Cryptococcal meningitis in Rio de Janeiro

The objective of this article was to evaluate the epidemiology of cryptococcal meningitis in Rio de Janeiro State, Brazil, from 1994 to 2004. Six hundred and ninety-six cases of cryptococcal meningitis were reported, with a mean incidence of 0.45 per 100,000 inhabitants. Patients were predominantly male; mean age was 35.9 years; AIDS was practically the only underlying disease, reported in 61.2% of cases; case-fatality was 51.8%. No decline in incidence was observed during the study period. AIDS is the main predisposing condition for cryptococcal meningitis, and thus the profile of most patients mirrors that of HIV infection. Missing information prevented the evaluation of other underlying diseases. Cryptococcal Meningitis; Incidence Rate; Epidemiologic Surveillance Introduction The principal etiological agent of fungal meningitis in the world is an encapsulated yeast that presents two distinct species recognized in the Cryptococcus neoformans complex: C. neoformans and C. gattii 1,2. C. neoformans is distributed worldwide and predominantly affects immunocompromised individuals. C. gattii infection generally affects immunocompetent individuals and predominates in tropical and subtropical regions. The disease is endemic in Northeast Brazil, Paraguay, Mexico, Australia, several African countries, India, Southeast Asia, and California (USA) 3. Due to the important tropism of this fungus for the central nervous system, meningitis is the principal clinical manifestation in some 85% of cases of cryptococcal infection 4,5. Until the late 1970s, cryptococcal disease was described in patients with underlying diseases like lymphoma, sarcoidosis, liver disease, and kidney transplant patients 6, and was considered a rare condition. Beginning in the 1980s, with the emergence of HIV infection, cryptococcal disease acquired a relevant role as an opportunistic infection, with increasing morbidity and mortality rates 6,7. The use of prophylactic antifungals and the introduction of HAART (highly active antiretroviral therapy) in 1995-1996 modified the course of cryptococcal disease in HIV patients, with reductions in the incidence rates varying from 46% to 75% 7,8,9,10,11. Despite a decrease in the numCad. Saúde Pública, Rio de Janeiro, 24(11):2582-2592, nov, 2008 2582 ARTIGO ARTICLE