User:Phwikiproj/Cryptococcosis/M.kal54 Peer Review

General info
Beelerq, Pachacuti Inca Yupanqui, and Phwikiproj
 * Whose work are you reviewing?


 * Link to draft you're reviewing:User:Phwikiproj/Cryptococcosis
 * Link to the current version of the article (if it exists):Cryptococcosis

Evaluate the drafted changes
(Compose a detailed peer review here, considering each of the key aspects listed above if it is relevant. Consider the guiding questions, and check out the examples of what feedback looks like.)

Epidemiology
Cryptococcus species are often found in the soil environment or in bird droppings.

Cryptococcosis is usually associated with immunosuppressed patients, such as AIDs, corticosteroid use, diabetes and organ transplant patients. 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%, middle income is 40%. In wealthy countries the case fatality is 20%. (I like the update in years as the original article was from 2009, were you able to find any more current research or was most of it shown for 2014? I would even say that maybe you could change some of this information is cryptococcal meningitis section because what you added here for numbers is almost like how they had it in that section. My group updated some sections dates as our own article was very outdated.) Cryptococcosis is the second most common cause of death for patients with AIDs, behind tuberculosis. In sub-Saharan Africa approximately 1/3 of HIV patients will develop cryptococcosis.

'''After doing my own research I realized that cryptococcosis meningitis is an effect of Cryptococcus neoformans. I think bringing up the two species of Cryptococcus before talking about the meningitis would help lessen that confusion. Even if you add the species before then you can say which one causes the meningitis, and with research that I did it seemed to be the neoformans species that caused this.'''

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 areas of North America have challenged this initial presumption of the geographic patterns.

'''I can see how you set up the two paragraphs to go along with your two subsections. As I stated later in the critique I didn't realize that the neoformans species is typically found in Sub-Saharan Africa and gattii affecting North American areas. I think putting this paragraph first to talk about the two species could help clear this up. As in the original article I know they have a section about cryptococcosis meningitis, but a little reminder in the beginning may help with lost information while reading the article.'''

'Overall I think this section is a great lead into your other sections showing how cryptococcosis can affect differing regions. It shows us updated research and how this infection is typically presented. Some of the suggestions I made were to promote fluidity throughout the intro and subsections, and help minimize repeated information in the article.'

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%. Though immunocompetent patients are still susceptible to infections by Cryptococcus gattii. Though cryptococcosis in immunocompetent people is rare it has been demonstrated that cryptococcosis is more common than previously thought. (Personally not the biggest fan in terms of word choice for this section. I don't think it is bad to add but I think having "though" starting both sentences doesn't allow for effective word flow) Upwards of 20% of cases of cryptococcosis occurs in immunocompetent people. Over 50% of cryptococcosis infections in North America and Australia  (I would eliminate this, just because your focus is on the United States, I don't personally see a need in adding this piece to this paragraph. I think finding a source that just focuses on cryptococcosis rates would be effective.) 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.

'''For the section underlined I would say a better summary of that sentence could be: "In immunocompetent patients cryptococcosis typically presents itself as Cryptococcus gattii. Despite its rarity cryptococcosis has been more commonly seen, with upwards of 20% of cases in immunocompetent people". '''

'You did a good job at keeping your focus on C. gattii, as it is the form that is most commonly seen in the United States. I would say if you wanted to add more to this section you could make another paragraph which discusses Cryptococcus neoformans as you did bring it up in the original lead into this subsection. But for the most part you did a nice job bringing the statistics in its prevalence. However it would be good to see what year you are exactly talking about as you did state the starting year, but I don't know what the end year is for this research.'

In sub-Saharan Africa
Globally, the majority of cryptococcal meningitis cases are reported in Sub-Saharan Africa. In a significant portion of Sub-Saharan Africa, Cryptococcus has become the prevailing cause of meningitis in adults. 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. Cryptococcus is responsible for 15% of AIDS-related fatalities. The source of Cryptococcus species in West Africa is primarily linked to pigeon droppings. Patients likely acquired the infection through exposure to the Cryptococcal species complex originating from environmental sources. (Isn't this the same thing? As you just said that it is primarily linked to pigeon droppings, why do we need to add that it comes from environmental sources. Unless you maybe include other sources, but I think if you just focus on the pigeon droppings which your lead and the rest of your article focuses on I think you can exclude the second sentence underlined). Analysis of Cryptococcal isolates from environmental sources shows minimal genetic diversity. Clinical isolates exhibit significant genetic variations, similar to those found in environmental isolates. (I personally don't see the point in adding this to your section? If your article may have talked about genetic diversity I would say adding it doesn't hurt, but when I reread your article I never saw anything about this. I think if you want to include it, it should have its own section, or delete it in general.) A 2020 study identifies that combined short-term mortality (death within two weeks) exceeds 50% for cryptococcal meningitis, with no recorded instances of long-term mortality (death within 10 weeks) in the Western part of Africa.

'I think overall this section could do well with some readjustments with where information is placed. At times it can seem a bit choppy to me with information. I think what made this section a little more difficult to write/follow is that in your beginning lead you do talk about Cryptococcus meningitis in many details, not allowing for much addition to its own section. Your article also has a nice section which speaks on this type of meningitis. I think maybe having a section on Cryptococcus neoformans can help with eliminating repetition between each section and help add more detail between the two species.'

''' Overall looking at the whole article I think the additions you have made improved your article drastically. The epidemiology section they had before was very limited for research, so I like how much attention to detail you focused on to help improve that area. I think your tone is very factual and informative for this article. You also used a variety of sources that I believe were beneficial to creating such an informed epidemiology section. I think you could add maybe one image of where Cryptococcus is present worldwide, such as a map. '''