Epidemiology of Cryptococcal Meningitis in the US: 1997–2009

• Published in: PloS one Vol. 8; no. 2; p. e56269
• Main Authors: Pyrgos, Vasilios, Seitz, Amy E., Steiner, Claudia A., Prevots, D. Rebecca, Williamson, Peter R.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.02.2013; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adrenocorticotropic hormone; AIDS; Biology; Comorbidity; Cryptococcal meningitis; Cryptococcus; Cryptococcus neoformans; Cushing syndrome; Defects; Epidemics; Epidemiology; Female; Health aspects; Health care; HIV; HIV infections; HIV Infections - epidemiology; Hospitalization - statistics & numerical data; Hospitals; Human immunodeficiency virus; Humans; Hydrocephalus; Hypogammaglobulinemia; Infections; Infectious diseases; Laboratories; Liver; Liver diseases; Lymphocytes B; Male; Medical care quality; Medicine; Meningitis; Meningitis, Cryptococcal - epidemiology; Meningitis, Cryptococcal - mortality; Meningitis, Cryptococcal - therapy; Morbidity; Mortality; Nervous system diseases; Patients; Pituitary; Population; Renal failure; Studies; Transplantation; Trends; United States - epidemiology; United States; United States > US; Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0056269

Cryptococcal meningitis (CM) causes significant morbidity and mortality globally; however, recent national trends have not been described. Incidence and trends for CM-associated hospitalizations in 18 states were estimated using the Agency for Healthcare and Research Quality (AHRQ) State Inpatient Databases (SID) datasets for 1997 through 2009. We identified 30,840 hospitalizations coded for CM, of which 21.6% were among HIV-uninfected patients. CM in-hospital mortality was significant (12.4% for women and 10.8% for men) with a total of 3,440 deaths over the study period. Co-morbidities of CM coded at increased frequency in HIV-uninfected CM hospitalized populations included hydrocephalus and acute/chronic renal failure as well as possible predispositions including transplantation, combined T and B cell defects, Cushing's syndrome, liver disease and hypogammaglobulinemia. Median hospitalization costs were significant for CM and higher for HIV-uninfected patients (16,803.01 vs. 15,708.07; p<0.0001). Cryptococcal meningitis remains a disease with significant morbidity and mortality in the U.S. and the relative burden among persons without HIV infection is increasing.