Fungal meningitis epidemiology and demographics: Difference between revisions

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===Gender===
===Gender===
The prevalence of fungal meningitis does not vary with gender.<ref name="pmid20375357" />


===Race===
===Race===

Revision as of 16:40, 8 February 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby; Prince Tano Djan, BSc, MBChB [2]

Overview

While cryptococccus and candida infections occur worldwide, other fungal infections tend to cluster in specific geographical regions.[1][2] The most common cause of fungal meningitis is Cryptococcus neoformans.[3][4][2]

Epidemiology

Incidence and prevalence

There is an increasing trend of fungal meningitis. This has been attributed to the following: [2][5]

  • Enlarging population of high-risk immunosuppressed patients
  • More successful pharmacological immunosuppression and chemotherapies
  • Increase in numbers of patients living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS)
  • Migration of susceptible persons into hyperendemic areas
  • Aging of the population

Cryptococcus Meningitis

  • Cryptococcus meningitis occurs worldwide but it is highly prevalent in southeast Asia and southern and east Africa where the prevalence of HIV is high.[7]
  • It is a common opportunistic infection in patients with HIV and it is considered as an AIDS defining lesion. [8]

The incidence of cryptococcal meningitis in is almost the same as in meningococcal meningitis[9] with an incidence of one case per 100,000 persons.[9] Prior to the introduction of highly active antiretroviral therapy (HAART) in the United States, yearly incidence rate of cryptococcal meningitis was on ascendancy with incidence of 6600 cases per 100,000 persons with AIDS[10] The incidence has decreased with the advent of HAART [11] although cases are still reported.[12]

The worldwide incidence of cryptococcal meningitis is pegged at 1,000,000 annually according to an estimate by Centers for Disease Control and Prevention CDC in 2009[13] with approximately half of these resulting in death.[13]

The predominate specie involved is cryptococcus neoformans, although there have been recent reports of incidence with Cryptococcus gattii Canada, Vancouver and the Pacific Northwestern United States[14][15]

Histoplasma meningitis

The incidence of Histoplasma meningitis is estimated to be 2.3 per 100,000 persons.[5]

Blastomyces meningitis

The incidence of Blastomyces meningitis is estimated to be 0.2 per 100,000 persons.[5]

Coccidioido meningitis

  • Coccidioidomycosis is only prevalent in the Western Hemisphere, especially in the southwestern United States and northwestern Mexico.
  • The annual incidence of the disease is not known.

Age

The prevalence of fungal meningitis does not vary with age.[16] The major factor accounting for age predilection has to do with the clinical state of the patient and the immune response.

For example candidda meningitis may occur in older children[17][18] and in adults with neutropenia, often presents with brain abscesses rather than meningitis.[19]

Children with the following conditions have higher incidence of fungal meningitis:

  • Chronic granulomatous disease of childhood[22][23]
  • Chronic mucocutaneous candidiasis[24]
  • Severe combined immunodeficiency SCID[25]
  • Direct extension via trauma [27]
  • Post ventriculostomy placement, or ventricular shunts, especially after antibacterial therapy[28][29]
  • Use of bischloroethylnitrosourea polymer wafers implanted for local therapy of CNS malignancies[30][31]
  • CNS drains and catheters represent disease[32]
  • In premature infants and neonates[33]

Gender

The prevalence of fungal meningitis does not vary with gender.[16]

Race

  • Non-Caucasian race have a higher prediclection to developing fungal meningitis especially coccidioidal meningitis[34]

Developed Vs developing countries

The geographical distribution of endemic fungi causiong meningtis are shown below:[35]

Fungus Demography
Blastomyces dermatiditis Midwest and southeast of USA, lower Mississippi Valley up to the north central states and into the mid-Atlantic states.
Coccidiodes immitis Mostly in dry, slightly acidic soil making it common in Southwest of USA, parts of Mexico and Central and South America.
Histoplasma Capsulatum: Ohio, central Mississippi River Valley and Appalachian Mountains,
Cryptococcus spp Cryptococcus neoformans is distributed worldwide with the following specifics:
  • Serotype A is the most common. Found in people with or without HIV worldwide
  • Serotypes B and C are mostly found in Australia, Southeast Asia, Central Africa and

recently in Vancouver, Canada and the Pacific Northwestern United States

  • Serotype D polysaccharide capsule and are primarily found in Europe and the United States.
Paracoccidioides brasiliensi Subtropical areas of Central and South America.
Hyalohyphomycoses There are numerous molds in this group, including Aspergillus, Scedosporium, and Fusarium species.  It has a worldwide distribution.
Candida Species Worldwide distribution
Sporothrix schenckii Worldwide distribution

