Preventing Deaths from Cryptococcal Meningitis
What is cryptococcal meningitis?
Cryptococcus neoformans is a fungus that lives in the environment throughout the world. Most people likely breathe in this microscopic fungus at some point in their lives but never get sick from it. However, in people with weakened immune systems, such as those living with HIV, Cryptococcus can stay hidden in the body and later cause a serious (but not contagious) brain infection called cryptococcal meningitis.
Why is cryptococcal meningitis a problem?
Worldwide, nearly 220,000 new cases of cryptococcal meningitis occur each year, resulting in an estimated 181,000 deaths. Most of the illness and deaths are estimated to occur in resource-limited countries, among people living with HIV. Improved access to antiretroviral therapy (ART) globally has helped improve the immune systems of many HIV patients so that they aren’t at increased risk of cryptococcal meningitis. However, cryptococcal meningitis is still a major problem where HIV prevalence is high and where access to healthcare may be limited.
Diagnosis and Treatment
Cryptococcal antigen, a biological marker that indicates a person has cryptococcal infection, can be detected in the body weeks before symptoms of meningitis appear. People who have advanced HIV infection should be tested for cryptococcal antigen. Patients who tests positive for cryptococcal antigen can take antifungal medication to help the body fight the early stage of the infection. This approach has been shown to reduce the chance of a patient developing cryptococcal meningitis.
- Cryptococcal antigen can be found in the body weeks before symptoms of meningitis.
- People with advanced HIV should be tested early for cryptococcal infection.
- Patients who test positive for cryptococcal antigen can take antifungal medicine.
- Antifungal medicine treats meningitis in those who have it, and can prevent meningitis in those who do not.
To screen people living with HIV for early cryptococcal infection and cryptococcal meningitis, healthcare facilities and laboratories must have access to the reliable tests. Currently, these tests are unavailable in many parts of the world. Improving access to these tests is a key step in reducing deaths from cryptococcal meningitis. Lateral flow assay is a reliable, rapid, and inexpensive test that can be used on a small sample of blood or spinal fluid to detect cryptococcal antigen. The test accurately detects cryptococcal infections more than 95% of the time. In addition, the test doesn’t require costly laboratory equipment and expertise, making it ideal for low-resource settings. To reduce mortality from cryptococcal infection, CD4 testing is also needed to identify patients with low CD4 counts, who are at highest risk for cryptococcal meningitis.
Amphotericin B, flucytosine, and fluconazole are antifungal medications shown to improve survival in patients with cryptococcal infections. These essential medications are often unavailable in areas of the world where they are most needed.
What CDC Is Doing
CDC supports various activities to reduce illness and death from cryptococcal meningitis including:
- Working with health programs to introduce and implement cryptococcal screening and treatment
- Helping health programs assess costs and impact of cryptococcal screening activities
- Supporting training of clinical and laboratory staff on diagnosing, treating, and managing cryptococcal infection and cryptococcal meningitis
- Collaborating with partners to improve access to cryptococcal diagnostics and antifungal drugs
CDC has developed training materials to help educate physicians, nurses, HIV/AIDS counselors, pharmacists, and patients about the diagnosis, management, and prevention of cryptococcal disease. These materials are intended to support cryptococcal screen-and-treat programs. CDC can also help provide customized resources on training and case studies for cryptococcal screening.
- CDC – C. neoformans cryptococcosis
- CDC – HIV
- Southern African HIV Clinicians Society guideline for the prevention diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update
- World Health Organization – Cryptococcal Infection
The World Health Organization has developed guidelines for the diagnosis, prevention, and management of cryptococcal disease in adults, adolescents, and children with HIV. These guidelines are the first to recommend cryptococcal screening in certain settings to prevent deaths due to cryptococcal meningitis.
Preventcrypto.org is an international collaboration between government and non-governmental organizations, academic institutions, and private industry partners. The group consists of public health professionals, healthcare providers, academic researchers, and laboratorians who are dedicated to reducing the global burden of cryptococcal disease.
- LIFE: Leading International Fungal Education
LIFE is an international nongovernmental organization that aims to fight fungal infections by facilitating access to quality diagnostics, patient care, and educational resources around the globe.
- World Health Organization – Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy
The World Health Organization has also developed guidelines for the management of advanced HIV disease, and recommends a package of care, including cryptococcal screening, to reduce mortality in this population.
- ICAP HIV Learning Network: The CQUIN Project for Differentiated Service Delivery
The CQUIN Network helps countries implement appropriate care packages for patients with HIV, including those at high risk for cryptococcal meningitis.
- Differentiated Service Delivery: Global Advanced HIV Disease Toolkit
The Elizabeth Glaser Pediatric AIDS Foundation is a major implementing partner for many national HIV programs in Africa and provides a toolkit with learning materials and job aids for health providers and patients.