people in the United States, most of these cases originating in Washington or Oregon.

Cryptococcosis in Sub-Saharan Africa
Sub-Saharan Africa is the main hub for HIV/AIDS worldwide. HIV/AIDS accounts for about 0.5% of the world's population. Remarkably, Sub-Saharan Africa holds 71% of HIV/AIDs cases. Cryptococcal meningitis is a primary contributor to mortality among individuals with HIV/AIDS in sub-Saharan Africa. Approximately 160,000 cases of cryptococcal meningitis are reported in West Africa, resulting in 130,000 deaths in sub-Saharan Africa. Uganda is reported to have the highest occurrence of cryptococcus meningitis. Reflecting that, Ethiopia has the least occurrence. Presently, treatment options involve either a 7 or 14-day regimen of amphotericin-B, coupled with oral antifungal tablets or oral fluconazole. It is important to note, amphotericin-B is not considered a treatment, as it showed not a significant reduction in the mortality rate.