References

  1. ↑ Shankar SK, Mahadevan A, Sundaram C, Sarkar C, Chacko G, Lanjewar DN; et al. (2007). "Pathobiology of fungal infections of the central nervous system with special reference to the Indian scenario". Neurol India. 55 (3): 198–215. PMID 17921648.
  2. ↑ 2.0 2.1 2.2 2.3 Gottfredsson M, Perfect JR (2000). "Fungal meningitis". Semin Neurol. 20 (3): 307–22. doi:10.1055/s-2000-9394. PMID 11051295.
  3. ↑ Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.
  4. ↑ 4.0 4.1 Williamson PR, Jarvis JN, Panackal AA, Fisher MC, Molloy SF, Loyse A; et al. (2017). "Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy". Nat Rev Neurol. 13 (1): 13–24. doi:10.1038/nrneurol.2016.167. PMID 27886201.
  5. ↑ 5.0 5.1 5.2 Fraser DW, Ward JI, Ajello L, Plikaytis BD (1979). "Aspergillosis and other systemic mycoses. The growing problem". JAMA. 242 (15): 1631–5. PMID 480580.
  6. ↑ Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.
  7. ↑ Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg K (2003) Review of human immunodeficiency virus type 1-related opportunistic infections in Sub-Saharan Africa. Clin Infect Dis, 36, 652–662.
  8. ↑ Chariyalertsak S, Sirisanthana T, Saengwonloey O, Nelson K (2001) Clinical presentation and risk behaviors of patients with acquired immunodeficiency syndrome in Thailand, 1994–1998: Regional variation and temporal trends. Clin Infect Dis, 32, 955–962.
  9. ↑ 9.0 9.1 Hajjeh RA, Brandt ME, Pinner RW (1995). "Emergence of cryptococcal disease: epidemiologic perspectives 100 years after its discovery". Epidemiol Rev. 17 (2): 303–20. PMID 8654513.
  10. ↑ Mirza SA, Phelan M, Rimland D, Graviss E, Hamill R, Brandt ME; et al. (2003). "The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992-2000". Clin Infect Dis. 36 (6): 789–94. doi:10.1086/368091. PMID 12627365.
  11. ↑ van Elden LJ, Walenkamp AM, Lipovsky MM, Reiss P, Meis JF, de Marie S; et al. (2000). "Declining number of patients with cryptococcosis in the Netherlands in the era of highly active antiretroviral therapy". AIDS. 14 (17): 2787–8. PMID 11125898.
  12. ↑ Hakim JG, Gangaidzo IT, Heyderman RS, Mielke J, Mushangi E, Taziwa A; et al. (2000). "Impact of HIV infection on meningitis in Harare, Zimbabwe: a prospective study of 406 predominantly adult patients". AIDS. 14 (10): 1401–7. PMID 10930155.
  13. ↑ 13.0 13.1 Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM (2009). "Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS". AIDS. 23 (4): 525–30. doi:10.1097/QAD.0b013e328322ffac. PMID 19182676.
  14. ↑ Kidd SE, Hagen F, Tscharke RL, Huynh M, Bartlett KH, Fyfe M; et al. (2004). "A rare genotype of Cryptococcus gattii caused the cryptococcosis outbreak on Vancouver Island (British Columbia, Canada)". Proc Natl Acad Sci U S A. 101 (49): 17258–63. doi:10.1073/pnas.0402981101. PMC 535360. PMID 15572442.
  15. ↑ MacDougall L, Kidd SE, Galanis E, Mak S, Leslie MJ, Cieslak PR; et al. (2007). "Spread of Cryptococcus gattii in British Columbia, Canada, and detection in the Pacific Northwest, USA". Emerg Infect Dis. 13 (1): 42–50. doi:10.3201/eid1301.060827. PMC 2725832. PMID 17370514.
  16. ↑ 16.0 16.1 Saccente M, Woods GL (2010). "Clinical and laboratory update on blastomycosis". Clin Microbiol Rev. 23 (2): 367–81. doi:10.1128/CMR.00056-09. PMC 2863359. PMID 20375357.
  17. ↑ Huttova M, Kralinsky K, Horn J, Marinova I, Iligova K, Fric J; et al. (1998). "Prospective study of nosocomial fungal meningitis in children--report of 10 cases". Scand J Infect Dis. 30 (5): 485–7. PMID 10066050.
  18. ↑ McCullers JA, Vargas SL, Flynn PM, Razzouk BI, Shenep JL (2000). "Candidal meningitis in children with cancer". Clin Infect Dis. 31 (2): 451–7. doi:10.1086/313987. PMID 10987704.
  19. ↑ del Pozo MM, Bermejo F, Molina JA, de la Fuente EC, Martínez-Martín P, Benito-León J (1998). "Chronic neutrophilic meningitis caused by Candida albicans". Neurologia. 13 (7): 362–6. PMID 9810800.
  20. ↑ Oleske J, Minnefor A, Cooper R, Thomas K, dela Cruz A, Ahdieh H; et al. (1983). "Immune deficiency syndrome in children". JAMA. 249 (17): 2345–9. PMID 6834633.
  21. ↑ Ludviksson BR, Thorarensen O, Gudnason T, Halldorsson S (1993). "Candida albicans meningitis in a child with myeloperoxidase deficiency". Pediatr Infect Dis J. 12 (2): 162–4. PMID 8381226.
  22. ↑ 22.0 22.1 Cohen MS, Isturiz RE, Malech HL, Root RK, Wilfert CM, Gutman L; et al. (1981). "Fungal infection in chronic granulomatous disease. The importance of the phagocyte in defense against fungi". Am J Med. 71 (1): 59–66. PMID 7195647.
  23. ↑ 23.0 23.1 Fleischmann J, Church JA, Lehrer RI (1986). "Primary Candida meningitis and chronic granulomatous disease". Am J Med Sci. 291 (5): 334–41. PMID 3706396.
  24. ↑ Germain M, Gourdeau M, Hébert J (1994). "Case report: familial chronic mucocutaneous candidiasis complicated by deep candida infection". Am J Med Sci. 307 (4): 282–3. PMID 8160723.
  25. ↑ Smego RA, Devoe PW, Sampson HA, Perfect JR, Wilfert CM, Buckley RH (1984). "Candida meningitis in two children with severe combined immunodeficiency". J Pediatr. 104 (6): 902–4. PMID 6726524.
  26. ↑ Casado JL, Quereda C, Oliva J, Navas E, Moreno A, Pintado V; et al. (1997). "Candidal meningitis in HIV-infected patients: analysis of 14 cases". Clin Infect Dis. 25 (3): 673–6. PMID 9314460.
  27. ↑ Brenier-Pinchart MP, Leclercq P, Mallié M, Bettega G (1999). "Candida meningitis possibly resulting from a harpoon injury". Eur J Clin Microbiol Infect Dis. 18 (6): 454–5. PMID 10442428.
  28. ↑ O'Brien D, Stevens NT, Lim CH, O'Brien DF, Smyth E, Fitzpatrick F; et al. (2011). "Candida infection of the central nervous system following neurosurgery: a 12-year review". Acta Neurochir (Wien). 153 (6): 1347–50. doi:10.1007/s00701-011-0990-9. PMID 21431456.
  29. ↑ Nguyen MH, Yu VL (1995). "Meningitis caused by Candida species: an emerging problem in neurosurgical patients". Clin Infect Dis. 21 (2): 323–7. PMID 8562739.
  30. ↑ O'Brien D, Cotter M, Lim CH, Sattar MT, Smyth E, Fitzpatrick F (2011). "Candida parapsilosis meningitis associated with Gliadel (BCNU) wafer implants". Br J Neurosurg. 25 (2): 289–91. doi:10.3109/02688697.2010.534202. PMID 21158511.
  31. ↑ Glick JA, Graham RS, Voils SA (2010). "Candida meningitis post Gliadel wafer placement successfully treated with intrathecal and intravenous amphotericin B." Ann Pharmacother. 44 (1): 215–8. doi:10.1345/aph.1M453. PMID 20028954.
  32. ↑ Geers TA, Gordon SM (1999). "Clinical significance of Candida species isolated from cerebrospinal fluid following neurosurgery". Clin Infect Dis. 28 (5): 1139–47. doi:10.1086/514755. PMID 10452649.
  33. ↑ Fernandez M, Moylett EH, Noyola DE, Baker CJ (2000). "Candidal meningitis in neonates: a 10-year review". Clin Infect Dis. 31 (2): 458–63. doi:10.1086/313973. PMID 10987705.
  34. ↑ Bouza E, Dreyer JS, Hewitt WL, Meyer RD (1981). "Coccidioidal meningitis. An analysis of thirty-one cases and review of the literature". Medicine (Baltimore). 60 (3): 139–72. PMID 7231152.
  35. ↑ Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.

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